Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder: Towards an Individualized Approach

Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder featuring repetitive intrusive thoughts and behaviors associated with a significant handicap. Of patients, 20% are refractory to medication and cognitive behavioral therapy. Refractory OCD is associated with suicidal behavior and significant degradation of social and professional functioning, with high health costs. Deep brain stimulation (DBS) has been proposed as a reversible and controllable method to treat refractory patients, with meta-analyses showing 60% response rate following DBS, whatever the target: anterior limb of the internal capsule (ALIC), ventral capsule/ventral striatum (VC/VS), nucleus accumbens (NAcc), anteromedial subthalamic nucleus (amSTN), or inferior thalamic peduncle (ITP). But how do we choose the “best” target? Functional neuroimaging studies have shown that ALIC-DBS requires the modulation of the fiber tract within the ventral ALIC via the ventral striatum, bordering the bed nucleus of the stria terminalis and connecting the medial prefrontal cortex with the thalamus to be successful. VC/VS effective sites of stimulation were found within the VC and primarily connected to the medial orbitofrontal cortex (OFC) dorsomedial thalamus, amygdala, and the habenula. NAcc-DBS has been found to reduce OCD symptoms by decreasing excessive fronto-striatal connectivity between NAcc and the lateral and medial prefrontal cortex. The amSTN effective stimulation sites are located at the...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research

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AbstractBody Dysmorphic Disorder (BDD) is a psychiatric diagnosis of an impairing condition in which the patient is preoccupied with a slight or perceived defect in their appearance. BDD patients have a higher rate of psychiatric comorbidities than the background population which include obsessive-compulsive disorder (OCD), depression, anxiety and suicide. It causes distress and affects the patient ’s quality of life. It is previously found that the prevalence of patients that suffers from BDD is higher among dermatology patients than in the background population. To create an overview of the original literature that...
Source: Psychiatric Quarterly - Category: Psychiatry Source Type: research
CONCLUSIONS: Elevated risk of eating disorders as well as of MDD, OCD, and anxiety disorders was found in international adoptees. A parallel pattern between AN and OCD was observed, which both display less elevated rates than the other diagnoses. A considerable number of biological, environmental, and societal factors have been suggested to explain the observed differences in mental health between adoptees and non-adoptees, but they remain primarily theoretical. PMID: 32452335 [PubMed - in process]
Source: Epidemiology and Psychiatric Sciences - Category: Psychiatry Tags: Epidemiol Psychiatr Sci Source Type: research
CONCLUSIONS.: Patients with OCTD vs with OCD showed a significantly higher rate of SA with no differences in SI. In particular, OCTD-SA group showed different unfavorable epidemiological and clinical features which need to be confirmed in future prospective studies. PMID: 32372727 [PubMed - as supplied by publisher]
Source: CNS Spectrums - Category: Neurology Authors: Tags: CNS Spectr Source Type: research
Credit: Gopen Rai/NEPALI TIMES ARCHIVEBy Sonia AwaleApr 26 2020 (IPS) The number of Nepalis suffering from mental health issues is increasing with the prolonged COVID-19 lockdown, and the lack of treatment and counselling means the country may be facing an epidemic of psychosocial disorders. Mental health is a hidden pre-existing crisis in Nepal because of social stigma, with a survey three years ago showing that a shocking 37% of the population suffered from some form of mental health problem. “During a time of a disaster or an epidemic, anxiety disorder, phobia, obsessive compulsive tendencies a...
Source: IPS Inter Press Service - Health - Category: International Medicine & Public Health Authors: Tags: Asia-Pacific Headlines Health Coronavirus Source Type: news
Major Depressive disorder (MDD) is the most common comorbidity with obsessive-compulsive disorder (OCD); more than 50% of OCD patients meet lifetime criteria for MDD or dysthymia[1]. Depression can significantly worsen OCD treatment outcomes[2] and elevate the risk for suicide[3]. While the multi-center-tested and FDA indicated deep transcranial magnetic stimulation (dTMS) treatment for OCD uses the H7 coil, to target dorsomedial prefrontal cortex (dmPFC) and anterior cingulate cortex (ACC)[4], the treatment for MDD uses the H1 coil to target the dorsolateral prefrontal cortex (dlPFC) bilaterally with preference to the left[5].
Source: BRAIN STIMULATION: Basic, Translational, and Clinical Research in Neuromodulation - Category: Neurology Authors: Source Type: research
Withdrawal symptoms after discontinuation of antidepressants are common and have long been known. Typical symptoms after dose reduction or discontinuation of antidepressants are dizziness, drowsiness, headache, flu-like symptoms, hyperarousal, imbalance, insomnia, irritability, and nausea. Rebound, relapse, or recurrence associated with the underlying mental disorder may also occur. The occurrence of obsessive-compulsive symptoms (OCS) following abrupt discontinuation of antidepressants have not yet been reported. Here we report the development of OCS (obsessional suicidal thoughts) in a patient with major depressive disor...
Source: Frontiers in Psychiatry - Category: Psychiatry Source Type: research
Comorbidity is the presence of one or more additional conditions co-occurring with a primary condition. In this episode, host schizophrenic Rachel Star Withers with her cohost Gabe Howard will be discussing comorbidity with schizophrenia. Comorbidity is associated with worse health outcomes, more complex clinical management and increased health care costs. Occupational therapist and host of the podcast Occupied, Brock Cook, will be joining us to discuss ways that he works with people with schizophrenia to manage multiple health issues.  Highlights from “Comorbidity with Schizophrenia” Episode [01:28] What ...
Source: World of Psychology - Category: Psychiatry & Psychology Authors: Tags: Antipsychotic Inside Schizophrenia Mental Health and Wellness Psychiatry Psychology Psychotherapy Bipolar disorder and schizophrenia comorbid comorbid psychiatric conditions Comorbidities Comorbidity Diagnosis Of Schizophrenia Livi Source Type: blogs
PURPOSE: Suicide is an important cause of death in patients diagnosed with obsessive-compulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psych...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Suicide and Self-Harm Source Type: news
Publication date: Available online 7 January 2020Source: Neuroscience &Biobehavioral ReviewsAuthor(s): Petya Vicheva, Matthew Butler, Paul ShotboltAbstractDeep brain stimulation (DBS) is considered a promising intervention for treatment-resistant obsessive-compulsive disorder (trOCD). We conducted a systematic search to investigate the efficacy and safety of DBS for OCD. Primary outcomes included the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), adverse events (AE), and quality of life. We assessed affective state, global functioning, cognition, and tolerability as secondary outcomes. Eight studies comprising 80 pati...
Source: Neuroscience and Biobehavioral Reviews - Category: Neuroscience Source Type: research
CONCLUSION: OCD prevalence in Singapore is high. Most people with OCD do not seek treatment despite experiencing significant comorbidity and loss of quality of life. PMID: 32200393 [PubMed - in process]
Source: Annals of the Academy of Medicine, Singapore - Category: General Medicine Authors: Tags: Ann Acad Med Singapore Source Type: research
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