Akiko Nakagawa

Differential neural network of checking versus washing symptoms in obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is clinically heterogeneous. The aim of this study was to investigate differential neural responses to a symptom provocation task in drug-free patients who have predominantly aggression/checking symptoms (Checkers) and patients with contamination/washing symptoms (Washers). We compared the Checkers (n=10) and the Washers (n=12) separately to normal controls during the symptom provocation tasks using fMRI (functional magnetic resonance imaging). Moreover, we performed correlative analysis in each OCD group between brain activation and symptom severity. The Checkers showed hypoactivation in the left caudate and left anterior cingulate cortex (ACC) compared to the normal controls and a positive correlation between activated brain areas and symptom severity in the left ACC. The Washers showed hyperactivation in several bilateral cortico-cerebellar regions and a positive correlation between symptom severity and the bilateral fronto-temporal gyrus. We suggest that the caudate and ACC are associated with checking rituals and that large cortical brain regions are related to washing rituals.

A preliminary study of individual cognitive behavior therapy for social anxiety disorder in Japanese clinical settings: a single-arm, uncontrolled trial

BackgroundCognitive behavior therapy (CBT) is regarded as an effective treatment for social anxiety disorder (SAD) in Europe and North America. Individual CBT might be acceptable and effective for patients with SAD even in non-Western cultures; therefore, we conducted a feasibility study of individual CBT for SAD in Japanese clinical settings. We also examined the baseline predictors of outcomes associated with receiving CBT.MethodsThis single-arm trial employed a 14-week individual CBT intervention. The primary outcome was the self-rated Liebowitz Social Anxiety Scale, with secondary measurements of other social anxiety and depressive severity. Assessments were conducted at baseline, after a waiting period before CBT, during CBT, and after CBT.ResultsOf the 19 subjects screened, 15 were eligible for the study and completed the outcome measures at all assessment points. Receiving CBT led to significant improvements in primary and secondary SAD severity (p s < .001). The mean total score on the Liebowitz Social Anxiety Scale improved from 91.8 to 51.7 (before CBT to after CBT), and the within-group effect size at the end-point assessment was large (Cohen’s d = 1.71). After CBT, 73% of participants were judged to be treatment responders, and 40% met the criteria for remission. We found no significant baseline predictors of those outcomes.ConclusionDespite several limitations, our treatment—which comprises a 14-week, individual CBT program—seems feasible and may achieve favorable treatment outcomes for SAD in Japanese clinical settings. Further controlled trials are required in order to address the limitations of this study.Trial registrationUMIN-CTR UMIN000005897

Strategy for treating selective serotonin reuptake inhibitor-resistant social anxiety disorder in the clinical setting: a randomised controlled trial protocol of cognitive behavioural therapy in combination with conventional treatment

Introduction Pharmacotherapy and cognitive behavioural therapy (CBT) are consistently effective as first-line treatments for social anxiety disorders (SADs). Nevertheless, pharmacotherapy is often the first choice in clinical practice. In many countries, the first line of pharmacotherapy involves the administration of a selective serotonin reuptake inhibitor (SSRI). Although a significant proportion of patients with SAD fail to respond to the initial SSRI administration, there is no standard approach to the management of SSRI-resistant SAD. This paper describes the study protocol for a randomised controlled trial to evaluate the clinical effectiveness of CBT as a next-step strategy, concomitant with conventional treatment, for patients with SSRI-resistant SAD. Methods and analysis This Prospective Randomized Open Blinded End-point study is designed with two parallel groups, with dynamic allocation at the individual level. The interventions for the two groups are conventional treatment, alone, and CBT combined with conventional treatment, for 16u2005weeks. The primary end-point of SAD severity will be assessed by an independent assessor using the Liebowitz Social Anxiety Scale, and secondary end-points include severity of other social anxieties, depressive severity and functional impairment. All measures will be assessed at weeks 0 (baseline), 8 (halfway point) and 16 (postintervention) and the outcomes will be analysed based on the intent-to-treat. Statistical analyses are planned for the study design stage so that field materials can be appropriately designed. Ethics and dissemination This study will be conducted at the academic outpatient clinic of Chiba University Hospital. Ethics approval was granted by the Institutional Review Board of Chiba University Hospital. All participants will be required to provide written informed consent. The trial will be implemented and reported in accordance with the recommendations of CONSORT. Clinical Trial Registration Number UMIN000007552.

