Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰

Brown, Lily A.; Wakschal, Emily S.; Block, Stefanie Russman; Boisseau, Christina L.; Mancebo, Maria C.; Eisen, Jane L.; Rasmussen, Steven A.

doi:10.1016/j.jad.2018.11.006

Cited by 16 publications

(17 citation statements)

References 69 publications

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“…Obsessive-compulsive disorder (OCD) is a chronic illness characterized by compulsive urges resembling avoidance of perceived danger 1 . Behaviorally, OCD is treated with exposure-with-response prevention (ERP) therapy, in which patients are coached to refrain from carrying out compulsions in response to environmental triggers, with the intention of extinguishing those behaviors.…”

Section: Introductionmentioning

confidence: 99%

Prolonged avoidance training exacerbates OCD-like behaviors in a rodent model

et al. 2020

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Obsessive-compulsive disorder (OCD) is characterized by compulsive behaviors that often resemble avoidance of perceived danger. OCD can be treated with exposure-with-response prevention (ERP) therapy in which patients are exposed to triggers but are encouraged to refrain from compulsions, to extinguish compulsive responses. The compulsions of OCD are strengthened by many repeated exposures to triggers, but little is known about the effects of extended repetition of avoidance behaviors on extinction. Here we assessed the extent to which overtraining of active avoidance affects subsequent extinction-with-response prevention (Ext-RP) as a rodent model of ERP, in which rats are extinguished to triggers, while the avoidance option is prevented. Male rats conditioned for 8d or 20d produced similar avoidance behavior to a tone paired with a shock, however, the 20d group showed a severe impairment of extinction during Ext-RP, as well as heightened anxiety. Furthermore, the majority of overtrained (20d) rats (75%) exhibited persistent avoidance following Ext-RP. In the 8d group, only a minority of rats (37%) exhibited persistent avoidance, and this was associated with elevated activity (c-Fos) in the prelimbic cortex and nucleus accumbens. In the 20d group, the minority of non-persistent rats (25%) showed elevated activity in the insular-orbital cortex and paraventricular thalamus. Lastly, extending the duration of Ext-RP prevented the deleterious effects of overtraining on extinction and avoidance. These rodent findings suggest that repeated expression of compulsion-like behaviors biases individuals toward persistent avoidance and alters avoidance circuits, thereby reducing the effectiveness of current extinction-based therapies.

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Section: Introductionmentioning

confidence: 99%

Prolonged avoidance training exacerbates OCD-like behaviors in a rodent model

et al. 2020

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“…Kamath et al 9 have found higher YBOCS obsession subscale scores in patients with OCD who had suicidal ideation and previous suicide attempts. Brown et al 3 have determined a one-way relationship between OCD symptoms and suicidal ideation in a 6-year follow-up study. According to Brown et al, 3 as the severity of OCD symptoms increased, the severity of suicidal ideation increased, but suicidal ideation did not affect OCD symptoms over the years.…”

Section: Discussionmentioning

confidence: 99%

“…Brown et al 3 have determined a one-way relationship between OCD symptoms and suicidal ideation in a 6-year follow-up study. According to Brown et al, 3 as the severity of OCD symptoms increased, the severity of suicidal ideation increased, but suicidal ideation did not affect OCD symptoms over the years. We found higher scores in avoidance, indecisiveness, global severity, and total obsession subdimensions of YBOCS, and also higher BSIS, PS, and total YBOCS scores in OCD patients with a history of previous suicide attempts.…”

Section: Discussionmentioning

confidence: 99%

“…Although Brown et al 3 reported the similarity of obsession-related stress to psychological pain recently, to the best of our knowledge, there is no study about psychache in patients with OCD. Determining risk factors for suicide in patients with OCD will provide an opportunity for early intervention and help to prevent possible deaths.…”

Section: Introductionmentioning

confidence: 98%

“…2 The negative consequences of OCD, such as decreased quality of life, and frequent psychiatric comorbidities, have often been focused on, but the relationship between OCD and suicide has not been adequately addressed. 3 Suicide is a major public health problem in all communities, characterized by processes that can range from thinking of death, desire to die, or not to find life worth living to the planning, undertaking and completing the attempt. 4 Psychiatric disorders are important risk factors for suicide.…”

