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Background Suicidal ideations were reported in many studies among patient with obsessive-compulsive disorder (OCD); this study aimed to evaluate the prevalence and factors associated with current suicidal ideations among Egyptian patients with obsessive-compulsive disorder (OCD). A consecutive sample of 120 Egyptian OCD patients was included in the study. OCD was diagnosed using the structured clinical interview for DSM-V axis Ι disorders, clinical version (SCID-I-CV). Yale-Brown Obsessive Compulsive Scale (Y-BOCS) was also applied to the patients. Presence of current suicidal ideations was assessed using Scale for Suicidal Ideation (SSI). Results Twenty eight (23.3%) of the OCD patients reported presence of current suicidal ideations, religious obsessions OR = 3.53, P = 0.009, and presence of comorbid major depressive disorder OR = 1.77, P = 0.04. Conclusion Religious obsessions and comorbid major depressive disorder were found to be significant predictors for the current suicidal ideations in patients with OCD; however, religious obsessions were the strongest predictor. Religious obsessions should be evaluated and treated to decrease the risk of suicidal thoughts in Egyptian OCD patients.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report instrument that addresses significant limitations of previous obsessive-compulsive (OC) symptom measures by separately assessing the severity of four OC symptom dimensions: contamination, responsibility for harm, unacceptable thoughts, and symmetry. Notably, no research has culturally adapted or validated the DOCS for the Mexican population (DOCS-M), and the current study seeks to bridge that gap. We recruited 457 adults, the majority of whom were college students, to evaluate the factor structure, internal consistency and convergent validity of the DOCS-M. A confirmatory factor analysis supported the four-factor structure. Moreover, excellent internal consistency was obtained for the subscale and total scores. Convergent validity was also supported through strong positive and significant correlations with the OBQ-SV and III-31-M. In sum, study findings suggest that the DOCS-M is a valid instrument for assessing OCD symptom dimensions and severity in a Mexican population.

The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) is the most common measure of Obsessive-Compulsive symptom severity. The Y-BOCS interview is considered gold standard, but its self-rating format is increasingly used in clinical trials. Few studies investigated congruency and potential changes over treatment. This question is highly relevant, as a systematic bias might obscure results of clinical trials. We examined the relationship of self- and clinician-rated Y-BOCS scores in participants with obsessive-compulsive disorder in pre (N = 128), post, (4 weeks, n = 104) and follow-up (6 months, n = 98) assessments of a randomized-controlled clinical trial. We administered Y-BOCS interview via telephone paralleling online administration of the self-report form. Analyses showed medium-to-strong correlations of Y-BOCS interview and self-rating scores at pre-assessment. Patients rated symptoms lower than clinicians. Larger discrepancies were associated with hoarding and age. Congruency was inferior for obsessions relative to compulsions, largely owing to the “resistance against obsessions” item. Agreement strongly increased at post and follow-up. Though overall congruency between the two Y-BOCS forms was satisfactory, results suggest a “correction over time” effect. Such bias may distort the precise interpretation of treatment effects. Therefore, we made several suggestions to improve the reliability of change scores assessed with the Y-BOCS self-rating.

Practice guidelines for adults with obsessive-compulsive disorder (OCD) recommend augmenting serotonin reuptake inhibitors (SRIs) with exposure and ritual prevention (EX/RP). However, fewer than half of patients remit after a standard 17-session EX/RP course. We studied whether extending the course increased overall remission rates and which patient factors predicted remission. Participants were 137 adults with clinically significant OCD (Yale-Brown Obsessive Compulsive Scale [Y-BOCS] score ≥18) despite an adequate SRI trial (≥12 weeks). Continuing their SRI, patients received 17 sessions of twice-weekly EX/RP (standard course). Patients who did not remit (Y-BOCS ≤12) received up to 8 additional sessions (extended course). Of 137 entrants, 123 completed treatment: 49 (35.8%) remitted with the standard course and another 46 (33.6%) with the extended course. Poorer patient homework adherence, more Obsessive-Compulsive Personality Disorder (OCPD) traits, and the Brain-Derived Neurotrophic Factor (BDNF) Val66MET genotype were associated with lower odds of standard course remission. Only homework adherence differentiated non-remitters from extended course remitters. Extending the EX/RP course from 17 to 25 sessions enabled many (69.3%) OCD patients on SRIs to achieve remission. Although behavioral (patient homework adherence), psychological (OCPD traits), and biological (BDNF genotype) factors influenced odds of EX/RP remission, homework adherence was the most potent patient factor overall.

Introduction: This article presents two international pilot studies examining brief intensive group cognitive behavioral therapy (BIG-CBT) for pediatric OCD. Aims: 1) to examine treatment outcome of BIG-CBT in two countries, 2) to explore the influence of potential predictors on treatment outcome. Methods: Study 1 (n = 59) was a retrospective study executed in the Netherlands, study 2 (n = 17) was a prospective study performed in Switzerland (total: 76 participants). The pilot studies were carried out in academic centers for child and adolescent psychiatry. BIG-CBT consisted of 5-day CBT in a group format, with exposure and response prevention as the main element. Results: Both studies showed a significant decrease from pre-to post-treatment on the Children's Yale-Brown Obsessive Compulsive Scale mean scores. In study 1, 44% of participants met the criterion for treatment responder at post-treatment (≥35% improvement), in study 2 this was 59% at post-treatment and 41% at 3-month-follow-up. In both studies, age, gender and baseline OCD severity did not significantly predict treatment outcome. Conclusion: The results of these two international pilots of BIG-CBT indicate that brief, intensive treatment has the potential to become a valuable addition to standard clinical care for pediatric OCD.

Background: Children with Tourette syndrome (TS) often have comorbid disorders, particularly attention-deficit/hyperactivity disorder (ADHD) and obsessive-compulsive disorder (OCD). While subtle premorbid symptoms have been described in various psychiatric disorders, the presence of clinical precursors that may exist before the onset of tics is unknown. This longitudinal study aimed to find clinical precursors of tics by assessing a range of clinical characteristics prior to tic onset in comparison with children without onset of tics.Methods: A sample of 187 3- to 10-year-old first-degree unaffected relatives of children with TS were followed up to 7 years in the European Multicentre Tics in Children Study (EMTICS). We investigated whether clinical characteristics assessed at baseline predicted tic onset, comparing 126 children without tic onset to 61 children who developed tics. We used the least absolute shrinkage and selection operator (LASSO) method, a penalised logistic regression approach. We also explored sex differences and repeated our analyses in an age- and sex-matched subsample.Results: Children with tic onset were more frequently male (beta = -0.36), had higher baseline severity of conduct problems (beta = 0.23), autism spectrum disorder symptoms (ASD; beta = 0.08), compulsions (beta = 0.02) and emotional problems (beta = 0.03) compared to children without tic onset. Conduct and ASD problems were male-specific predictors, whereas severity of compulsions and oppositional (beta = 0.39) and emotional problems were female-specific predictors.Conclusion: This study supports the presence of clinical precursors prior to tic onset and highlights the need of sex-specific monitoring of children at risk of developing tics. This may aid in the earlier detection of tics, particularly in females. We moreover found that tics most often persisted one year after tic onset, in contrast to the common belief that tics are mostly transient.