Transporting Cognitive Behavioral Therapy (CBT) and the Improving Access to Psychological Therapies (IAPT) project to Japan: preliminary observations and service evaluation in Chiba

Purpose – The purpose of this paper is to discuss the implementation and evaluation of a cognitive behavioral therapy (CBT) training course for clinicians in Chiba, the sixth-largest province in Japan. Design/methodology/approach – Individual CBT for obsessive-compulsive disorder, bulimia nervosa, or social anxiety disorder was delivered by trainees of the Chiba CBT training course in a single study design. Findings – The results demonstrated that individual CBT delivered by trainees led to statistically significant reductions in symptom severity for all three disorders. Feedback from the trainees indicated that the training course achieved its aims. Research limitations/implications – Barriers to the dissemination of CBT in Japan such as opportunities for training and possible solutions are discussed. Originality/value – This paper evaluates the Chiba CBT training course, which is a Japanese adaptation of the UK Improving Access to Psychological Therapies Project and the first post-qualification CBT trai...

A feasibility study of the clinical effectiveness and cost-effectiveness of individual cognitive behavioral therapy for panic disorder in a Japanese clinical setting: an uncontrolled pilot study.

AbstractBackgroundIn Japan, cognitive behavioral therapy (CBT) for panic disorder (PD) is not well established. Therefore, a feasibility study of the clinical effectiveness and cost-effectiveness of CBT for PD in a Japanese clinical setting is urgently required. This was a pilot uncontrolled trial and the intervention consisted of a 16-week CBT program. The primary outcome was Panic Disorder Severity Scale (PDSS) scores. Quality of life was assessed using the EuroQol’s EQ-5D questionnaire. Assessments were conducted at baseline, 8xa0weeks, and at the end of the study. Fifteen subjects completed outcome measures at all assessment points.ResultsAt post-CBT, the mean reduction in PDSS scores from baseline was −6.6 (95xa0% CI 3.80 to −9.40, pxa0<xa00.001) with a Cohen’s dxa0=xa01.77 (95xa0% CI 0.88–2.55). Ten (66.7xa0%) participants achieved a 40xa0% or greater reduction in PDSS. By calculating areas under the curve for EQ-5D index changes, we estimated that patients gained a minimum of 0.102 QALYs per 1xa0year due to the CBT.ConclusionsThis study demonstrated that individual CBT for PD may be useful in Japanese clinical settings but further randomized control trials are needed.n Trial registration: UMIN-CTR UMIN000022693 (retrospectively registered)

Correlation between Morphologic Changes and Autism Spectrum Tendency in Obsessive-Compulsive Disorder

OBJECTIVESnObsessive-compulsive disorder (OCD) is one of the most debilitating psychiatric disorders, with some speculating that a reason for difficulty in its treatment might be its coexistence with autism spectrum. We investigated the tendency for autistic spectrum disorders (ASD) in patients with OCD from a neuroimaging point of view using voxel-based morphometry.nnnMETHODSnWe acquired T1-weighted images from 20 patients with OCD and 30 healthy controls and investigated the difference in regional volume between the groups as well as the correlation between Autism-Spectrum Quotient (AQ) scores and regional cerebral volumes of patients with OCD.nnnRESULTSnVolumes in the bilateral middle frontal gyri were significantly decreased in patients with OCD compared to controls. Correlational analysis showed significant positive correlations between AQ scores and regional gray matter (GM) volumes in the left dorsolateral prefrontal cortex (DLPFC) and left amygdala. Furthermore, GM volumes of these regions were positively correlated with each other.nnnCONCLUSIONSnThe positive correlation of ASD traits in patients with OCD with regional GM volumes in the left DLPFC and amygdala could reflect the heterogeneity of patient symptoms. Our results suggest that differences in GM volume might allow classification of patients with OCD for appropriate therapy based on their particular traits.

Cognitive-Behavioral Therapy for Obsessive–Compulsive Disorder with and without Autism Spectrum Disorder: Gray Matter Differences Associated with Poor Outcome

Cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) and is also applicable to patients with both OCD and autism spectrum disorder (ASD). However, previous studies have reported that CBT for patients with both OCD and ASD might be less effective than for patients with OCD alone. In addition, there is no evidence as to why autistic traits might be risk factors. Therefore, we investigated whether comorbidity between ASD and OCD may significantly affect treatment outcome and discovered predictors of CBT outcomes using structural magnetic resonance imaging (MRI) data. A total of 39 patients, who were diagnosed with OCD, were enrolled in this study. Of these, except for 2 dropout cases, 15 patients were diagnosed with ASD, and 22 patients were diagnosed with OCD without ASD. Both groups took CBT for 11–20 sessions. First, to examine the effectiveness of CBT for OCD patients with and without ASD, we compared CBT outcomes between the two groups. Second, to investigate how the structural abnormality profile of the brain at pretreatment influenced CBT outcomes, we performed a structural MRI comparison focusing on the gray matter volume of the whole brain in both patients with only OCD, and those with both OCD and ASD. In order to discover neurostructural predictors of CBT outcomes besides autistic traits, we divided our samples again into two groups of those who did and those who did not remit after CBT, and repeated the analysis taking autistic traits into account. The results showed that OCD patients with ASD responded significantly less well to CBT. The OCD patients with ASD had much less gray matter volume in the left occipital lobe than OCD patients without ASD. The non-remission group had a significantly smaller volume of gray matter in the left dorsolateral prefrontal cortex (DLPFC) compared with the remission group, after having partialed out autistic traits. These results indicate that the abnormalities in DLPFC negatively affect the CBT outcome, regardless of the severity of the autistic traits.