Section: Introductionmentioning

confidence: 99%

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<p>Psychache and Suicidal History in Patients with Obsessive-Compulsive Disorder</p>

Demirkol

Namlı

Davul³

et al. 2019

NDT

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Purpose: Suicide is an important cause of death in patients diagnosed with obsessivecompulsive disorder (OCD) as well as other psychiatric disorders. Early determining of risk factors provides an opportunity for intervention. The mediating effect of psychological pain (also known as psychache) on suicide has been shown in various disorders but has not been investigated in patients with OCD. In this study, we aimed to show the relationship between psychological pain and other clinical variables and suicide in OCD patients. Patients and methods: This cross-sectional study consisted of 67 patients diagnosed with OCD according to DSM-5 criteria with no comorbid psychiatric diagnosis who applied to the psychiatric outpatient clinic of Çukurova University Faculty of Medicine and 63 healthy controls. Among the OCD patients, 12 had previous suicide attempts. In addition to the sociodemographic data form, participants filled out the Yale-Brown Obsessive Compulsive Scale (YBOCS), the Psychache Scale (PS), the Beck Scale for Suicidal Ideation (BSIS), and the Hamilton Depression Scale (HDS). Results: OCD group's median obsession, compulsion, and the total scores of YBOCS, and the mean PS scores were higher than the control group. There was no difference between the sociodemographic variables of OCD patients with and without previous suicide attempts such as age, gender, years of education, place of residence, marital, and occupational status. The median scores of obsession, avoidance, global severity, and indecisiveness subdimensions of YBOCS, the mean BSIS and PS scores, the rates of current aggressive, current contamination, and the past religious obsessions were higher in the suicidal group. There were moderately significant relationships in the same direction between the PS, BSIS, and total YBOCS scores. Multivariate regression analysis demonstrated that only the PS scores predicted previous suicide attempts. Conclusion: Our results demonstrated that current aggressive, current contamination, past religious obsessions, and the higher psychological pain are related to previous suicide attempts in OCD patients. Our regression analysis supports Shneidman's hypothesis: there would be no suicide without psychache. Relieving psychache in OCD patients may reduce suicide attempts even if there is no diagnosis of comorbid depression.

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The associations of obsessive–compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive–compulsive disorder: The role of specific stress responses to COVID‐19

Khosravani

Ardestani

Bastan

et al. 2021

Clin Psychology and Psychoth

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Suicidal ideation is prevalent in patients with obsessive-compulsive disorder (OCD); but, during COVID-19, it may be increased. The present study aimed to examine the effects of obsessive-compulsive (OC) symptom dimensions and OCD severity on suicidal ideation by considering the role of stress responses in reaction to COVID-19 in a clinical sample of patients with OCD. In a cross-sectional study, 304 patients with OCD completed measures of OC symptom dimensions, OCD severity, general mental health (depression and anxiety), and COVID-19-related stress. Results showed that after controlling for depression, anxiety, comorbidity, and lifetime suicide attempts, the OC symptom dimensions of responsibility for harm and unacceptable obsessional thoughts as well as general severity had indirect effects on suicidal ideation through the specific stress responses to COVID-19, including traumatic stress and compulsive checking. The study shows that OCD patients with specific OC symptom dimensions and severe OCD are more likely to have suicidal ideation during the pandemic. Further, the specific stress responses to COVID-19 may be an underlying mechanism.Clinicians should carefully assess suicidal ideation in patients with OCD who experience responsibility for harm and unacceptable thoughts, particularly during the pandemic.

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Directionality of change in obsessive compulsive disorder (OCD) and suicidal ideation over six years in a naturalistic clinical sample✰

Cited by 16 publications

References 69 publications

Prolonged avoidance training exacerbates OCD-like behaviors in a rodent model

Prolonged avoidance training exacerbates OCD-like behaviors in a rodent model

<p>Psychache and Suicidal History in Patients with Obsessive-Compulsive Disorder</p>

The associations of obsessive–compulsive symptom dimensions and general severity with suicidal ideation in patients with obsessive–compulsive disorder: The role of specific stress responses to COVID‐19

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