Background and objectives: Criticism is thought to play an important role in obsessive-compulsive disorder (OCD), and obsessive behaviors have been considered as childhood strategies to avoid criticism. Often, patients with OCD report memories characterized by guilt-inducing reproaches. Starting from these assumptions, the aim of this study is to test whether intervening in memories of guilt-inducing reproaches can reduce current OCD symptoms. The emotional valence of painful memories may be modified through imagery rescripting (ImRs), an experiential technique that has shown promising results. Methods: After monitoring a baseline of symptoms, 18 OCD patients underwent three sessions of ImRs, followed by monitoring for up to three months. Indexes of OCD, depression, anxiety, disgust and fear of guilt were collected. Results: Patients reported a significant decrease in OCD symptoms. The mean value on the Yale−Brown Obsessive Compulsive Scale (Y-BOCS) changed from 25.94 to 14.11. At the three-month follow-up, 14 of the 18 participants (77.7%) achieved an improvement of ≥ 35% on the Y-BOCS. Thirteen patients reported a reliable improvement, with ten reporting a clinically significant change (reliable change index = 9.94). Four reached the asymptomatic criterion. Clinically significant changes were not detected for depression and anxiety. Conclusions: Our findings suggest that after ImRs intervention focusing on patients’ early experiences of guilt-inducing reproaches there were clinically significant changes in OCD symptomatology. The data support the role of ImRs in reducing OCD symptoms and the previous cognitive models of OCD, highlighting the role of guilt-related early life experiences in vulnerability to OCD.

There is growing support for the use of acceptance and commitment therapy (ACT) as a treatment for adults with obsessive-compulsive disorder (OCD), but no research has been published on the use of ACT for adolescent OCD. This preliminary study investigated ACT for youth with OCD using a multiple baseline across participants design. Three adolescents, ages 12 or 13 years, were treated with 8–10 sessions of ACT (without in-session exposure exercises). The primary dependent variable was daily self-monitoring of compulsions. Results showed a 40% mean reduction in self-reported compulsions from pretreatment to posttreatment, with results maintained at 3-month follow-up, for a reduction of 43.8%. Pretreatment to posttreament reductions in Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS) ratings of OCD severity were 50.0%, 12.5%, and 22.0%; pretreatment to follow-up reductions were 54.0%, 12.5%, and 61.0%. Treatment procedures were rated by participants and parents as highly acceptable. Implications and future directions are discussed.

Obsessive-compulsive symptom dimensions are important in studies about the pathogenesis and treatment of obsessive-compulsive disorder. More than 30 factor analytic studies using the Yale-Brown Obsessive Compulsive Scale Symptom Checklist (Y-BOCS-SC) interview version have been published. However, a drawback of the Y-BOCS-SC interview is that it is time-consuming for the clinician. Baer's self-report version of the Y-BOCS-SC could be a less time-consuming alternative. The purpose of this study was to examine the factor structure of Baer's self-report Y-BOCS-SC. In a sample of 286 patients, we performed two factor analyses, one using categories and one using items of the Y-BOCS-SC. Using category-level data, we identified four factors; when using items we identified six factors. Symptom dimensions for contamination/cleaning, symmetry/repeating/counting/ordering and hoarding were found in both analyses. The impulsive aggression, pathological doubt, sexual, religious somatic and checking categories formed one factor in the analysis using category-level data and divided into three factors using item-level data. These factors correspond with studies using the interview version and support our hypothesis that the self-report version of the Y-BOCS-SC could be an alternative for the interview version.

Previous studies in non-clinical populations suggest that obsessive-compulsive symptoms are associated with hypothalamic-pituitary-adrenal (HPA) axis measures and that there are sex differences in these associations. We aimed to replicate these findings in a sample of 57 patients with obsessive-compulsive disorder (OCD) and 98 healthy subjects. Current and lifetime OCD symptom dimensions were assessed with the Dimensional Yale-Brown Obsessive Compulsive Scale (DY-BOCS). Depressive symptoms and state and trait anxiety were also assessed. The following HPA axis measures were analysed in saliva: the diurnal cortisol slope (calculated using two formulas: [1] awakening to 11 p.m. [AWE diurnal slope] and [2] considering fixed time points [FTP diurnal slope] from 10 a.m. to 11 p.m.) and the dexamethasone suppression test ratio (DSTR) after 0.25 mg of dexamethasone. Multiple linear regression analyses were conducted to explore the contribution of OCD symptom dimensions to each HPA axis measure while adjusting for age, sex, BMI, smoking, trait anxiety and depressive symptoms. A sex-specific association between current ordering/symmetry symptoms and AWE diurnal cortisol slope (positive association [flattened slope] in men, inverse association [stepper slope] in women) was found. Two similar sex by OCD dimensions interactions were found for lifetime aggressive and ordering/symmetry symptoms and both (FTP, AWE) diurnal cortisol slopes. Current and lifetime hoarding symptoms were associated to a more flattened FTP diurnal cortisol slope in women. The DSTR was not associated with OCD symptoms. The lifetime interference in functionality was associated with a more flattened AWE diurnal cortisol slope. In conclusion, our study suggests that there are sex differences in the association between OCD subtypes and specific HPA axis measures.

Our aim was to introduce more homogenous phenotypes for studying genetic variations in the clinically heterogeneous obsessive compulsive disorder (OCD) beside classical case-control analysis. Symptoms were assessed with Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and principle component analysis of the lifetime symptom categories yielded four factors (Cleaning, Obsessive, Compulsive, Sexual). The comparison of serotonin transporter linked polymorphic region (5-HTTLPR) in 102 OCD patients and 223 controls showed an increased L-allele frequency but no difference was observed when rs25531 was included. Intronic variants of the serotonin transporter gene did not show association with either OCD, nor with the obtained factors.

Previous research using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) suggests that the heterogeneous symptoms of obsessive-compulsive disorder (OCD) may reflect four underlying dimensions. However, past results vary substantially, which may be due to (a) the reliance on aggregated scores, (b) the common use of exploratory factor analyses, and (c) the exclusion of several symptoms. The present study tested the homogeneity of the original Y-BOCS categories using confirmatory factor analysis and modified categories where necessary. To test multidimensional models, data were further analyzed with Bayesian structural equation models, which better capture item heterogeneity in contrast to ordinary factor analysis. All analyses were run with two samples of patients with OCD allowing for cross-validation. Only a minority of the original Y-BOCS categories proved to be homogeneous. Modification yielded 10 homogeneous first-order factors, which can be reduced to four second-order factors: Incompleteness, Taboo Thoughts, Responsibility, and Contamination. This two-level factor model outperformed competing factor structures. The results corroborate the notion of four broader symptom dimensions in OCD, although the specific factor structure deviates from previous research. Differences presumably derive from using the full range of OCD symptoms and the combined exploratory and confirmatory approach with BSEM as a theoretically more appropriate analytical framework.

Studies have confirmed the efficacy of the cognitive intervention Association Splitting (AS) in obsessive-compulsive disorder (OCD) when applied as a self-help technique. AS aims to alter symptom-provoking automated cognitive networks of OC-related stimuli by building new or strengthening established but weak neutral associations. The aim of this study was to investigate the acceptance and benefits of therapist-assisted AS as an add-on to cognitive behavioral therapy (CBT). One hundred and nine patients with OCD who were undergoing CBT were randomly assigned to either AS or cognitive remediation (CR). Both groups were assessed at baseline, 4 weeks and 6 months later. The primary measure was the Yale-Brown Obsessive Compulsive Scale. Although patients’ acceptance of AS was good, AS was not better than CR regarding overall symptom severity. However, a larger decrease was found from baseline to 6 months follow-up in AS regarding avoidance. Moreover, subsidiary analyses excluding control patients who had obtained information about AS indicated its superiority. Because superiority of AS was found in post hoc analyses excluding control patients who had obtained information on AS, we suggest that contagion effects deserve consideration.

