Michal Raszka

Medial frontal and dorsal cortical morphometric abnormalities are related to obsessive-compulsive disorder

Whole-brain voxel-based morphometry (VBM) studies provide support for orbitofrontal, medial frontal as well as for dorsal cortical volumetric alteration in obsessive-compulsive disorder (OCD). However, there is still a need to replicate a priori unpredicted findings and to elucidate white matter volumetric abnormalities and relationships between grey (GM) and white (WM) matter volume and clinical characteristics of OCD. We compared GM and WM volume in a group of 14 patients with OCD and 15 healthy controls using a 3T MRI scanner and an optimized VBM protocol. Regression analysis was used to examine relationships between GM and WM volume and clinical variables. In OCD we have found total WM volume reduction and marked mediofrontal, right temporo-parieto-occipital, right precentral, left middle temporal, left cerebellar and bilateral pons and mesencephalon GM volume reduction in the voxel-based analysis (p<or=0.05, FDR corrected, extent threshold 100 voxels). Regression analysis indicated a positive relationship between left orbitofrontal GM volume and severity of obsessive-compulsive symptoms and a negative relationship between symptom severity and GM volume in supramarginal gyri. Earlier age of OCD onset and longer illness duration were associated with smaller left occipital GM and right parietal WM and with greater left medial frontal GM and left frontal WM (p <or=0.001, uncorrected, extent threshold 50 voxels). Our results confirm volumetric abnormalities in the medial frontal and dorsal cortical areas in OCD. The relationships between OCD and clinical variables provide further evidence that frontal, parietal and occipital structures play a role in the disorder.

EEG source analysis in obsessive–compulsive disorder

OBJECTIVE The goal of this study was to assess the activity of intracortical EEG sources in patients with OCD. METHODS We compared resting state EEG from 50 OCD patients and 50 matched controls using standardized low-resolution electromagnetic tomography (sLORETA) and normative independent component analysis (NICA). Data were analyzed with 1 Hz frequency resolution. Group ICA was used to separate seven independent components from the control group data. The resulting weights and norms served to derive the same components from the OCD group and to compare their power with controls. RESULTS In OCD, sLORETA indicated low-frequency power excess (2-6 Hz) in the medial frontal cortex, whereas group ICA showed increased low-frequency power in a component reflecting the activity of subgenual anterior cingulate, adjacent limbic structures and to a lesser extent also of lateral frontal cortex. CONCLUSIONS Both methods provided evidence for medial frontal hyperactivation in OCD. SIGNIFICANCE Our study is the first to use normative ICA in a clinical sample and indicates its potential utility as a diagnostic tool. The findings provide consistent results based on EEG source localization in OCD and are of practical interest for therapeutic interventions.

Prediction of treatment response and the effect of independent component neurofeedback in obsessive-compulsive disorder: a randomized, sham-controlled, double-blind study.

Aims: The goal of this study was to assess the effect of independent component neurofeedback (NFB) on EEG and clinical symptoms in patients with obsessive-compulsive disorder (OCD). Subsequently, we explored predictors of treatment response and EEG correlates of clinical symptoms. Methods: In a randomized, double-blind, parallel design, 20 inpatients with OCD underwent 25 sessions of NFB or sham feedback (SFB). NFB aimed at reducing EEG activity in an independent component previously reported abnormal in this diagnosis. Resting-state EEG recorded before and after the treatment was analyzed to assess its posttreatment changes, relationships with clinical symptoms and treatment response. Results: Overall, clinical improvement in OCD patients was not accompanied by EEG change as assessed by standardized low-resolution electromagnetic tomography and normative independent component analysis. Pre- to posttreatment comparison of the trained component and frequency did not yield significant results; however, in the NFB group, the nominal values at the downtrained frequency were lower after treatment. The NFB group showed significantly higher percentage reduction of compulsions compared to the SFB group (p = 0.015). Pretreatment higher amount of delta (1-6 Hz) and low alpha oscillations as well as a lower amount of high beta activity predicted a worse treatment outcome. Source localization of these delta and high beta oscillations corresponded with previous EEG resting-state findings in OCD patients compared to healthy controls. Conclusion: Independent component NFB in OCD proved useful in percentage improvement of compulsions. Based on our correlation analyses, we hypothesize that we targeted a network related to treatment resistance.

Standardized low-resolution electromagnetic tomography in obsessive-compulsive disorder--a replication study.

