Altered fear learning processes could be mechanistically linked to the development and/or maintenance of obsessive-compulsive disorder (OCD). From a clinical perspective, the first-line psychological treatment for OCD is cognitive-behavioral therapy (CBT), which is based on the principles of fear learning. However, no previous functional magnetic resonance imaging (fMRI) studies have evaluated the predictive capacity of regional brain activations during fear learning on CBT response in patients with OCD.

We aimed at exploring whether brain activation during fear learning in patients with OCD are associated with CBT outcome.

We assessed 18 patients with OCD and 18 healthy participants during a 2-day experimental protocol where brain activation and skin conductance responses (SCR) where assessed during fear conditioning, extinction learning, and extinction recall within the fMRI scanner. Following the protocol, patients with OCD received CBT.

We found non-significant between-group differences in SCR during fear learning. Patients with OCD showed significantly diminished activation of the dorsal anterior cingulate cortex and the right insula during fear conditioning. Importantly, our analyses revealed a significant negative association between clinical improvement after CBT and activity at the right insula during fear conditioning (x = 39, y = 12, z = -11; t = 5.64; p<0.001; k = 928). This finding is displayed in Figure 1 below.

Patients with OCD may require less fear-conditioned brain responses to achieve the same level of psychophysiological fear conditioning as healthy participants. Interestingly, insula activations during fear-conditioned responses may represent a potential predictor biomarker of response to CBT for OCD.

No significant relationships.

To evaluate social and occupational functioning in patients in partial remission (PR) compared with patients in complete remission (CR) of a major depressive disorder (MDD) episode.

This is a six-month prospective study. PR was defined as a score more than 7 and less or equal to 15 in the Hamilton Depression Rating Scale, and CR as less or equal to 7. All patients had been on acute antidepressant treatment during the previous three months and no longer met criteria for MDD. Functioning was assessed by the Social and Occupational Functioning Assessment Scale (SOFAS).

Mean (S.D.) patient age was 50.5 (14.5) years (N = 292) and 77% were female. At baseline, partial remitters showed greater impairment in social and occupational functioning than complete remitters (62.8 [12.6] versus 80.4 [10.5], respectively; P < .0001). After six months, only 47% PR versus 77% CR reached normal functioning, and SOFAS ratings for PR were below normal range (76.2 [12.3] PR versus 84.6 [9.4] CR; P < .0001). PR reported three times more days absent from work due to sickness than CR (63 days versus 20 days; P < .001).

We conclude that PR of an MDD episode is associated with significant functional impairment that persists even after nine months of antidepressant treatment. Our results underline the importance of treating the patient until achieving full remission.

Counterfactual thoughts (CFT) are mental representations of alternatives to past events, actions or states. For example, “If only I had studied, I would have passed the exam”).

CFT in healthy subjects is associated with learning, behavioral regulation and planning.

Damage to the prefrontal brain regions has been related to decreased generation and use of CFT. Due to the fact that frontal deficits are documented in patients with schizophrenia, it is expected that these patients could also present impairments in CFT.

The aim of our study was to examine the role of the generation of CFT in schizophrenia patients.

Forty subjects who met DSM-IV criteria for schizophrenia and 40 healthy control participants were recruited. The two groups were matched in age, education, and handedness.

To investigate the generation of CTF we used an adaptation of the task made by Wells, Taylor & Turtle (1987). In this task, we presented to the subjects one history with 4 different scenarios. After the presentation of the history, we asked to the subjects that list alternatives to solve the problem presented in the history.

The schizophrenic patients generated less responses of CTF that controls. The patients obtained a mean of responses of 1.48 (1 SD). The mean for the controls was 2.08 (.971 SD). The control subjects generated significantly more counterfactual responses than schizophrenic patients ([t (78) = −2.670, p = .269]).

Our findings indicate that patients with schizophrenia have impoverished the generation of CFT compared to normal control participants.

The objective of this study was to examine the experience and expression of anger in eating disorders (EDs) including bulimia nervosa purging (BN-P) and anorexia nervosa restrictive (AN-R) subtypes, impulsive disorders such as pathological gambling (PG), obsessive-compulsive disorder (OCD) and a non psychiatric healthy control group.

The sample comprised 80 female SODs individuals (20 BN-P, 21 AN-R, 19 PG, 21 TOC) consecutively admitted to our Department and 21 healthy controls. Patients were diagnosed according to DSM-IV-R criteria. We administered the State-Trait Anger Expression Inventory-2 (STAXI-2). in the control group, the GHQ-28 was also employed.