Exposure and Response Prevention (ERP) is considered the most effective psychotherapeutic treatment for Obsessive-Compulsive Disorder (OCD). The literature supports its adoption yet results vary and vagueness regarding therapy protocol exists. We present an updated review and meta-analysis to provide clarity in the comparison of strict ERP protocol to control or active therapy groups. Moderator analyses were conducted to investigate treatment effect of cognitive elements, hours of therapy and duration of OCD. A systematic literature search, concluded in January 2021, identified twenty-four studies, published between 1997 and 2018, including a total of 1134 patients. The main analysis assessed the difference between pre-treatment and post-treatment scores compared amongst ERP and the other groups. We found a statistically significant different reduction in pre-treatment to post-treatment Yale-Brown Obsessive Compulsive Scale scores between ERP therapy versus other groups. We also found a statistically significant moderation effect of cognitive elements. The other two moderators, hours of therapy and OCD duration, were non-significant. Our review suggests that ERP was superior to the other groups, including both neutral and active treatments, in reducing OCD symptomatology and should therefore be recommended as an optimal therapy. Future research should focus on tailoring ERP to the individual and investigating further refinements.

Background: This study was carried out to enumerate the level of difference in functional impairment and quality of life (QOL) in obsessive-compulsive disorder (OCD) patients and normal control group to find out the relationship among ICD functional impairment and QOL. Methodology: Thirty patients diagnosed with OCD as per International Classification of Diseases Diagnostic Criteria for Research-10 were taken for study. The control group consists of 30 normal participants from the community. Functional impairment and QOL questionnaires were administered on both groups to measure functional impairment and QOL in OCD. Results: The mean age of onset of OCD was (23.8 ± 7.25), mean duration of illness was (6.3 ± 4.47), and mean duration of treatment was (2.56 ± 2.47). It was also observed that total score as well as all the domains of the World Health Organization QOL-BREF, OCD patients scored significantly less (P < 0.001) compared to normal controls. Dysfunctional Analysis Questionnaire (DAQ)-Social area and DAQ-Personal area had statistically significant positive correlation (P < 0.05) with an obsessive subscale of Yale–Brown Obsessive Compulsive Scale (Y-BOCS) whereas DAQ-social area (P < 0.05), DAQ-Personal Area (P < 0.05) had statistically significant positive correlation with a total score of Y-BOCS. Conclusion: The presence of functional impairment leads to poor QOL in the persons with OCD.

This pilot study was conducted to evaluate the feasibility and efficacy of exposure and response prevention therapy in Japanese patients with obsessive-compulsive disorder. This study was the first to examine the effectiveness of exposure and response prevention therapy provided by Japanese clinical psychologists. The sample comprised 37 adults (male = 17, female = 20, mean age = 35.7 years, standard deviation [ SD ] = 10, mean Yale-Brown Obsessive Compulsive Scale score = 26.9, SD = 23.35) with a diagnosis of obsessive-compulsive disorder receiving treatment. Individually administrated exposure and response prevention was provided to the 37 patients with obsessive-compulsive disorder. We evaluated the feasibility and safety of the program using the dropout rate and adverse events. The primary outcome was the reduction of the Yale-Brown Obsessive Compulsive Scale score between the pre- and post-treatment periods. Secondary outcomes were depression, anxiety, and quality of life. Of the 37 patients, 5 (14%) dropped out and 32 (86%) completed the entire program. No severe adverse event was observed. The patients reported significant reductions in the Yale-Brown Obsessive Compulsive Scale score (obsession: Hedges’ g = 2.11, 95% CI [1.57, 2.68]; compulsion: Hedges’ g = 2.05, 95% CI [1.41, 2.56]). Some secondary outcomes (depression and quality of life) also showed significant change. The results suggest that the exposure and response prevention program provided by Japanese clinical psychologists is an efficacious and feasible treatment approach for Japanese patients with obsessive-compulsive disorder.

Trichotillomania (TTM) and eating disorders (ED) share many phenomenological similarities, including ritualized compulsive behaviors. Given this, and that comorbid EDs may represent additional functional burden to hair pullers, we sought to identify factors that predict diagnosis of an ED in a TTM population. Subjects included 555 adult females (age range 18–65) with DSM-IV-TR TTM or chronic hair pullers recruited from multiple sites. 7.2% (N = 40) of our TTM subjects met criteria for an ED in their lifetime. In univariable regression analysis, obsessive-compulsive disorder (OCD), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) worst-ever compulsion and total scores, certain obsessive-compulsive spectrum disorders, anxiety disorder, attention-deficit/hyperactivity disorder (ADHD), and substance disorder all met the pre-specified criteria for inclusion in the multivariable analysis. In the final multivariable model, diagnosis of OCD (OR: 5.68, 95% CI: 2.2–15.0) and diagnosis of an additional body-focused repetitive behavior disorder (BFRB) (OR: 2.69, 95% CI: 1.1–6.8) were both associated with increased risk of ED in TTM. Overall, our results provide further support of the relatedness between ED and TTM. This finding highlights the importance of assessing for comorbid OCD and additional BFRBs in those with TTM. Future research is needed to identify additional predictors of comorbid disorders and to better understand the complex relationships between BFRBs, OCD and EDs.

There are few studies on suicidal risk and its related factors in patients diagnosed with obsessive-compulsive disorder (OCD). This study investigated the associations of early maladaptive schemas, OC symptom dimensions, OCD severity, depression and anxiety with suicidality (i.e., suicidal ideation and suicide attempts) in OCD patients. Sixty OCD outpatients completed the Scale for Suicide Ideation (SSI), the Young Schema Questionnaire-Short Form (YSQ-SF), the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Dimensional Obsessive-Compulsive Scale (DOCS) and the Depression Anxiety Stress Scales (DASS-21). 51.7% of patients had lifetime suicide attempts and 75% had suicidal ideation. OCD patients with lifetime suicide attempts exhibited significantly higher scores on early maladaptive schemas than those without such attempts. Logistic regression analysis revealed that the mistrust/abuse schema and the OC symptom dimension of unacceptable thoughts explained lifetime suicide attempts. The mistrust/abuse schema, unacceptable thoughts and depression significantly predicted suicidal ideation. These findings indicated that the mistrust/abuse schema may contribute to high suicidality in OCD patients. Also, patients suffering from unacceptable thoughts need to be assessed more carefully for warning signs of suicide.

