Inferential confusion,cognitive change and treatment outcome in Obsessive–Compulsive Disorder

Inferential confusion has been defined as a confusion between reality and possibility, where the person with Obsessive–Compulsive Disorder (OCD) persists in his/her obsessional belief despite sense information to the contrary. The current study investigates whether inferential confusion is associated with treatment outcome in an OCD sample receiving cognitive–behavioral therapy (CBT). Results indicated that changes in inferential confusion as measured by the Inferential Confusion Questionnaire (ICQ) were significantly associated with treatment outcome. In addition, inferential confusion showed differential validity as a cognitive marker in OCD and was specifically associated with change in obsessive–compulsive symptoms during treatment, rather than confounded with change in negative mood states. Results are discussed in terms of the importance of the concept of inferential confusion for obsessive–compulsive disorder with and without schizotypal characteristics. Copyright © 2005 John Wiley & Sons, Ltd.     

Intrusions related to obsessive‐compulsive disorder: a question of content or context?

The aim of the current study was to investigate whether intrusions of individuals with obsessive‐compulsive disorder (OCD) and nonclinical individuals differed in content and in context of occurrence. The results suggest that although the intrusions of OCD and nonclinical individuals are similar in content, they differ in their context of occurrence. Chi square analyses revealed that the intrusions of nonclinical participants were more likely to be directly linked than indirectly linked to observations in the here and now, whereas the intrusions of participants with OCD were more prone to be indirectly linked than directly linked to triggers in the environment at the time they occurred. The implications of the results for cognitive models of OCD are discussed. © 2009 Wiley Periodicals, Inc. J Clin Psychol 65: 1–14, 2009.     

Is exposure and response prevention treatment for obsessive–compulsive disorder as aversive as we think?

Background: Meta‐analytical studies have confirmed that exposure and response prevention (ERP) is the psychological treatment of choice for obsessive–compulsive disorder (OCD). Anecdotal evidence suggests that patients drop out of ERP because of the aversive nature of the treatment. Methods: In this study, eight individuals diagnosed with OCD described their experience of ERP treatment in one‐to‐one semi‐structured interviews. Qualitative data analysis was used to identify common themes across participants. Results: Common themes were categorised into a) Experience of ERP, b) specific treatment factors, c) non‐specific treatment factors, and d) quality of life impact. Conclusions: Several specific and non‐specific variables emerged as significantly impacting on the experience of completing ERP. A number of important themes emerged that provide special areas for consideration for minimising distress to clients when treating OCD using ERP.     

Inferential confusion,obsessive beliefs and obsessive–compulsive symptoms: a multidimensional investigation of cognitive domains

Generally, research into the relationship between cognitive domains and obsessive–compulsive symptoms involves the use of scales that are highly intercorrelated with each other. The current study investigates the relationship between cognitive constructs and obsessive–compulsive symptoms using the item set of the Obsessive Beliefs Questionnaire and the Inferential Confusion Questionnaire. In order to create constructs that would not be excessively correlated with each other, factor scores were used to investigate the relationship between cognitive domains and obsessive–compulsive symptoms. Factor analysis followed by oblique rotation resulted in four moderately correlated cognitive constructs (importance/control of thoughts, inferential confusion/threat estimation, perfectionism/certainty and responsibility for preventing harm). With the exception of responsibility for preventing harm, the cognitive constructs under investigation were quite strongly related to obsessive–compulsive symptoms. In particular, hierarchical regression revealed the construct inferential confusion/threat estimation to be a global and strong predictor of obsessive–compulsive symptoms, followed by the constructs of perfectionism/certainty and the construct importance/control. Responsibility for preventing harm acted to be a negative predictor of obsessive–compulsive symptoms. It is concluded that the construct of inferential confusion acts as a more powerful predictor of obsessive–compulsive symptoms than any specific obsessive belief Copyright © 2008 John Wiley & Sons, Ltd.     

