András Harsányi

Long-term follow-up of patients with obsessive-compulsive disorder treated by anterior capsulotomy: A neuropsychological study

BACKGROUND For treatment-refractory Obsessive-Compulsive-Disorder (OCD) patients, anterior capsulotomy is a potential therapy. We investigated what kinds of cognitive deficits treatment-refractory patients have and how anterior capsulotomy modifies their clinical and cognitive profiles. METHODS Ten treatment-refractory OCD patients were examined in two groups (operated and non-operated) with 5 participants in each group, matched for symptom severity, gender, age and education. The operated group was treated with anterior capsulotomy; the non-operated group was treated only with pharmaco- and psychotherapy. The Yale-Brown Obsessive-Compulsive Rating Scale (Y-BOCS) was used to measure OCD symptoms, and ten neuropsychological tests were used to measure cognitive functioning. RESULTS In the operated group, the score of Y-BOCS score significantly decreased during the two-year follow-up period. Additionally, we found a significant increase in neuropsychological test scores on the Wechsler Intelligence Test (MAWI), California Sorting Test Part A (CST-A), Stroop Test Interference Score (STR-I), Verbal Fluency Test and Iowa Gambling Test. As a negative result, we observed intrusion errors in the Category Fluency Test. In the non-operated group significant improvement was found in Y-BOCS scores. At follow-up, we found significant differences between the operated and non-operated groups on three neuropsychological tests: Trail Making Test Part B, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Attention Index and RBANS Language Index, with better performance in the non-operated group. CONCLUSIONS Both treatment methods (i.e. anterior capsulotomy and pharmaco- and psychotherapy) seem effective in reducing OCD symptoms and cognitive deficits, but, importantly, to different degrees. The clinical and neuropsychological improvements were more impressive in the operated group.

Obsessed not to forget: Lack of retrieval-induced suppression effect in obsessive-compulsive disorder

The aim of the present study was to investigate the role of executive functions in resolving memory interference in a clinical sample of patients with obsessive-compulsive disorder (OCD). Retrieval of memories has been shown to involve some form of executive act that diminishes the accessibility of rival memory traces, leading to retrieval-induced forgetting (RIF). These executive control processes might suppress unwanted thoughts and irrelevant memories during competitive retrieval. We assessed RIF with the retrieval practice paradigm among 25 OCD patients and 25 healthy controls matched for age and education. Retrieval of target memories led to enhancement of target memory recall in both groups, but suppression of related memories (RIF) occurred only among controls. Our results suggest that suppression of irrelevant, interfering memories during competitive recall is impaired in OCD.

THE EFFECT OF EMOTIONAL CUES ON EVENT-BASED PROSPECTIVE MEMORY PERFORMANCE IN OBSESSIVE COMPULSIVE DISORDER

Introduction Prospective memory (PM) is defined as the ability to formulate, retain and carry out intentions, plans and promises at the appropriate time or in the appropriate context. Previous studies found evidence that patients with obsessive compulsive disorder (OCD) beside the executive deficit manifest impairment in various PM tasks (Harris et al., 2010; Racsmany et al., 2011; Yang et al., 2015). Our aim with this study was to investigate the influence of emotional stimuli on event-based PM performance in OCD. Material And Methods Thirteen OCD patients took part in the study. An emotional event-based PM task was administered to each participant under two conditions: (1) a baseline condition in which no PM stimuli occurred and the ongoing trials were presented in three blocks based on the stimulus valence as positive, negative and neutral and a (2) PM condition in which beside the ongoing trials positive, negative and neutral PM stimuli also occurred. There were two arrows, pointing right and left, and one of them was black, the other was white. The order of colours varied randomly. Two pictures also appeared on the screen and were located at equal distances above and below the arrows. Participants in the baseline condition were asked to press the arrow key corresponding to the black arrow (ongoing task). In the PM condition the task was similar, except participants were told to press the up-arrow key if the two pictures above and below the fixation point were the same on any trial, this instruction served as a PM task. Results And Conclusions Based on our preliminary results and analysis it seems that the stimulus valence does not influence significantly the accuracy rate and reaction time scores on PM trials. The emotional cues have no beneficial effect on patients PM performance as suggested in previous findings. Further analysis and the recruitment of a healthy control group are under way.

Visuo-spatial memory impairment in obsessive compulsive disorder (OCD): from neuropsychological findings to eye-tracking

abstract There is a growing amount of evidence about the deficit of executive system in OCD, which is strongly related to the fronto-basal loop dysfunctions of the disorder (e.g. Chamberlain et al., 2005; Olley et al., 2007). In addition to the executive deficit, several studies found impaired visual and spatial memory performance in this disorder. In an early neuropsychological model, Savage (1998) suggested that the fronto-striatal dysfunctions along with impaired executive functioning leads to observed memory difficulties (encoding and retrieval of nonverbal information). Following this suggestion, here we aimed at investigating visuo-spatial memory functions in a pool of OCD patients in two studies. We combined neuropsychological tasks and computer based working memory paradigms with eye-tracking methodology. In Study 1 the Rey Complex Figure Task (RCFT) was used and it was found that OCD patients performed significantly poorer in the copy and recall phase of the task in comparison with matched healthy control group. Symptom severity and the level of anxiety were assessed by the Yale Brown Obsessive Compulsive Scale (Y-BOCS) and the State-Trait Anxiety Inventory (STAI), respectively. There was a significant negative correlation between symptom severity (Y-BOCS total scores) and the recall scores of the RCFT. In Study 2 we developed a computer-based Visual Pattern Task to investigate the eye movement correlates of cognitive processes involved in visuo-spatial working memory function. In addition subjects were also screened by a neuropsychological test battery including tasks on shifting (Wisconsin Card Sorting Test), response inhibition (Stop Signal Task, Stroop Task) and working memory capacity functions (n-back Task). According to our preliminary eye-tracking results, in comparison with healthy control subjects, OCD patients produced a significant decrease in target-related dwell time scores during the delay phase of the task. We will discuss the possible relationships between eye movement patterns, cognitive deficits and symptom severity.