BACKGROUND: Patients with obsessive compulsive disorder (OCD) frequently show traits of autism spectrum disorders (ASD). This is one of the first studies to explore the clinical impact of the overlap between OCD and ASD as a categorical diagnosis. METHODS: A cross-sectional survey in 73 adult outpatients with DSM-IV OCD. Autistic traits were measured using the Autism-Spectrum Quotient (AQ). A clinical estimate ASD diagnosis was made by interview using DSM-IV-TR criteria. OCD patients with and without autistic traits or ASD were compared on demographic and clinical parameters and level of OCD treatment-resistance based on treatment history. RESULTS: Thirty-four (47%) patients scored above the clinical threshold on the AQ (> =26) and 21 (27.8%) met diagnostic criteria for ASD. These diagnoses had not been made before. Patients with autistic traits showed a borderline significant increase in OCD symptom-severity (Yale-Brown Obsessive Compulsive Scale (Y-BOCS); p=.054) and significantly increased impairment of insight (Brown Assessment of Beliefs Scale; p=.01). There was a positive correlation between AQ and Y-BOCS scores (p =.04), but not with OCD treatment resistance. CONCLUSION: There is a high prevalence of previously undiagnosed ASD in patients with OCD. ASD traits are associated with greater OCD symptom-severity and poor insight.

The aims of this study were to evaluate alexithymia subscales [i.e. difficulty in identifying feelings (DIF), difficulty in describing feelings (DDF) and externally-oriented thinking (EOT)] in patients with obsessive-compulsive disorder (OCD) and to clarify the relationships of alexithymia subscales to obsessive-compulsive (OC) symptom dimensions and other clinical variables. One hundred fifteen OCD outpatients and two control groups including 80 normal controls and 100 alcoholic patients participated in this study. The data were collected by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Farsi version of the Toronto Alexithymia Scale (FTAS-20) and the Depression Anxiety Stress Scales (DASS-21). 60.7% of OCD patients and 48% of alcoholics were classified as alexithymics. Those with OCD revealed significantly higher scores on alexithymia and its subscales than alcoholics and normal controls. OCD patients with alexithymia showed higher means in Y-BOCS and its subscales as well as the OC dimensions of mental neutralizing and obsessing than non-alexithymics. DIF and EOT were significantly correlated with obsessing and mental neutralizing respectively. DDF and EOT were related to OCD severity. It was concluded that DIF and EOT may be specific to obsessing and mental neutralizing in OCD patients.

Obsessive-compulsive disorder (OCD) is characterized by obsessions and compulsions. Treatment usually consists of serotonergic medications along with exposure therapies. Danger ideation reduction therapy (DIRT) is an alternative therapy predominantly for washing compulsions and focuses on reduction of danger ideations. DIRT was tried on Ms. S. with a history of OCD for 15 years and improvement was noticed on Yale–Brown Obsessive Compulsive Scale, Padua Inventory, Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale after 15 sessions of DIRT though she was not fully symptom-free. Thus, DIRT was found to improve OCD symptoms and improved her insight into illness.

Obsessive-compulsive disorder (OCD) is a heterogeneous condition characterized by largely variable phenotypic expressions. Previous findings suggested that gender may be a relevant factor in mediating this heterogeneity. The present study aimed at exploring gender differences in a large clinical sample of Italian OCD patients.Socio-demographic and clinical variables of a sample of 229 consecutive OCD outpatients were included in a common database. Patients were assessed through structured clinical interviews, the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Clinical Global Impression (CGI) scale.Female OCD patients were more likely than males to have lifetime psychiatric comorbidities (72.6% vs 56.9%; p 0.05), poly-comorbidities being twice as high compared to males. The female group also showed a significant later onset of symptoms (63.7% vs 44.8%; p 0.005) and a higher age at first treatment (30.98 ± 13.1 years vs 27.81 ± 11.3; p 0.005). Moreover, the female subgroup presented higher rates of cleaning and washing compulsions, compared to the male subgroup (28.7% vs 12.6% in the male group; p 0.005).The current study supports the notion that OCD in female gender is frequently a comorbid condition with other specific clinical characteristics compared to male patients. These findings should be considered in epidemiologic and therapeutic perspectives.

Contains fulltext : 219241.pdf (Publisher’s version ) (Closed access) INTRODUCTION: Obsessive compulsive disorder (OCD) is a chronic psychiatric disorder where most patients do not reach full symptomatic remission. Identifying predictors of course can improve patients' care by informing clinicians on prognosis and enhancing treatment strategies. Several predictors associated with improved outcome of OCD were identified. However, research focused mainly on clinical, illness-related predictors of the course of OCD. This study examined the contribution of environmental and interpersonal predictors on the long-term outcome of OCD, in addition to the previously identified clinical indicators. METHODS: We used the baseline, two and four-year data of 382 adult OCD patients participating in the naturalistic cohort study of the Netherlands Obsessive Compulsive Disorder Association (NOCDA). Remission was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Predictors of outcome were assessed at baseline, via clinician-rated and self-report instruments. RESULTS: Remission at two and at four-year follow-up ranged from 11% to 26%. Early age of onset and the presence of childhood trauma predicted a worse four-year course. Secure attachment style emerged as a protective predictor of improved outcome. LIMITATIONS: The naturalistic design of our study did not enable a systematic estimation the effect of treatments received during the follow-up period. Furthermore, age of onset and childhood trauma were assessed retrospectively, which may contribute to recall bias. CONCLUSION: Results coincide with previous prediction research and stress the importance of adaptive interpersonal functioning in the course of OCD. Clinical implications and future research directions are discussed. 9 p.

Background: The aim of this study was to test, through a chronobiologic approach, the existence of a significant circannual rhythm of tics and obsessive-compulsive symptoms in patients with Obsessive-Compulsive Tic Disorder (OCTD). The chronotype effect on tics and OC symptoms during seasons was also studied. Methods: Patients with a diagnosis of OCTD (N = 37; mean age = 18.78 ± 8.61) underwent four clinical evaluations: Winter (WIN), Spring (SPR), Summer (SUM) and Autumn (AUT). Tics were evaluated through Yale Global Tic Severity Scale (YGTSS) and OC symptoms through Yale-Brown Obsessive Compulsive Scale (Y-BOCS). Patients’ chronotype was assessed by the Horne-Ostberg morningness-eveningness questionnaire (MEQ), which categorizes subjects according to the individuals'chronotype, being morning-type, evening-type, and neither-type. Results: A statistically significant circannual rhythm was observed for OC symptoms (p = 0.007), with the acrophase occurring between AUT and WIN. Y-BOCS differed along the year (p = 0.0003 and η2p = 0.40) with lower results in SUM compared to WIN (p < 0.05) and AUT (p < 0.01). Tics displayed no circannual rhythm and YGTSS scores were comparable among seasons. Patients were classified as 15 morning-types (40.5%) 15 neither-types (40.5%) and 7 evening-types (19.0%). YGTSS data were similar for all chronotypes while Y-BOCS results were greater during SUM in evening-types than morning-type patients (p < 0.05; 15.7 ± 5.2 vs 3.4 ± 6.0). Limitations: It is essential to investigate the existence of tics and OC symptoms circannual rhythms over the course of more than one year with a larger sample. Conclusions: OC symptoms displayed a significant circannual rhythm and were influenced by patients’ chronotype. On the contrary, tics resulted similar among seasons and chronotypes.

A considerable proportion of obsessive-compulsive disorder (OCD) patients receiving first-line pharmacological therapy, fail to fully respond to treatment and continue to exhibit significant symptoms. In this systematic review, we evaluate the efficacy of memantine, as a glutamate-modulating agent, in moderate to severe OCD. Single and double blinded as well as open-label trials of memantine augmentation in adults with OCD were considered. Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores were the primary outcome measure. The electronic databases of PubMed, Scopus, Embase and Google Scholar were searched for relevant trials using keywords ‘obsessive-compulsive disorder OR OCD’ AND ‘memantine’. The meta-analysis of eight studies involving 125 OCD subjects receiving memantine augmentation exhibited a significant overall mean reduction of 11.73 points in Y-BOCS scores. The categorical analysis of treatment response (a minimum of 35% reduction in Y-BOCS) in four double-blind placebo-controlled studies indicated that OCD patients receiving memantine augmentation were 3.61 times more likely to respond to treatment than those receiving placebo. We found that 20 mg/day memantine augmentation to first-line pharmacological treatment for a period of at least 8 weeks is a safe and effective intervention for moderate to severe OCD.