Compared to the healthy control group, elevated Trait Anger scores were revealed for the BN-P (p< .011) and OCD (p< .003) groups. in addition, the OCD group scored higher on this scale than the PG patients (p< .039). as regards to State Anger, higher scores were uncovered for the OCD patients than for the control group (p< .017). Finally, when Anger Expression was assessed, higher scores were found for the OCD (p< .001) and BN (p< .001) individuals when compared to healthy controls. in addition, compared to AN-R, the BN-P and OCD exhibited higher scores on this scale (p< .001 and p< .037, respectively).

Our results indicate that, OCD and BN-P patients may have inadequate anger expressions and deficits in coping with anger and frustration when compared to a healthy control group. Conversely, no significant differences were revealed between AN-R, PG and controls. Finally, some differences across diagnoses were also obtained.

This study attempted to determine whether Anorexia nervosa (AN), Bulimia nervosa (BN) and Obsessive Compulsive Disorder (OCD) share clinical and psychopathological traits.

The sample consisted of 90 female patients (30 OCD; 30 AN; 30 BN), who had been consecutively referred to our Unit. All subjects met DSM-IV criteria for those pathologies. The assessment consisted on the Maudsley Obsessive-Compulsive Inventory, Questionnaire of obsessive traits and personality by Vallejo, Eating Attitudes Test-40, Eating Disorder Inventory, and Beck Depression Inventory. ANCOVA tests (adjusted for age and body mass index) and multiple linear regression models based on obsessive-compulsiveness, obsessive personality traits and perfectionism, as independent variables, were applied to determine the best predictors of eating disorder severity.

ANCOVA revealed several significant differences between obsessive-compulsive and eating disordered patients (MOCI, p < 0.001; EAT, p < 0.001; EDI, p < 0.001), whereas some obsessive personality traits were not eating disorder-specific. 16.7% OCD presented a comorbid eating disorder, whereas 3.3% eating disorders had an OCD diagnosis. In the eating disorder group, the presence of OC symptomatology was positively associated (r = 0.57, p < 0.001) with the severity of the eating disorder. The results were maintained after adjusting for comorbidity.

Although some obsessive-compulsive and eating disorder patients share common traits (e.g. some personality traits especially between OCD and AN), both disorders seem to be clinically and psychopathologically different.

To determine whether increased physiological arousal immediately after trauma or at emergency admission can predict post-traumatic stress disorder (PTSD) in motor vehicle accident (MVA) survivors with physical injuries.

We included 119 MVA survivors with physical injuries. In this prospective cohort study, heart rate (HR) and blood pressure (BP) were assessed during ambulance transport (T1) and at hospital admission (T2). One and four months after the accident, we assessed patients for PTSD (Davidson trauma scale, confirmed with the structured clinical interview for DSM-IV axis I disorders). Multivariate logistic regression models assessed the relationship between HR or BP and PTSD.

PTSD was diagnosed in 54 (45.4%) patients at 1 month and in 39 (32.8%) at 4 months. In the multivariate analysis, HR at T1 or at T2 predicted PTSD at 1 month (OR=1.156, 95% CI [1.094;1.221] p < 0.0001). Only HR at T1 (not at T2) predicted PTSD at 4 months (OR=1.059, 95% CI [1.013; 1.108] p = 0.012). Injury severity predicted PTSD at 4 months (OR=1.207, 95% CI [1.085; 1.342] p = 0.001). A cut-off of 84 beats per minute yielded a sensitivity of 62.5% and a specificity of 75.0% for PTSD.

HR measured at the scene of MVA and severity of injury predicted PTSD 4 months later.

Contemporary cognitive models emphasize the importance of certain dysfunctional beliefs in the development and maintenance of Obsessive-Compulsive Disorder (OCD): overimportance of thoughts, need to control thoughts, perfectionism, intolerance of uncertainty, inflated responsibility, and overestimation of threat. Although a recent twin study suggests that these dysfunctional beliefs are significantly heritable, there have been no previous attempts to analyze candidate genes associated with them.

Our study aimed to investigate the possible association between OC-related dysfunctional beliefs and variants of two functional polymorphisms of the COMT (Val158Met) and BDNF (Val66Met) genes in 141 OCD patients.

The non-synonymous mutation Val158Met (rs4680) in the COMT gene and the Val66Met functional variant (rs6265) in the BDNF gene were genotyped with the KASPar assay system. The validated Spanish short version of the Obsessive Beliefs Questionnaire, (OBQ-44), was used to assess dysfunctional beliefs. Multivariate analysis of covariance (MANCOVA) and a post hoc one-way analysis of covariance (ANCOVA) were perfomed.