The probability of association between response inhibition and compulsive symptoms of obsessive-compulsive disorder: response to Abramovitch and Abramowitz.

Abramovitch and Abramowitz (2014) listed several problems with the conclusions they interpret as having been drawn from cross-sectional (correlational) data in our recent article (Harsányi et al., 2014). First of all, causal inferences such as response inhibition deficits underlying compulsive rituals cannot logically be concluded from correlational data. However, this conclusion was never drawn in our article. Contrary to what Abramovitch and Abramowitz state in their Letter to the Editors, we did not conclude that response inhibition leads to obsessive-compulsive disorder (OCD); rather, we reported that inhibition deficit can be observed in OCD. We, of course, share the opinion of Abramovitch and Abramowitz that extensive deficits of executive functions, including response inhibition, are identifiable in several other psychiatric illnesses (e.g., in schizophrenia, bipolar affective disorder, attention deficit/hyperactivity disorder, anxiety disorders, and depression). We described correlations in our article based on the results of our research. However, we would like to emphasize the fact that in the case of the 51 OCD patients, we not only used questionnaires measuring executive functions (DEX, WBSI), but we also used a well-validated neurocognitive test battery to assess these functions. Abramovitch and Abramowitz question whether the Dysexecutive Questionnaire (DEX) adequately measures executive deficits. They base their skepticism on a study by Chaytor et al. (2006) in which the correlation of the DEX with executive tests was not particularly high. In reference, we would like to highlight that the study by Chaytor et al. (2006) is grounded on the data of a group of merely 46 patients, with a variety of neurological disorders, where correlation was carried out with a few tests measuring executive performance and experimental methods (Wisconsin Card Sorting Test (WCST), Trail Making Test, Stroop Color and Word Test, Controlled Oral Word Association Test (COWAT)), and between the DEX and other questionnaires. This study found a moderate correlation between the DEX and the Stroop task (r1⁄40.35) and weak or no correlation between the DEX and the Trail Making Test-Part B, COWAT and WCST (r1⁄40.25, r1⁄40.28, r1⁄40.03, respectively). In our opinion, the biggest problemwith this study is that it did not find a substantially stronger correlation between the other executive tests either. For example, the WCST shows an r1⁄40.34 correlation with the Trail Making Test-Part B, and an r1⁄40.33 and r1⁄40.00 correlation with the Stroop interference scores. Does this mean that the WCTS is also an inadequate tool for measuring executive deficit? Wilson et al. (1996) and Burgess et al. (1998), in contrast with Chaytor et al. (2006), when standardizing the DEX, examined 92 patients with brain injuries (closed head injuries, encephalitis, dementia, stroke) and compared data from the DEX with one of the most comprehensive neuropsychological test batteries (Behavioral Assessment of the Dysexecutive Syndrome (BADS)), consisting of six sub-tests. Research data showed a strong correlation between the BADS total score and DEX other ratings (r1⁄4 0.62). The above-cited studies indicate that we can, indeed, regard the DEX score of significant other ratings as a reliable research tool. Since the manual of the DEX/BADS presents inclusive statistics of dysexecutive symptoms of frontal lobe brain injury patients, the sentence in our publication, namely that ‘Based on the normative scales of the DEX questionnaire the presence and severity of executive problems of our 51 OCD patients were between 31 and 53 percentile, which shows a severe executive impairment comparing to the normal control of the manual of the DEX,’ needs to be more accurate. In the DEX/BADS manual, the percentage values are not representative of normal persons but of brain injury patients. Therefore, the fact that the executive function disorders in our examined OCD patients fell between 25 and 50 percent provides an even stronger basis for the presence of ‘severe executive impairment’, as it stands on a comparable level with the ‘severe’ extent of injury level reflecting executive deficit in brain injury patients. However, we did make an ambiguous statement in our article, but owing to the standardization logic of the DEX, the 25– 50 percent value in our examined OCD group (based on the data of a group of patients with brain injuries showing severe executive deficit) qualifies in the severely impaired range. Nonetheless, we can also assert, based on clinical data of our examined sample of patients, that DEX values correlated well with inhibition markers in the conducted executive tests measuring attentional focus and switching skills. To summarize, in our opinion, it is far from clear that the DEX is an unreliable neuropsychological tool, based both on literature and our own data. The neuropsychological tasks used to examine executive functions in our research confirm that scores of the DEX other ratings are capable of describing executive deficit and provide an ecologically valid measurement. Regarding OCD and impulsivity, on the one hand, we are of a similar opinion as Abramovitch and Abramowitz in that compulsions are ‘carefully planned and executed, and are usually carefully timed in response to obsessions.’ At the same time, we disagree with their assertion based on clinical observations that ‘...in clinical work with patients, it is easy to observe that individuals