Objective: Obsessions have been categorized as autogenous obsessions and reactive obsessions on the original of the cognitive theory and this study aimed to evaluate whether differences are found between obsessive compulsive disorder (OCD) subgroups in terms of biochemical markers. Methods: Thirty patients with obsessions defined as autogenous, 30 patients with obsessions defined as reactive group and 30 healthy volunteers were consisted the sample of the study. Sociodemographic Data Form, Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI) were filled to the participants. The activity of paraoxanase, prolidase and Hs-CRP and brain-derived neurotrophic factor (BDNF) levels were detected. Results: There was no any statistically significant difference between autogenous and reactive obsession groups in terms of total mean score of Y-BOCS, BDI and BAI. Paraoxanase activity did not statistically significant difference between all groups. Prolidase activity showed significantly higher in reactive group than autogenous obsession and control groups. Serum Hs-CRP levels were not statistically different among participants of autogenous group, reactive group and control groups. Serum BDNF levels were significantly lower in autogenous obsession group rather than reactive obsession and control groups. Conclusion: This finding indicates that neurobiological pro-cesses have important role in the pathophysiology of autogenous obsessions.

The current study examined the temporal precedence of change in obsessive-compulsive symptoms and change in depressive symptoms during the course of an Exposure and Response Prevention (ERP) for pediatric OCD. Participants included 142 children and adolescents (7–17 years; mean age = 12.39, SD = 2.92; 51.40% female; 60.40% Non-Hispanic White) with a primary or co-primary diagnosis of OCD who received ERP in a two-site randomized controlled trial on d -cycloserine augmentation of CBT for pediatric OCD. Participants completed clinician-administered assessments of OC symptoms (Children's Yale-Brown Obsessive Compulsive Scale) and depressive symptoms (Children's Depression Rating Scale-Revised) from baseline to post-treatment follow-up. Lagged mediational analyses did not yield evidence in support of a mediating role for the change in OC symptoms in the effect of ERP on the change in depressive symptoms. In contrast, change in depressive symptoms mediated the effect of ERP treatment on the subsequent change in OC symptoms (95% confidence interval for indirect effect = −0.04 to −0.001), though the effect size was small. Controlling for the prior levels of the depressive symptoms this indirect effect became non-significant. Theoretical and clinical implications of the findings for the youth with OCD and comorbid depression are discussed.

Introduction.Bipolar disorder (BD) and obsessive compulsive disorder (OCD) are prevalent, comorbid, and disabling conditions, often characterized by early onset and chronic course. When comorbid, OCD and BD can determine a more pernicious course of illness, posing therapeutic challenges for clinicians. Available reports on prevalence and clinical characteristics of comorbidity between BD and OCD showed mixed results, likely depending on the primary diagnosis of analyzed samples.Methods.We assessed prevalence and clinical characteristics of BD comorbidity in a large international sample of patients with primary OCD (n = 401), through the International College of Obsessive–Compulsive Spectrum Disorders (ICOCS) snapshot database, by comparing OCD subjects with vs without BD comorbidity.Results.Among primary OCD patients, 6.2% showed comorbidity with BD. OCD patients with vs without BD comorbidity more frequently had a previous hospitalization (p < 0.001) and current augmentation therapies (p < 0.001). They also showed greater severity of OCD (p < 0.001), as measured by the Yale–Brown Obsessive Compulsive Scale (Y-BOCS).Conclusion.These findings from a large international sample indicate that approximately 1 out of 16 patients with primary OCD may additionally have BD comorbidity along with other specific clinical characteristics, including more frequent previous hospitalizations, more complex therapeutic regimens, and a greater severity of OCD. Prospective international studies are needed to confirm our findings.

Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition. Specific patterns of psychiatric comorbidity, early age at onset, long duration of illness (DI) and untreated illness (DUI) have been associated with poor outcome in OCD. The present study was aimed to explore sociodemographic and clinical characteristics associated with increased severity of illness in a sample of OCD patients.A total of 124 OCD outpatients were recruited and divided into two groups on the basis of their severity of illness, as assessed through the Yale-Brown Obsessive Compulsive Scale (24). Chi-squared test and t-test for independent samples were performed to compare sociodemographic and clinical variables between the two groups.The group with increased severity of illness had a younger age, an earlier age at onset and age at first pharmacological treatment (p .05). In addition, the same group showed a longer DI but a shorter DUI (p .01). Moreover, significantly higher rates of psychiatric comorbidities (p .01) were observed in the higher severity group.Earlier age, age at onset and age at first pharmacological treatment, longer DI, shorter DUI and higher rate of psychiatric comorbidities were associated with increased severity of OCD. Further studies on larger samples are warranted to confirm the reported results.

IntroductionWe previously reported that deep brain stimulation (DBS) in the anterior limb of the internal capsule/bed nucleus of the stria terminalis (IC/BST) is effective in reducing symptoms in severe treatment-resistant obsessive-compulsive disorder patients.ObjectiveTo examine the long-term evolution of obsessive compulsive disorder (OCD) symptoms in 24 patients treated with chronic electrical stimulation in IC/BST.AimsWe aimed to examine the evolution of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and to determine if a number of predictors assessed before surgery are significantly related to this evolution.MethodsWe used a linear mixed model to investigate the evolution of the Y-BOCS in 24 patients. Data was collected in a naturalistic manner. Seven hundred measurements, taken during a total of 1836 follow-up months, are included in this analysis.ResultsOur analysis showed a long-term, sustained effect of electrical stimulation in the IC/BST. After a fast initial decline of OCD symptoms, these symptoms stay relatively stable. In addition, results show a strong ON/OFF effect of stimulation (e.g., due to battery depletion). Beside the ON/OFF effect of stimulation, the surgery itself has no additional effect on OCD symptoms. The Beck Depression Inventory (BDI) at baseline was the only predictor significantly related to the evolution of the Y-BOCS. A higher BDI at baseline seemed to be related to a smaller decrease of the Y-BOCS over time.ConclusionElectrical stimulation in the IC/BST has a fast and sustained effect on OCD symptoms.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Self-help resources are frequently sought out by individuals with obsessive-compulsive disorder (OCD); however their efficacy has rarely been evaluated in randomized controlled trials, despite frequently bold claims for their efficacy. In the present study, we examined if a metacognitive self-help manual called myMCT (for “my Metacognitive Training”), which encompasses exercises from cognitive-behavioral therapy (CBT) and its "third wave", is superior to a wait-list control group in reducing OCD symptoms. Further, we examined whether an individually adapted version of the manual suited to personal problems would yield larger effects than the full manual. Methods A total of 89 individuals with OCD symptoms participated in the online study. Participants were randomly assigned to three conditions; patients either received the full myMCT manual (sent via email attachment), an individually adapted myMCT version, or were allocated to a wait-list control group. Before randomization (pre-assessment) and six weeks later (post-assessment), individuals were asked to fill out several questionnaires tapping obsessive-compulsive and depressive symptoms. Results Individuals in the two myMCT conditions improved significantly more on the Yale-Brown Obsessive Compulsive Scale and Obsessive-Compulsive Inventory-Revised total scores than the wait-list control group (between-group comparison), with a medium to large effect size. Subsidiary analyses showed that improvements were particularly pronounced for obsessions, while effects on compulsions were mainly small and insignificant. Contrary to our expectation, the adapted version did not lead to better outcomes than the full version. Discussion The present study supports the feasibility of a bibliotherapeutic metacognitive approach for the treatment of obsessive thoughts. While results confirm prior reports that metacognitive training is effective in OCD, results are limited by a rather high non-completion rate. Further studies should investigate the long-term effectiveness of the approach and its utility in the framework of guided self-help or face-to-face treatment.