Variability in dysfunctional beliefs was not affected by the COMT or BDNF genotype when examining the two genes in isolation, but we detected a significant COMT x BDNF interaction effect on responsibility and overestimation of threat scores. These cognitive distortions were significantly higher among OCD subjects with the BDNF Met-present genotype who were also carriers of the COMT Val/Met and Met/Met genotypes.

Our data suggest that an interaction between dopaminergic and neurotrophic functional gene variants influences some of the dysfunctional belief domains hypothesized to contribute to the etiology of OCD.

Research integrating neuroimaging and molecular genetics has yielded important insights into how variability in brain chemistry predicts brain function and structure, behaviour and risk for psychopathology. Disrupted neurotransmission of glutamate within corticalstriatal-thalamocortical circuitry has been hypothesized to play a role in the pathogenesis of Obsessive-Compulsive Disorder (OCD). Candidate gene studies have identified associations between variants in glutamate system genes and OCD, particularly for SLC1A1, although these results remain controversial after GWAS and meta-analytical approaches.

To examine the effects of multiple polymorphisms of the glutamatergic pathway on frontostriatal connectivity, measured by resting state functional magnetic resonance imaging (fMRI), in OCD.

Individual multilocus genetic profile scores (MGPS) reflecting the additive effects of multiple alleles of the glutamatergic pathway, analysed by the Affymetrix GeneticChip® SNP array, were compiled for 134 OCD patients and 63 healthy controls. Association between these genetic scores and brain functional connectivity patterns between the dorsal and ventral striatal regions and limbic cortical areas including the orbitofrontal cortex and surrounding areas, such as the anterior prefrontal and perigenual anterior cingulate cortex, were investigated.

In the entire group, glutamatergic MGPS were significantly associated with connectivity patterns involving the ventral striatum and orbitofrontal cortex. Distinct relationships between MGPS and functional connectivity between the ventral striatum, amygdala, ventromedial frontal cortex and insula between OCD and healthy subjects emerged.

Glutamatergic genetic risk variants are related to normal frontostriatal connectivity; a fact that might explain the role of glutamatergic pathway disruptions in the susceptibility to develop OCD.

Recent research suggests that the brain-derived neurotrophic factor (BDNF) may play a role in extinction learning. The goal of this study was to test whether variation in the BDNF Val66Met polymorphism is related to treatment response to exposure-based cognitive-behavior therapy (CBT), a form of extinction learning, in obsessive-compulsive disorder (OCD).

One hundred and six OCD patients from a specialized clinic, who underwent a standardized CBT treatment after partial or non-response to a 12-week pharmacological trial, were genotyped for the BDNF Val66Met and the relationship between genotype and treatment response was analyzed.

Among 98 CBT completers, 36% of those carrying the BDNF Met allele were rated as CBT responders compared to 60% of nonMet allele carriers (P = 0.027). When analyzing the different obsessive-compulsive symptom dimensions, in patients with contamination/cleaning symptoms, the Met allele was associated with a significantly worse CBT response (P<0.0001) and a lower obsessions severity decrease from pre- to posttreatment (P = 0.046).

Genetic variation in BDNF may be associated with treatment response in exposure-based CBT in OCD, especially in those patients exhibiting contamination/cleaning symptoms.

Compulsive buying behavior (CBB) is receiving increasing consideration in both consumer and psychiatric-epidemiological research, yet empirical evidence on treatment interventions is scarce and mostly from small homogeneous clinical samples.

To estimate the short-term effectiveness of a standardized, individual cognitive behavioral therapy intervention (CBT) in a sample of n = 97 treatment-seeking patients diagnosed with CBB, and to identify the most relevant predictors of therapy outcome.

The intervention consisted of 12 individual CBT weekly sessions, lasting approximately 45 minutes each. Data on patients’ personality traits, psychopathology, sociodemographic factors, and compulsive buying behavior were used in our analysis.

The risk (cumulative incidence) of poor adherence to the CBT program was 27.8%. The presence of relapses during the CBT program was 47.4% and the dropout rate was 46.4%. Significant predictors of poor therapy adherence were being male, high levels of depression and obsessive-compulsive symptoms, low anxiety levels, high persistence, high harm avoidance and low self-transcendence.

Cognitive behavioral models show promise in treating CBB, however future interventions for CBB should be designed via a multidimensional approach in which patients’ sex, comorbid symptom levels and the personality-trait profiles play a central role.

Psychotic depression has a higher rate of disability and relapse than non psychotic depression, however the optimal maintenance treatment after an acute response to either the antidepressant/antipsychotic combination or an ECT course is unclear (Rothschild, 2013). Although ECT is an effective therapy in affective disorders and M/C ECT is used to achieve and maintain patient's stability (Brown, 2014), very little is known about its implications in functionality or quality of life.

