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ocd seeds

Ocd seeds

The findings, says Nestadt, suggest that doubt has important implications for understanding the nature of OCD. For one thing, the severity of doubt was distributed in the sample such that many cases were rated as severely burdened with doubt, whereas a sizeable proportion were rated as having no or little doubt. “This suggests that doubt may not be a core feature of all OCD cases, but rather a frequently occurring symptom of, or related to, the disorder,” says Nestadt.

The study found that doubt in patients with OCD was strongly related to the number of checking symptoms and, to a lesser extent, to the number of contamination/cleaning and hoarding symptoms patients experienced.

So, what can provide relief for these patients? “Typically, 60 to 70 percent of people respond to cognitive-behavioral therapy,” says Nestadt. “But in patients with severe doubt, only about 35 percent respond. That’s where antidepressants come in.”

The biggest surprise, he adds, was the finding that “the more doubtful you are, the more dysfunctional you are; 80 percent of the doubters were extremely dysfunctional.” Most likely, explains Nestadt, these symptoms emerge “from a neurocognitive vulnerability in the mental life of the individual, which has a basis in neurophysiology.”

It’s not uncommon, says psychiatrist Gerald Nestadt, to hear someone joke over cocktails, “I’m so OCD,” implying that the person is exceedingly fastidious about everything. But obsessive-compulsive disorder, which affects some 3 percent of the world’s population, is no laughing matter.

In a recent study published in Comprehensive Psychiatry, Nestadt and his colleagues report an investigation of 1,182 adults with OCD who were assessed to evaluate the relationship between doubt and OCD’s clinical features. “It’s the first investigation of the clinical significance of the doubt construct in OCD,” says Nestadt.

Now he’s digging deeper to understand another component of the disorder: doubt. “I’ve been fascinated by its clinical relevance,” Nestadt says. “Doubt is not based on insufficient knowledge to make decisions. It’s a behavioral trait.” In the context of OCD, he theorizes, doubt demonstrates a “lack of confidence in one’s own memory, attention and perception necessary to reach a decision.”

Nestadt gives the example of patients who feel compelled to keep checking their front door to ensure that it’s closed. “They check it with their own eyes, but yet still need to go back and jiggle the lock to be sure,” says Nestadt. He suspects a genetic basis for this behavior, though environment also plays a role.

Doubt was assessed with the following questions: After you complete an activity, do you doubt whether you performed it correctly? Do you doubt whether you did it at all? When carrying out routine activities, do you feel you don’t trust your senses—i.e., what you see, hear or touch? Cases were categorized as mild, moderate, severe or extreme on a “doubting” scale.

Ocd seeds

The free app guides patients through exposure and response prevention (ERP) exercises, a type of cognitive behavioral therapy that is especially effective for OCD. ERP carefully exposes suffers to stimuli, including images or situations, that trigger their symptoms and then guides them through exercises to help them manage anxiety and compulsive behaviors. nOCD’s founder and chief executive officer Stephen Smith describes ERP as a “virtual gym.”

After taking a break from college to focus on nOCD, Smith returned to school at Pomona College. Before graduating last year, he commuted between its Claremont, California campus and nOCD’s office in Chicago.

nOCD, an app created to help people treat obsessive-compulsive disorder, will launch an Android version and add more features after raising a $1 million seed round from early-stage healthcare investment firm 7wire Ventures.

Ocd seeds

Imaging data were acquired on a Siemens Skyra 3-T magnetic resonance scanner at the Second Xiangya Hospital of Central South University. All participants were instructed to lie supine with their closed eyes, to remain still, and to think of nothing in particular but to avoid falling asleep. Their heads were fixed snugly with foam pads and straps to minimize head movement. We collected resting-state fMRI series using an echoplanar imaging sequence with the following parameters: 39 axial slices, 3.5-mm slice thickness, no gap, 2500-ms repetition time (TR), 25-ms echo time (TE), 3.8 × 3.8 × 3.5-mm voxel size, 90° flip angle, 240-mm field of view, 64 × 64 data matrix, and 200 volumes. In addition, three-dimensional T1-weighted, magnetization-prepared rapid gradient echo (MPRAGE) sagittal images were acquired with the follow parameters: 176 slices, 1900-ms TR, 2.01-ms TE, 1.00-mm slice thickness, 1.0 × 1.0 × 1.0-mm voxel size, 9° flip angle, 900-ms inversion time, 256-mm field of view, and 256 × 256 matrix.

OCD-GI, OCD with good insight; OCD-PI, OCD with poor insight; HC, healthy control; Y-BOCS, Yale-Brown Obsessive-Compulsive Scale; STAI-T, Spielberger State-Trait Anxiety Inventory-Trait Form; STAI-S, Spielberger State-Trait Anxiety Inventory-State Form; BDI, Beck Depression Inventory; BABS, Brown Assessment of Beliefs Scale.

2.5. Seed selection and functional connectivity analysis

Means with standard deviations in parentheses.

It should be noted that structural abnormality of the right mOFC (Shad et al., 2006) and impaired insula-vmPFC rsFC (Gerretsen et al., 2014) were implicated previously in insight level in schizophrenic patients. Additionally, Ćurčić-Blake et al. (2015) found that altered insula-vmPFC connectivity during a self-reflection task was associated with insight level in schizophrenic patients, though the correlation did not survive FDR correction (p = 0.055). Our findings may be consistent with these results to some extent, at least in terms of supporting the importance of AI-mOFC connectivity in insight capacity. In addition, although the OFC has been recognized as a consistently altered brain region in the pathophysiology of OCD, a meta-analysis demonstrated a high level of heterogeneity for the right OFC in OCD (Rotge et al., 2009). Interestingly, this heterogeneity of the right OFC could be associated with OCD refractoriness (Atmaca et al., 2006). The previously established association of the OCD-PI designation with a less favorable responsivity to behavioral and pharmacological interventions (Erzegovesi et al., 2001, Himle et al., 2006) raises the possibility of an overlap between OCD-PI and so-called refractory OCD. The persistent OFC alteration in refractory patients might be in line with our present finding of specific abnormal right AI-right mOFC connectivity impairment in OCD-PI to some extent.

Table 1

Verification of OCD-GI vs. OCD-PI classification was based on the Brown Assessment of Beliefs Scale (BABS; Eisen et al., 1998). The BABS is a clinician-administrated 7-item scale that was developed to assess insight across a variety of psychiatric disorders. The Chinese version of the BABS has been confirmed to have good reliability and validity (Niu et al., 2016). Specific probes of this scale included conviction, perception of other’s views or beliefs, explanation of differing views, fixity of ideas, attempts to disprove beliefs, insight, and ideas/delusions of reference. In the BABS, each item is rated on a scale ranging from 0 (non-delusional or least pathological) to 4 (delusional or most pathological), and scores for the first six items are summed to create a total score (range: 0 to 24). Previous research has demonstrated the utility of the BABS in classifying individuals into OCD-GI vs. OCD-PI subgroups (Eisen et al., 2001, Kishore et al., 2004, Catapano et al., 2010) wherein poor insight can be indicated by a total BABS score ≥ 12 and a score ≥ 3 for the conviction item (fairly or completely convinced that belief/worry is true). The research psychiatrist, blinded to the patients’ prior classification, rated the BABS for each patient. Notably, our BABS ratings were fully consistent with all 44 of the patients’ prior classifications (kappa = 1.00).