The Dimensional Obsessive-Compulsive Scale (DOCS) is a self-report measure of the severity of obsessive-compulsive symptoms (OCS) along with four dimensions. The aim of this study was to assess the factor structure, reliability and validity of the Persian version of the DOCS (P-OCDS) among patients with obsessive-compulsive disorder (OCD). A total of 764 outpatients with a DSM-IV diagnosis of OCD completed the P-DOCS, the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Vancouver Obsessive-Compulsive Inventory (VOCI), the Obsessive-Compulsive Inventory-Revised (OCI-R), the Penn State Worry Questionnaire-Short Form (PSWQ-SF), and the Beck Depression Inventory-II (BDI-II). Similar to the original version of the DOCS, results showed that the P-DOCS had a four-factor structure. Also, the P-DOCS showed good reliability through calculating McDonald's Omega and test-retest. In addition, convergent and discriminant validity of the P-DOCS was confirmed through its strong and weak correlations with other OCD measures and measures of global psychological distress respectively. Findings indicate that the DOCS is a reliable scale to use in Iranian clinical samples with OCD.

The Vancouver Obsessional-Compulsive Inventory (VOCI) was validated in Iranian non-clinical individuals, but not in patients with obsessive-compulsive disorder (OCD). Accordingly, this study aims to further evaluate the six-factor first-order and one-factor second-order structures, validity, and reliability of the scale and also to adapt this scale to the DSM-5 recommendations regarding hoarding behavior in Iranian OCD patients. Three hundred and sixty patients completed the VOCI, the Dimensional Obsessive-Compulsive Scale (DOCS), the Yale-Brown Obsessive Compulsive Scale checklist (Y-BOCS), the Obsessive-Compulsive Inventory-Revised (OCI-R); the Penn State Worry Questionnaire (PSWQ-SF), the Beck Depression Inventory-II (BDI-II), and the Beck Anxiety Inventory (BAI). Results showed that the six-factor first-order model of the VOCI had acceptable fit, while the five-factor first-order model had more appropriate fit by deleting the hoarding subscale's items. Also, one-factor second-order structure of the scale has been found to have an adequate fit. In addition, reliability and convergent and discriminant validity of the VOCI have been found to be good. The findings indicate that although the VOCI with the six-factor first-order and one-factor second-order structures is a valid scale in Iranian OCD patients, the VOCI adapted to the DSM-5 is more reliable to be used in Iranian community.

A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.

Background and objectives: Some individuals with Obsessive Compulsive Disorder (OCD) may experience recurrent intrusive distressing images, which may be emotionally linked to past aversive memories. Our aim was to investigate whether Imagery Rescripting was an effective intervention for such individuals with OCD. Method: Twelve cases who experienced intrusive distressing images are presented in a A1BA2CA3 single case experimental design. After a baseline of Compulsive Scale, with a decrease from a mean of 24.1 to 10.7. Reliable symptom monitoring (A1), participants had a control intervention of talking about the memory related image (B), followed by symptom monitoring (A2), a single session of Imagery Rescripting (C) and further monitoring for up to 3 months (A3). Results: Minimal change was seen following the control intervention. However, at 3 months following ImRs, there was a drop in the Yale-Brown Obsessive improvement was achieved in 9 out of the 12 cases and clinically significant change in 7 out of 12 at 3-month follow up. The limitations are that all cases were selected on the basis that they had an aversive memory linked to their imagery. Conclusions: Imagery Rescripting is a promising therapeutic technique for OCD as an adjunct to CBT where intrusive images are linked to aversive memories.

The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive-compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7-17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children's Yale-Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10-17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.

Pediatric obsessive–compulsive disorder (OCD) is a disorder associated with distress and impairment in many domains. Moreover, there is a high risk of relapse and developing a chronic illness. Randomized-controlled trails (RCT), the gold-standard for evaluating treatments, show treatments to be efficacious, yet little is known about their generalizability and long-term durability in “usual-care” settings. The aim of the present study is to evaluate the feasibility and effectiveness of evidence-based pediatric OCD-treatments in regular practice. Participants were 109 children (aged 7–17 years) with a primary diagnosis of OCD, recruited from a specialized OCD-clinic in Sweden. Few exclusion criteria were applied. The youths were assessed at baseline, 6 and 12 months following the first assessment, using Children׳s Yale-Brown Obsessive Compulsive Scale and Children׳s OCD Impact Scale. They were treated with Cognitive Behavior Therapy, augmented with SSRI when indicated. The majority responded well to treatment i.e. were free from OCD or in remission at 12 month evaluation. Moreover, the participants psychosocial functioning significantly improved from baseline to evaluation at 6 and 12 months.

Randomised and sham-controlled trials (RCTs) of repetitive transcranial magnetic stimulation (rTMS) in the treatment of obsessive-compulsive disorder (OCD) have yielded conflicting results, which may be due to the variability in rTMS parameters used. We performed an updated systematic review and meta-analysis on the effectiveness of rTMS for the treatment of OCD and aimed to determine whether certain rTMS parameters, such as cortical target, may be associated with higher treatment effectiveness. After conducting a systematic literature review for RCTs on rTMS for OCD through to 1 December 2016 using MEDLINE, PubMed, Web of Science, PsycINFO, Google, and Google Scholar, we performed a random-effects meta-analysis with the outcome measure as pre-post changes in Yale-Brown Obsessive Compulsive Scale (Y-BOCS) scores. To determine whether rTMS parameters may have influenced treatment effectiveness, studies were further analysed according to cortical target, stimulation frequency, and length of follow-up. Data were obtained from 18 RCTs on rTMS in the treatment of OCD. Overall, rTMS yielded a modest effect in reducing Y-BOCS scores with Hedge's g of 0.79 (95% CI = 0.43-1.15, p

OBJECTIVE: Tourette syndrome (TS) is a childhood-onset neurodevelopmental disorder characterized by tics and frequent comorbidities. Although tics often improve during adolescence, recent studies suggest that comorbid obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) tend to persist. This large prospective follow-up study describes the clinical course of tics and comorbidities during adolescence and the prevalence of coexisting psychopathologies.METHOD: The clinical cohort was recruited at the Danish National Tourette Clinic, and data were collected at baseline (n = 314, age range 5-19 years) and at follow-up 6 years later (n = 227) to establish the persistence and severity of tics and comorbidities. During follow-up, the Development and Well-Being Assessment (DAWBA) was used to diagnose coexisting psychopathologies. Repeated measures of severity scores were modeled using mixed effects models.RESULTS: Tic severity declined yearly (0.8 points, CI: 0.58-1.01, on the Yale Global Tic Severity Scale [YGTSS]) during adolescence; 17.7% of participants above age 16 years had no tics, whereas 59.5% had minimal or mild tics, and 22.8% had moderate or severe tics. Similarly, significant yearly declines in severity of both OCD (0.24, CI: 0.09-0.39, on the Yale-Brown Obsessive Compulsive Scale for Adults [Y-BOCS] and Yale-Brown Obsessive Compulsive Scale for Children [CY-BOCS]) and ADHD (0.42, CI: 0.32-0.52, DSM-IV) were recorded. At follow-up, 63.0% of participants had comorbidities or coexistent psychopathologies, whereas 37.0% had pure TS.CONCLUSION: Severity of tics, OCD, and ADHD were significantly associated with age and declined during adolescence. However, considerable comorbidities and coexisting psychopathologies persist throughout adolescence and require monitoring by clinicians.

