Obsessive-Compulsive Disorder Associated With Educational Underachievment

MedicalResearch.com Interview with:

Ana Pérez-Vigil MD Department of Clinical Neuroscience Child and Adolescent Psychiatry Research Center Karolinska Institutet

Dr. Perez-Vigil

Ana Pérez-Vigil MD
Department of Clinical Neuroscience
Child and Adolescent Psychiatry Research Center
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Everyone who regularly works with persons who have obsessive-compulsive disorder (OCD) has seen that their patients often struggle with school work. It is not uncommon for these individuals to have poor school attendance and severe patients can be out of the education system altogether. This applies to persons of all ages, from school children to young adults who may be at university.

On the other hand there is a group of patients who, against all odds, working 10 times as hard as everybody else, manage to stay in education and eventually get a degree. So we have long suspected that OCD has a detrimental impact on the person’s education, with all the consequences that this entails (worse chances to enter the labour market and have a high paid job). But we did not really know to what extent OCD impacts education. So we wanted to know what is the actual impact of OCD on educational attainment using objectively collected information from the unique Swedish national registers. Previous work had been primarily based on small clinical samples from specialist clinics, using either self or parent report and cross-sectional designs. Previous work also tended not to control for important confounders such as psychiatric comorbidity or familial factors (genetic and environmental factors that could explain both OCD and the outcomes of interest).

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Multispecies Study Identifies Critical Genes in OCD Neurobiology

MedicalResearch.com Interview with:

Hyun Ji Noh PhD Postdoc in the Genome Sequencing and Analysis Program Broad Institute of MIT and Harvard

Dr. Hyun Ji Noh

Hyun Ji Noh PhD
Computational Scientist, Medical and Population Genetics
Broad Institute of MIT and Harvard

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obsessive-compulsive disorder (OCD) is a debilitating neuropsychiatric disorder, characterized by intrusive thoughts and repetitive behaviors. OCD is estimated to affect roughly 80 million people worldwide, but its neurobiology remains poorly understood. To understand the disorder’s underpinnings, we searched for genetic mutations that are associated with OCD.

For this, we first identified 608 genes that were most likely to be important  in OCD – some that have previously been identified in OCD-like behaviors in dogs and mice, and others in human autism, which also involves repetitive behaviors. We compared these genes in 592 people with OCD and 560 people without OCD, and found that 4 of these genes were significantly different between people with and without OCD: NRXN1, HTR2A, CTTNBP2 and REEP3. All of these four genes have important functions in the brain. Specifically, we found that the variants in NRXN1 are likely to change its ability to bind other synaptic proteins. Synaptic proteins link neurons together, and are critical for transmitting signals through the brain. We also found that the variants in CTTNBP2 and REEP3 don’t actually change the proteins made by these genes, but instead probably affect gene regulation (for example, how much of the protein is made). These ‘regulatory’ variants disrupt the binding of transcription factors (proteins that regulate expression of genes in the body) near the gene.

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OCD Not Associated With Above-Average Intelligence

MedicalResearch.com Interview with:

Amitai Abramovitch, PhD Assistant Professor Department of Psychology Texas State University

Dr. Abramovitch

Amitai Abramovitch, PhD
Assistant Professor
Department of Psychology
Texas State University

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Obsessive-Compulsive Disorder (OCD) is associated with moderate degree of underperformance on several cognitive tests such as processing speed, and some higher order functions such as planning and inhibition. While this does not constitute a clinically meaningful impairment on these functions, we set out to explore the prevailing myth that OCD is associated with above-average intelligence. This myth, that was propagated by Sigmund Freud 115 years ago and is still surprisingly all too prevalent –  was never tested empirically. The notion of above average intelligence in OCD didn’t make sense to us given that IQ tests are comprised of subtests that assess cognitive function. To test this, we collected all the available data ever published in the scientific literature regarding IQ in OCD versus control samples, and conducted a meta-analysis. Our results show that OCD is not associated with higher IQ than average. In fact we found a slightly lowered IQ in OCD compared to controls, although IQ scores for OCD samples were in the average range. The total IQ score (Full Scale IQ) is comprised of two subscales, namely Verbal IQ, and Performance IQ.

Our results show that reduced Full Scale IQ stems primarily from lowered Performance IQ, a scale that is comprised of a number of timed tests. In other words, as opposed to Verbal IQ tests, test scores on Performance IQ subtests rely heavily on performance within a specific time frame, and not only on performance accuracy.

Thus, our findings suggest that reduced processing speed found in OCD could lead to reduced Performance IQ, and subsequently lead to lowered Full Scale IQ, and may not be indicative of specific cognitive deficits. This finding suggests that IQ tests administered to individuals diagnosed with OCD may result in a biased Full Scale IQ scores that does not accurately reflect their full intellectual potential.

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Could a Strep Throat Increase Risk of OCD?