To study the relation between psychotic symptoms and functionality and quality of life in patients with Major Depressive Disorder (MDD) undergoing M/C ECT.

Transversal descriptive study of a sample of 17 MDD patients in M/C ECT. Administration of SF-36 (quality of life related to health), FAQ (functionality), Family APGAR, MMSE, GAF, HDRS. Informed consent. Statistical analysis with SPSS18.

The mean age of the sample was 72.47 years, 58.8% presented with psychotic symptoms and 41.2% with melancholic symptoms. We only found a statistically significant negative correlation between the Family APGAR and the presence of psychotic symptoms (U = –2.291, P = 0.025), without other differences in terms of functionality or quality of life.

This study supports that there is no implication in the presence of psychotic symptoms regarding functionality or quality of life among the patients undergoing M/C ECT. We emphasize the need for randomized control trials to disentangle the effects of multiple variables on the functionality and quality of life of patients in M/C ECT.

The authors have not supplied their declaration of competing interest.

Obsessive-compulsive disorder (OCD) is a highly disabling condition, with frequent early onset. Adult/adolescent OCD has been extensively investigated, but little is known about prevalence and clinical characterization of geriatric patients with OCD (G-OCD = 65 years). The present study aimed to assess prevalence of G-OCD and associated socio-demographic and clinical correlates in a large international sample.

Data from 416 outpatients, participating in the ICOCS network, were assessed and categorized into 2 groups, age < vs = 65 years, and then divided on the basis of the median age of the sample (age < vs = 42 years). Socio-demographic and clinical variables were compared between groups (Pearson Chi-squared and t tests).

G-OCD compared with younger patients represented a significant minority of the sample (6% vs 94%, P < .001), showing a significantly later age at onset (29.4 ± 15.1 vs 18.7 ± 9.2 years, P < .001), a more frequent adult onset (75% vs 41.1%, P < .001) and a less frequent use of cognitive-behavioural therapy (CBT) (20.8% vs 41.8%, P < .05). Female gender was more represented in G-OCD patients, though not at a statistically significant level (75% vs 56.4%, P = .07). When the whole sample was divided on the basis of the median age, previous results were confirmed for older patients, including a significantly higher presence of women (52.1% vs 63.1%, P < .05).

G-OCD compared with younger patients represented a small minority of the sample and showed later age at onset, more frequent adult onset and lower CBT use. Age at onset may influence course and overall management of OCD, with additional investigation needed.

Elevated physical activity has been observed in some patients with anorexia nervosa (AN) despite their emaciated condition. However, its effects on treatment outcome remain unclear. This study aimed to examine objectively measured physical activity in this clinical population and how it might be related to a partial hospitalization therapy response, after considering potential confounders.

The sample comprised 88 AN patients consecutively enrolled in a day hospital treatment program, and 116 healthy-weight controls. All participants were female and a baseline assessment took place using an accelerometer (Actiwatch AW7) to measure physical activity, the Eating Disorders Inventory-2 and the Depression subscale of the Symptom Checklist-Revised. Outcome was evaluated upon the termination of the treatment program by expert clinicians.

Although AN patients and controls did not differ in the average time spent in moderate-to-vigorous physical activity (MVPA) (P = .21), nor daytime physical activity (P = .34), fewer AN patients presented a high physical activity profile compared to the controls (37% vs. 61%, respectively; P = .014). Both lower levels of MVPA and greater eating disorder severity had a direct effect on a poor treatment outcome. Depression symptoms in the patients were associated with lower MVPA, as well as with an older age, a shorter duration of the disorder and greater eating disorder psychopathology.

There is a notable variation in the physical activity profile of AN patients, characterized by either low or very high patterns. Physical activity is a highly relevant issue in AN that must be taken into account during the treatment process.

Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition characterized by a few consistent, temporally stable symptom dimensions. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a recently developed instrument that allows patient and clinician ratings of dimension-specific symptom severity, as well as estimates of global symptom severity in patients with OCD.

We examined the psychometric properties of the DY-BOCS in a sample of 128 European adult patients with OCD.

The results of the psychometric analyses were overall excellent. The internal consistency across the domains of time, distress and interference for each dimension was high. The subscales of the DY-BOCS were largely independent from one another. The convergent and discriminant validity of the DY-BOCS subscales were adequate. The Global Severity and Interference scales were largely intercorrelated, suggesting that they may be redundant. The level of agreement between self-report and expert ratings was adequate although somewhat lower than in the original validation study.

The results of the present study confirm the excellent psychometric properties of the DY-BOCS reported in the original validation study.