Background: Family accommodation (FA) is a phenomenon whereby caregivers assist/facilitate rituals or behaviors related to obsessive–compulsive disorder (OCD). FA, however, has been explored primarily in the Western population, and it is unclear to what extent it might be present in diverse cultural settings. At present, little is known about the extent and predictors of FA among caregivers of adult OCD patients in India. Aims: The study aims to assess the extent, clinical correlates, and predictors of FA in the caregivers of adults with OCD. Settings and Design: Cross-sectional study conducted in an outpatient setting in a tertiary-care hospital. Materials and Methods: Hundred and one adult patients of either gender with Diagnostic and Statistical Manual of Mental Disorders-5 diagnosis of OCD and 101 caregivers were included. The patients were assessed using Yale–Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D), World Health Organization Disability Assessment Schedule Version 2.0 12-item version (WHO-DAS 2.0.12), Clinical Global Impressions Scale for Severity (CGI-S), and Clinical Global Impressions Scale for Improvement. The FA Scale-Self Rated Version (FAS-SR) was applied on caregivers after Hindi translation. Statistical Analysis: Descriptive statistics, group comparisons, and Pearson's product moment correlations were carried out. Multiple linear regression modeling was performed with the total FAS-SR score as the dependent variable. Results: About 92% of caregivers displayed at least some form of FA. Higher scores on HAM-D, YBOCS, WHODAS, and CGI-S were associated with higher scores on FAS-SR scale, which reached statistical significance (P < 0.01). Conclusions: FA in OCD appears to be a frequent phenomenon. Higher FA is associated with higher symptom severity and disability, emphasizing its clinical and research relevance for future studies.

Objective: The primary aim of this study is to evaluate the possible relationship between obsessive-compulsive symptoms (OCS) and traumatic life events (TLEs) in this clinical sample of adolescents. The secondary objective is to evaluate the relationship between different clinical presentations and severities of OCS and specific TLEs. Methods: The study included 60 adolescents between 12-16 ages, with obsessive-compulsive disorder (OCD) ac-cording to DSM-V and 60 adolescents without any psychiatric diagnosis. Sociodemographic characteristics of cases were evaluated with detailed form; in addition, neuropsychological tests were applied to investigate development of intelligence and trauma characteristics of childhood. Turkish version of Schedule for Affective Disorders and Schizo-phrenia for School-Age-Children Present and lifetime version, Children's Yale-Brown Obsessive Compulsive Scale, Children's Depression Inventory and Childhood Trauma Questionnaire-short form were applied in order to assess psychopathology. Intelligence level of patients were assessed with Wechsler Intelligence Scale for Children-Re-vised. Results: It was determined that there was a strong relationship between TLEs and OCS in adolescents, especially in females. TLEs were associated with all OCS manifestations, most prominently with sexual, religious and harm obsessions. The sexual abuse showed stronger associations with OCS compared with other TLEs. Dis-cussion: Due to limited number of patients, our findings couldn’t be generalized to all adolescents with OCS; there-fore there is a need for more studies in this area.

The aim of this study is to investigate the effects of obsessive-compulsive symptoms (OCS) on quality of life (QoL) and to identify the OCS with a particular effect on QoL, and whether there are any such symptoms for patients with schizophrenia.We studied three groups of patients with schizophrenia. One group of patients (n = 45) without OCS or obsessive-compulsive disorder (OCD), one group with OCS, not fulfilling the diagnostic criteria for OCD (n = 31), and one group with OCD as a comorbid condition (n = 24). Severity of clinical symptoms was evaluated with the Positive and Negative Symptom Scale and OCS was examined using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist. We also administered the Y-BOCS. The patients' QoL was assessed using the Quality of Life Scale (QLS).QLS interpersonal relationships subscale scores of those with OCS were lower than those without OCS. There was no difference among OCS, non-OCS, and OCD groups in terms of QoL. There was no relationship between QLS scores and symmetry, contamination and causing harm obsessions, but those with cleaning and repeating compulsions had lower QoL.Questioning of comorbid OCS and treatment with specific medication in schizophrenia patients may increase QoL.

Effective treatments for obsessive-compulsive disorder (OCD) exist, however, many patients experience barriers to treatment. Internet-administered cognitive-behavioral therapy (iCBT), which has the potential to reduce these barriers, has recently been shown to be efficacious in the treatment of OCD. To date, only therapist-guided iCBT interventions have been studied for OCD. Self-guided iCBT, administered without a therapist, may help to further reduce barriers to treatment, particularly for those concerned about stigma or who are unlikely to engage in treatment with a therapist. The present article describes the results of two open-trial feasibility studies that examined the acceptability and preliminary efficacy of fully self-guided iCBT for symptoms of OCD. In both trials scores on the Yale–Brown Obsessive Compulsive Inventory-Self-Report and the Dimensional Obsessive Compulsive Scale reduced significantly over time and moderate to large effect sizes were obtained. In trial 1, 29% met criteria for clinically significant change at 3-month follow-up and in trial 2, 32% met criteria for clinically significant change at 3-month follow-up. These results indicate that self-guided iCBT may be an acceptable and effective treatment for some individuals with obsessive-compulsive symptoms.

Background Family accommodation describes ways in which parents modify their behavior to help a child avoid or alleviate distress caused by emotional disorders. Accommodation is associated with increased symptom severity, lower functioning, and poorer treatment outcomes. Accommodation is prevalent in childhood obsessive-compulsive disorder (OCD) and anxiety disorders (ADs) but no studies have compared accommodation in these groups or compared them to healthy controls to ascertain if accommodation is prevalent in the general population. This study addresses these gaps by comparing patterns of accommodation, factors that maintain accommodation, and its relation to symptom severity in OCD and AD, relative to healthy controls. Method We directly compared reports of accommodation to childhood OCD (N = 26) and AD (N = 31), and a comparison group of nonanxious (NA) children (N = 30). Mothers completed measures of accommodation (Family Accommodation Scale (FAS)/Family Accommodation Scale–Anxiety (FASA)), anxiety (Screen for Childhood Anxiety Related Emotional Disorders–Parent Report (SCARED-PR)), and OCD (Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS)). Results Family accommodation is prevalent among mothers of children with OCD and AD. Few differences were found between the two clinical groups who reported more accommodation (F[2,84] = 23.411, P < .001, partial η2 = .358), greater distress (F[2,84] = 24.050, P < .001, partial η2 = .364), and more consequences of not accommodating (F[2,84] = 18.967, P < .001, partial η2 = .311), than the NA group. Accommodation was associated with severity of anxiety in AD (r = .426, P = .017) and OCD (r = .465, P = .017), but not in the NA group. Conclusions Findings highlight family accommodation as a phenomenon that applies broadly and in a similar manner to children with AD and OCD. Evaluating accommodation provides useful information for clinical care and is an important part of the assessment of children with AD and OCD.