MedicalResearch.com Interview with:
Sonja Orlovska MD, PhD student

Mental Health Centre Copenhagen
Denmark

MedicalResearch.com: What is the background for this study?

Response: This Danish register-based study is the largest study so far investigating the hypothesis PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) which describes a possible link between streptococcal throat infection and the subsequent development of OCD and tic disorders in children. PANDAS is in thread with research in mental health in recent years, suggesting that infections and immune activation might increase the risk of mental disorders.

MedicalResearch.com: What are the main findings?

Response: Out of the 1,1 million individuals <18 years of age born in the study period, we found that the 349,982 individuals tested positive for a streptococcal throat infection by their GP had an increased risk of mental disorders by 18% and the risk of specifically OCD and tic disorders was increased with respectively 51% and 35%, compared to individuals who had never been tested. This seems to confirm PANDAS which speaks in favor of a specific link between strep throat and the development of OCD and tic disorders. However, we also found that non-streptococcal throat infection increased the risk of mental disorders, even though the risk of OCD and all mental disorders was larger after a strep throat. The study was performed at the Mental Health Centre Copenhagen together with Senior researcher Michael Eriksen Benros.

MedicalResearch.com: What should readers take away from your report?

Response: Our results indicate that the brain might be affected by the immunological activation caused by a streptococcal infection possibly due to streptococcal antibodies cross-reacting with brain tissue causing psychiatric symptoms which is the theory of PANDAS. However, it seems as if the immunological response caused by other types of throat infections might also have a damaging effect in some individuals. Nevertheless, it cannot be ruled out that the results to some extent might be driven by a medical care-seeking behavior in some parents bringing their child to the GP more often in spite of only few symptoms of throat infection leading to testing for strep throat and also more frequent examination and diagnosis by a psychiatrist.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Even though our study supports some elements of the PANDAS hypothesis, more research is needed to fully confirm PANDAS. The research field would benefit from larger clinical studies following children with PANDAS over a longer period of time with frequent follow-ups in order to establish if streptococcal throat infections cause and worsen neuropsychiatric symptoms of OCD and tic disorders.

MedicalResearch.com: Thank you for your contribution to the MedicalResearch.com community.

Citation:

Orlovska S, Vestergaard CH, Bech BH, Nordentoft M, Vestergaard M, Benros ME. Association of Streptococcal Throat Infection With Mental DisordersTesting Key Aspects of the PANDAS Hypothesis in a Nationwide Study. JAMA Psychiatry. Published online May 24, 2017. doi:10.1001/jamapsychiatry.2017.0995

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

More Medical Research Interviews on MedicalResearch.com

Cognitive Behavior Therapy Most Effective Treatment for OCD, Anxiety and PTSD

David Mataix-Cols

Prof. Mataix-Cols

MedicalResearch.com Interview with:
David Mataix-Cols PhD
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Stockholm County Council
Stockholm, Sweden

MedicalResearch.com: What is the background for this study?

Response: Exposure-based Cognitive Behavior Therapy (CBT) is the treatment of choice for patients with anxiety, obsessive compulsive disorder (OCD) and post-traumatic stress disorders. Some patients do not respond sufficiently to such treatment. This has led researchers to find ways to augment (enhance) CBT with pharmacological agents, such as D-cycloserine (DCS).

Because CBT is such a powerful treatment for most patients, we suspected that the effects of DCS would probably be small. This means that very large samples of patients are needed to show statistically significant differences between groups. Previous studies and meta-analyses were underpowered to detect such small effects. Combining the raw data from all available studies to date gave us the power we needed to address the question of whether DCS is an efficacious augmenting strategy, over and above CBT.

We also had a second research question. Previous research from our group had suggested that there may be undesirable interactions between DCS and antidepressants, whereby patients taking both types of drugs would have significantly worse outcomes (see Andersson et al JAMA Psychiatry. 2015 Jul;72(7):659-67.
doi: 10.1001/jamapsychiatry.2015.0546).

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Perinatal Adverse Events Linked To Increased Risk of OCD

MedicalResearch.com Interview with:
Gustaf Brander
Department of Clinical Neuroscience
Karolinska Institutet

MedicalResearch.com: What is the background for this study?

Response: Obsessive-compulsive disorder (OCD) is believed to be caused by a complex interaction between genetic and environmental factors. Whereas genetic studies are well underway, the research on environmental factors has been lagging behind. As they explain a significant portion of the variance, are potentially malleable, and are essential for understanding how the genetic component works, this area of research is of great importance.