Relationship between symptom dimensions and brain morphology in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is known as a clinically heterogeneous disorder characterized by symptom dimensions. Although substantial numbers of neuroimaging studies have demonstrated the presence of brain abnormalities in OCD, their results are controversial. The clinical heterogeneity of OCD could be one of the reasons for this. It has been hypothesized that certain brain regions contributed to the respective obsessive-compulsive dimensions. In this study, we investigated the relationship between symptom dimensions of OCD and brain morphology using voxel-based morphometry to discover the specific regions showing alterations in the respective dimensions of obsessive-compulsive symptoms. The severities of symptom dimensions in thirty-three patients with OCD were assessed using Obsessive-Compulsive Inventory-Revised (OCI-R). Along with numerous MRI studies pointing out brain abnormalities in autistic spectrum disorder (ASD) patients, a previous study reported a positive correlation between ASD traits and regional gray matter volume in the left dorsolateral prefrontal cortex and amygdala in OCD patients. We investigated the correlation between gray and white matter volumes at the whole brain level and each symptom dimension score, treating all remaining dimension scores, age, gender, and ASD traits as confounding covariates. Our results revealed a significant negative correlation between washing symptom dimension score and gray matter volume in the right thalamus and a significant negative correlation between hoarding symptom dimension score and white matter volume in the left angular gyrus. Although our result was preliminary, our findings indicated that there were specific brain regions in gray and white matter that contributed to symptom dimensions in OCD patients.

White matter features associated with autistic traits in obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) is among the most debilitating psychiatric disorders. Comorbid autism spectrum disorder (ASD) or autistic traits may impair treatment response in OCD. To identify possible neurostructural deficits underlying autistic traits, we performed white matter tractography on diffusion tensor images (DTI) and assessed autistic trait severity using the Autism-Spectrum Quotient (AQ) in 33 OCD patients. Correlations between AQ and the DTI parameters, fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), and radial diffusivity (RD) were examined in major white matter tracts that were suggested to be altered in previous OCD studies. We found a negative correlation between AQ and FA and positive correlations between AQ and MD, AD and RD in the left uncinate fasciculus using age, Beck Depression Inventory, Yale-Brown Obsessive-Compulsive Scale, intelligence quotient and medication as covariates. However, we could not detect the significant results between AQ and all DTI parameters when adding gender as a covariate. In addition, in the ASD comorbid group, FA in the left uncinate fasciculus was significantly lower than in the non-ASD comorbid group and MD and RD were significantly higher than in the non-ASD group. These results did not survive correction for multiple comparisons. In ASD, the socio-emotional dysfunction is suggested to be related to the alteration of white matter microstructure in uncinate fasciculus. Our results suggest that variations in white matter features of the left uncinate fasciculus might be partly explained by autistic traits encountered in OCD patients.

Does cognitive behavioral therapy alter mental defeat and cognitive flexibility in patients with panic disorder

ObjectiveMental defeat and cognitive flexibility have been studied as explanatory factors for depression and posttraumatic stress disorder. This study examined mental defeat and cognitive flexibility scores in patients with panic disorder (PD) before and after cognitive behavioral therapy (CBT), and compared them to those of a gender- and age-matched healthy control group.ResultsPatients with PD (nxa0=xa015) received 16 weekly individual CBT sessions, and the control group (nxa0=xa035) received no treatment. Patients completed the Mental Defeat Scale and the Cognitive Flexibility Scale before the intervention, following eight CBT sessions, and following 16 CBT sessions, while the control group did so only prior to receiving CBT (baseline). The patients’ pre-CBT Mental Defeat and Cognitive Flexibility Scale scores were significantly higher on the Mental Defeat Scale and lower on the Cognitive Flexibility Scale than those of the control group participants were. In addition, the average Mental Defeat Scale scores of the patients decreased significantly, from 22.2 to 12.4, while their average Cognitive Flexibility Scale scores increased significantly, from 42.8 to 49.5. These results suggest that CBT can reduce mental defeat and increase cognitive flexibility in patients with PDTrial registration The study was registered retrospectively in the national UMIN Clinical Trials Registry on June 10, 2016 (registration ID: UMIN000022693).