Previous EEG source localization studies in obsessive-compulsive disorder (OCD) reported ambiguous results. The reason probably lies in different OCD samples included in the studies - obsessive-compulsive subjects selected based on a psychopathology questionnaire (the Symptom Checklist - Revised), drug-naïve OCD cases or patients with a long-term disorder. This study was conceived as a replication of our previous research on OCD population coming to treatment in Prague Psychiatric Centre [9]. We included 50 OCD patients (8 drug-free and 42 medicated with SSRIs) and 50 healthy controls. All subjects were different from those enrolled in the previous study. Resting state EEG was analyzed in 8 frequency bands as well as with 1 Hz frequency resolution using the standardized low-resolution electromagnetic tomography (sLORETA). In OCD, sLORETA indicated low-frequency power excess at 2 and 3 Hz in the cingulate gyrus with maximal t-values in Brodmann area 24. The low-frequency activity was unrelated to the severity of clinical symptoms and illness duration but delta power in the right orbitofrontal cortex positively correlated with age of OCD onset. Our results confirm previous finding of the low-frequency excess in the cingulate gyrus in OCD and document the essential role of delta frequencies. Delta activity in the cingulate gyrus is negatively associated with reward-signalling dopamine release in the ventral striatum and increases in states connected with a need for reinforcement. Thus, delta activity could reflect a repetitive need to perform compulsive behaviour in OCD patients.

Contents Vol. 67, 2013

R. Calati, Bologna A. Drago, Naples G. Erdmann, Berlin A. Fischer, Göttingen J.M. Ford, San Francisco, Calif. S. Galderisi, Naples M. Hatzinger, Solothurn K. Hirata, Mibu M. Kato, Osaka J. Kindler, Bern T. Koenig, Bern D. Lehmann, Zürich M. Maes, Geelong, Vic. L. Mandelli, Bologna P. Monteleone, Naples G. Okugawa, Osaka G.N. Papadimitriou, Athens M. Popoli, Milano M. Reuter, Bonn G. Ruigt, Oss J.K. Rybakowski, Poznan F. Rybakowski, Warzaw/Poznan F. Schneider, Aachen R. Schwarting, Marburg D. Souery, Brussels A. Steiger, Munich S. Walther, Bern K. Watanabe, Tokyo P. Willner, Swansea M. Yoshimura, Osaka Associate Editors

P-140 - Level of dissociation predicts the therapeutic response to cognitive behavioral therapy in patients sufering with obsessive compulsive disorder resistant to psychopharmacscs

Background The purpose of the present study is to examine the effectiveness of CBT on a sample of no selected, pharmacologically treatment-resistant OCD patients and to find the predictors of successful treatment in these conditions. The therapy was conducted in a naturalistic setting and systematic CBT steps were adapted to each patient. Pharmacologic treatment underwent no or minimal changes during the trial period. Outcome measures included the Y-BOCS, CGI, BDI, BAI, Somatoform Dissociation Questionaire, and Dissociative Experience Scale. The primary outcome measure for response was a rating of 25% improvement in Y-BOCS. There was border for remission -12 points or less on the same scale, and 1-2 points in CGI-S. Results As far 47 patients completed the trial. All patients finished minimum of 5 weeks of CBT and showed statistically significant improvement on all outcome measures. At the end of therapy 64.1% of patients were improved. 50% of patients reach remission according Y-BOCS and 40.4% according CGI. The main predictors of good therapeutic outcome were lower scores in Y-BOCS, good insight, high resistance against symptoms, low level of dissociation, and aggressive character of obsessions. The negative predictors were control/symmetry obsession and compulsions, and obsessive slowness and ambivalence. Conclusion CBT could be effectively used for medication-resistant OCD patients. There are some factors, like intensity of OCD symptoms, level of insight, resistance against symptoms, and level of dissociation, which could predict outcome of the therapy.