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Brain Scans May Predict Which OCD Patients Will Relapse After Cognitive-Behavioral Therapy

Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences Director, Adult OCD Program Director, Eating Disorder and Body Dysmorphic Disorder Research Program Semel Institute for Neuroscience and Human Behavior David Geffen School of Medicine at UCLA University of California, Los Angeles Los Angeles, CA 90095MedicalResearch.com Interview with:
Jamie D. Feusner, M.D.
Associate Professor of Psychiatry and Biobehavioral Sciences
Director, Adult OCD Program
Director, Eating Disorder and Body Dysmorphic Disorder Research Program
Semel Institute for Neuroscience and Human Behavior
David Geffen School of Medicine at UCLA
University of California, Los Angeles
Los Angeles, CA 90095

Medical Research: What is the background for this study? What are the main findings?

Dr. Feusner: Cogntive-behavioral therapy (CBT), is an effective treatment for most people OCD,with response rates between 50-70%. However, a portion of the people who respond will experience a return of their symptoms after the therapy, with 20% meeting criteria for relapse. In this study we set out to determine if brain connectivity patterns prior to treatment, derived from fMRI brain scans, can help predict worsening of symptoms after a course of intensive CBT.

We found that a pattern of “small-worldness,” which is a measure of efficiency of brain network organization, was significantly associated with worsening of OCD symptoms after 4 weeks of intensive cogntive-behavioral therapy. Those with higher network efficiency, interestingly, were the ones more likely to experience worsening. Yet almost all of the participants improved in their OCD symptoms with the treatment. So (although it remains to be further studied) one possible interpretation is that brain network reorganization may need to occur contemporaneously with symptom improvement during CBT in order to maintain the gains beyond the therapy period. Those who are already at the “ceiling” of network efficiency may not have room for this network reorganization.

Another interesting finding was that the severity of symptoms prior to treatment, and even after treatment, did not predict who would experience worsening of symptoms in the follow-up period.

Medical Research: What should clinicians and patients take away from your report?

Dr. Feusner: In addition to the finding that CBT is an effective treatment for obessive compulive disorder that results in reorganization of brain networks, this is a promising early indication that in the future we may be able to use brain scans to help predict who may do better or worse in the long run after CBT. This could potentially help improve personalization of treatment, so that we can identify which treatments (e.g. shorter or longer courses of CBT, medications, medications plus CBT, brain stimulation) could be the most likely to help an OCD sufferer, in the long run. This could reduce time, cost, and suffering otherwise associated with “trial and error” approaches to treatment for OCD.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Feusner: This is a small, preliminary study. Thus, we need to replicate the results in a larger sample of people with OCD, and with a more controlled follow-up so we can make sure that other factors are not contributing to changes in symptoms after CBT. In addition, we plan to test whether combinations of other brain factors such as neurochemistry and other connectivity patterns may be able to provide even better predictors, which could eventually be tested to determine their predictive value on the level of an individual person.

Citation:

Brain connectivity and prediction of relapse after cognitive-behavioral therapy in obsessive–compulsive disorder

Jamie D. Feusner,1,* Teena Moody,1 Tsz Man Lai,1 Courtney Sheen,1 Sahib Khalsa,2,3 Jesse Brown,4 Jennifer Levitt,1 Jeffry Alger,5 and Joseph O’Neill1

Front. Psychiatry, 20 May 2015
http://dx.doi.org/10.3389/fpsyt.2015.00074

 

Jamie D. Feusner, M.D. Associate Professor of Psychiatry and Biobehavioral Sciences, & Director, Adult OCD Program (2015). Brain Scans May Predict Which OCD Patients Will Improve With Cogntive-Behavioral Therapy 

Obsessive-Compulsive Disorder Increases Risk Of Schizophrenia

MedicalResearch.com Interview with:
Sandra M. Meier, PhD
The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH,
National Centre for Register-Based Research
Aarhus University, Aarhus, Denmark

Medical Research: What are the main findings of the study?

Dr. Meier: People with an obsessive-compulsive disorder are at a 6 to 7 times higher risk of developing schizophrenia than people without an obsessive-compulsive disorder. If the parents are diagnosed with an obsessive-compulsive disorder, their offspring experience a 3 to 4 times higher chance to develop schizophrenia.
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OCD: Adding Cognitive Therapy to SSIs

H. Blair Simpson, M.D., Ph.D. Professor of Clinical Psychiatry, College of Physicians and Surgeons at Columbia University Director of the Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute  1051 Riverside Drive, Unit 69 New York, NY 10032MedicalResearch.com Interview with:
H. Blair Simpson, M.D., Ph.D.
Professor of Clinical Psychiatry, College of Physicians and Surgeons at Columbia University
Director of the Anxiety Disorders Clinic and the Center for OCD and Related Disorders at the New York State Psychiatric Institute
New York, NY 10032

MedicalResearch.com: What are the main findings of the study?

Dr. Simpson: This is the first RCT to compare two recommended SRI augmentation strategies for adults with OCD. Adding EX/RP to SRIs was superior to risperidone and to pill placebo in reducing OCD symptoms and improving insight, functioning, and quality of life. Risperidone was not superior to placebo on any outcome.
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