Objectives Our main goal was to provide the psychometric properties of the Spanish version of the Dimensional Obsessive–Compulsive Scale (DOCS) in a non-clinical sample (n = 237) and in adult patients with Obsessive–Compulsive Disorder (OCD) (n = 110). We also examined the association between OC symptom dimensions and obsessive beliefs. Methods The psychometric properties involved four steps: reliability, structural validity, convergent and discriminant validity and diagnostic sensitivity. Linear regression analyses were used to assess the associations between OC symptoms and obsessive beliefs. Results Exploratory and confirmatory factor analyses replicated the original four-factor structure in both samples. The DOCS showed good performance in terms of internal consistency, test–retest reliability and convergent validity in both samples. The DOCS showed better diagnostic sensitivity than another self-report instrument of OC symptoms, the Obsessive–Compulsive Inventory Revised. Findings of the relationship between obsessive beliefs and OC symptoms revealed that certain obsessive beliefs predicted specific OC symptom dimensions. Conclusions The Spanish version of the DOCS has similar psychometric properties than the original English instrument, although its performance is somewhat better in OCD patients than in students. It will be important to ascertain its ability to discriminate OCD from other associated disorders.

Obsessive-compulsive disorder (OCD) is a common anxiety disorder. Although effective treatments exist many patients experience difficulties accessing treatment. Treatments that are delivered remotely, such as bibliotherapy-administered CBT (bCBT) and internet-administered CBT (iCBT) have the potential to improve access to treatment. This study was a three group randomized controlled trial that aimed to examine the benefits and acceptability of these two remote treatment options in the treatment of OCD, compared to a waitlist control group. Participants in the bCBT and iCBT groups read five lessons and received twice-weekly contact from a remote therapist. The control group did not receive any clinical contact during this time. The results indicated that participants in both remote treatment conditions (bCBT and iCBT) improved from pre-treatment to post-treatment and pre-treatment to 3-month follow-up on the Yale-Brown Obsessive Compulsive Scale. Once the bCBT and iCBT groups completed treatment, the control group was provided the iCBT protocol but with clinician contact only once per week. Results from the control group, after receiving iCBT treatment, indicated that large effect sizes can be obtained with weekly contact. These results provide preliminary support for the use of either bCBT or iCBT in the remote treatment of OCD.

Background: Reward-processing deficits have been demonstrated in obsessive–compulsive disorder (OCD) and this has been linked to ventral striatal abnormalities. However, volumetric abnormalities of the nucleus accumbens (NAcc), a key structure in the reward pathway, have not been examined in OCD. We report on the volumetric abnormalities of NAcc and its correlation with illness severity in drug-naïve, adult patients with OCD. Method: In this cross-sectional study of case–control design, the magnetic resonance imaging (MRI) 1.5-T (1-mm) volume of NAcc was measured using 3D Slicer software in drug-naïve OCD patients ( n = 44) and age, sex and handedness-matched healthy controls (HCs) ( n = 36) using a valid and reliable method. OCD symptoms were assessed using the Yale–Brown Obsessive Compulsive Scale (Y-BOCS) Symptom checklist and severity and the Clinical Global Impression-Severity (CGI-S) scale. Results: There was no significant difference in NAcc volumes on either side between OCD patients and HCs ( F = 3.45, p = 0.07). However, there was significant negative correlation between the right NAcc volume and Y-BOCS compulsion score ( r = −0.48, p = 0.001). Conclusions: Study observations suggest involvement of the NAcc in the pathogenesis of OCD, indicating potential reward-processing deficits. Correlation between the right NAcc volume deficit and severity of compulsions offers further support for this region as a candidate for deep brain stimulation treatment in OCD.

The Dimensional Obsessive Compulsive Scale (DOCS) is a self-report instrument to assess severity of OC symptoms along four thematically distinct symptom dimensions. This may carry benefits; both in assessment and for studying the link between OC related beliefs and symptoms. The validity and factor structure of the Icelandic version of the DOCS was investigated in a sample of 547 university students and the congruence between OC related beliefs and symptoms was also compared across different symptom measures (DOCS and OCI-R). Confirmatory factor analysis supported the proposed four-factor structure and a model with a higher-order general severity factor accounting for the inter-relations between the factors. Convergent validity of the scale was supported with moderate to strong correlations with the OCI-R and the Y-BOCS-Self Report version and its symptom checklist. Divergent validity was supported with low to moderate correlations with measures of general anxiety, depression and worry. Regression analyses partly replicated previous results regarding congruence between beliefs and DOCS symptom dimensions. Results did not depend on the symptom measure used. The DOCS has good psychometric properties and may be a useful assessment instrument in both research and clinical settings, although its advantages compared to other self-report measures are not clear.

Obsessive-compulsive disorder (OCD) is a notably heterogeneous disorder. As such, there has been increased interest in subtyping OCD into homogeneous entities using biological characteristics such as sex. Whereas there is large consensus in the literature regarding sex differences in the phenotypic expression of OCD, there are numerous disadvantages to how OCD has been previously measured and assessed. The present investigation explored potential sex differences in OCD symptoms using the Dimensional Obsessive Compulsive Scale (DOCS), a redesigned measure that more reliably assesses the four most commonly replicated OCD symptom dimensions. A large sample of community participants with elevated levels of OCD symptoms (N = 297) was recruited from an online crowdsourcing marketplace. Surprisingly, no differences in means were observed across sexes. However, results did reveal sex differences when examining relations between OCD dimensions. In particular, correlations between the OCD symptom dimensions were stronger in males compared to females. The common perception of OCD as a heterogeneous disorder may hold for females more so than for males. Future research should seek to replicate these findings using multimethod approaches including clinical, behavioral, and neuroimaging assessments.

The Obsessive Compulsive Inventory (OCI) is often used as a screening instrument for symptoms of Obsessive-Compulsive disorder (OCD) and as an outcome measure for treatment. Three versions of the OCI are available: the original 42-item version, the revised 18-item version (OCI-R) and a shorter version that focuses on the highest subscale (OCI-R Main). Our aim was to determine sensitivity to change and evaluate cut-off scores for caseness in each version of the OCI using the same dataset. Method: We compared the effect size and the number of patients who achieved reliable and clinically significant change after cognitive behavior therapy in two samples of out-patients with OCD. One sample (n=63) had OCD of minor to moderate severity and a second sample (n=73) had severe, treatment refractory OCD. Results: The OCI-R is a valid self-report outcome measure for measuring change and is less burdensome for patients to complete than the OCI. Questions remain about whether the OCI or OCI-R is sufficiently sensitive to change for a service evaluation. We would recommend a slightly higher cut-off score of ≥17 on the OCI-R for the definition of caseness. Discussion: In both samples, the OCI and OCI-R had very similar treatment effect sizes and to a lesser extent in the percentage who achieved reliable improvement and clinically significant change. The OCI-R Main was more sensitive to change than the OCI or OCI-R in both samples. All versions of the OCI were less sensitive to change compared with the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).