P03-38 Dissociation is related to self-directedness and self-transcedence character traits in obsessive-compulsive disorder

Introduction The purpose of this study was to investigate the temperament and character patterns in patients with obsessive-compulsive disorder (OCD) and to determine whether any presupposed relationship between harm avoidance, self-directedness, self-transcedence scores and dissociation in patients with OCD is present. Methods The study sample comprised of 43 patients with OCD (26 females) and 44 healthy controls (29 females). All subjects were assessed with the Temperament and Character Inventory (TCI), Beck Depression Inventory-II (BDI-II), and Beck Anxiety Inventory (BAI). Dissociation was quantified by the Dissociative Experiences Scale (DES). Obsessive-compulsive symptoms in OCD group were assessed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Correlation, unpaired t-test with Bonferroni correction for seven comparisons, and multiple linear regression analyses were performed. Results OCD patients had significantly higher scores of harm avoidance and self-directedness compared with healthy comparison subjects. Dissociative experiences were more frequent in OCD patients comparing with controls. DES scores had negative correlation with self-directedness and positively correlated with self-transcedence scores, as well as with BDI-II and BAI scores in OCD group. Multiple regression analyses revealed that the severity of depressive symptoms, self-directedness and self-transcedence scores predicted the DES score. There was no significant correlation between severity of OCD symptoms and patterns of temperament and character. Conclusion Dissociation is associated with self-directedness and self-transcedence dimensions of the Temperament and Character Inventory in OCD subjects. It emphasize the importance of considering the influence of dissociation in further studies of personality factors in neuropsychiatric conditions. This research was supported by grant MZ CR IGA 9323-3/2007.

W09-01 Dissociative disorders - clinical manifestation and management

Dissociative disorders are heterogeneous group of mental disorders with dissociation as dominant symptoms. Dissociation is often defined as partial or total disconnection between memories of the past, awareness of identity and of immediate sensations, and control of bodily movements, often resulting from traumatic experiences, intolerable problems, or disturbed relationships. Etiopatogenezis of dissociative disorders have not exactly known yet. The process of dissociation is independently associated with several distressing conditions such as psychiatric diagnoses, somatization, current psychological distress, and past sexual and physical victimization. The disturbance may have a sudden or gradual onset and may be temporary or chronic in its course. Dissociation has a negative impact on treatment oucome. Additionaly, dissociative patients may have an insecure attachment pattern negatively affecting the therapeutic relationship. Conceptually, the course of treatment is to improve coping, maintain reality, and establish normal integrative functions. Goals: 1. improve thought processes; 2. maintain a sense of reality; 3. improve coping skills; 4. develop stress management abilities; 5. increase identity integration. The treatment is possible with psychotherapy or pharmacotherapy or both. We will introduce the CBT approach. Participants will learn: • pharmacological possibilities in the treatment of dissociative disorders; • CBT model of dissociative disorders; • motivational interviewing with dissociative patient; • how to develope therapeutic relationship with dissociative patient; • conceptualization of dissociative disorder with the patient; • Socratic questioning; • working with cognitive, emotional and behavioral avoidance; • exposure technique with dissociative problems; • problem solving. Supported by the research project IGA NR 9323-3.

P-935 - Augmentation of antidepressants with bright light therapyin patients with comorbid depression and borderline personality disorder

Backround. Borderline personality disorder (BPD) is typically characterized by instability and impairmed behaviour, affectivity, interpersonal relations and lifestyle. The most common condition comorbid with BPD is a depressive episode. Depression is associated with severe disturbance of the circadian rhythms. This is apparent in depressive patients with BPD. Both sleep and diurnal rhythms are disturbed and the symptoms fluctuate. Bright light may be an effective in treatment of seasonal affective disorder, circadian sleep disorder and jet lag. It also improves sleep-wake patterns and behavioural disorders in hospitalized patients with Alzheimer’s disease. Several studies have suggested antidepressant effects of phototherapy in non-seasonal depressive episodes. The treatment of comorbid depressive disorder and borderline personality disorder (BPD) is usually reported to be less successful than the treatment of patients without personality disorder. Studies describing the use of bright light in depressed patients with comorbid BPD have not been published so far. Method. The aim of this open study was to assess the effectiveness of a 6-week combined therapy with the application of bright light (10,000 lux, 6:30 to 7:30 a.m. for 6 weeks) added to SSRIs in drug-resistant depressed patients with comorbid BPD who did not respond with improvement to 6-week administration of antidepressants. The study comprised 13 female patients who met the ICD-10 diagnostic criteria for research and the DSM-IV-TR diagnostic criteria for major depression. The participants were regularly evaluated using the CGI, HAMD and MADRS scales and the BDI and BDI self-report inventories. Results. According to all the assessment instruments, the application of bright white light leads to a significant improvement. However, the results must be interpreted with caution due to the open nature of the study.