The role of feared possible selves in obsessive–compulsive and related disorders: A comparative analysis of a core cognitive self‐construct in clinical samples

Increasingly, cognitive‐behavioural models have been considering the role of beliefs about the self in the development and maintenance of obsessive–compulsive disorder (OCD), including sensitive domains of self‐concept and feared self‐perceptions. This has led to the development of the Fear of Self Questionnaire (FSQ; Aardema et al., 2013 ), which has shown strong internal consistency, divergent and convergent validity, and found to be a major predictor of unwanted thoughts and impulses (i.e., repugnant obsessions). The current study aimed to investigate fear of self‐perceptions using the FSQ in an OCD sample (n = 144) and related psychological disorders (eating disorders, n = 57; body dysmorphic disorder, n = 33) in comparison to a non‐clinical (n = 141) and clinical comparison group (anxiety/depressive disorders, n = 27). Following an exploratory factor analysis of the scale in the OCD sample, the results showed that participants with OCD in general did not score significantly higher on fear of self‐perceptions than did the clinical comparison participants. However, consistent with previous findings, fear of self was highly characteristic among OCD patients with unwanted repugnant thoughts and impulses. In addition, fear of self‐perceptions were significantly more elevated in those with eating or body dysmorphic disorders relative to the other non‐clinical and clinical groups. The construct of a “feared possible self” may be particularly relevant in disorders where negative self‐perception is a dominant theme, either involving concerns about one's inner self or concerns related to perceived bodily faults.     

Turkish adaptation of the Short Schema Mode Inventory

The purpose of the current study is to present the psychometric properties of the Short Schema Mode Inventory in the Turkish culture. The study sample comprised 1,287 participants, including both clinical and nonclinical participants. The age of the participants ranged between 18 and 48 years. The construct validity of the scale was tested using confirmatory factor analysis. The internal (Cronbach's alpha) and test–retest reliability coefficients were used to examine the reliability of the scale. Discriminant validity was investigated by comparing the nonclinical and clinical participants. Concurrent validity was tested via the Splitting Scale. The results of the study showed that the tested model had good data‐model fit statistics. Additionally, the reliability analyses revealed that the scales had good internal and test–retest reliability coefficients. A significant association was found between the subscales of the Schema Mode Inventory. Furthermore, the scores of the clinical participants were significantly higher compared with the scores of the nonclinical participants for the maladaptive schema modes. Nonetheless, the participants in the nonclinical group had significantly higher levels of the healthy schema modes than individuals in the clinical group. The results of this study demonstrated that the Schema Mode Inventory was a reliable and valid instrument to measure schema modes in the Turkish population.     

Confirmatory factor analysis and psychometric properties of the Emotion Regulation Questionnaire in participants with personality disorders

Emotional dysregulation is a key symptom in participants with personality disorders. The Emotional Regulation Questionnaire (ERQ) has been studied with nonclinical samples; however, it is necessary to confirm the factorial structure of the ERQ in participants with personality disorders. The aims of the present study were to confirm the factorial structure of the Spanish version of the ERQ and analyse its psychometric properties as well as the association between the ERQ and the Borderline Symptoms List (BSL-23) and the Difficulties in Emotion Regulation Scale (DERS). The overall sample was composed of 250 patients with personality disorders, of whom 195 met the criteria for borderline personality disorder. Confirmatory factor analysis was conducted. The two-factor model showed an acceptable fit, similar to the original structure, in the participants with personality disorders and with borderline personality disorder. Cognitive reappraisal was negatively correlated with the DERS and BSL-23, and expressive suppression was positively correlated with the BSL-23. The ERQ is a reliable and valid instrument to evaluate emotional dysregulation in participants with personality disorders and participants with borderline personality disorder.     

The erring brain: Error‐related negativity as an endophenotype for OCD—A review and meta‐analysis

Obsessive‐compulsive disorder (OCD) is a complex and heterogeneous disorder that is associated with high personal and societal costs. Feelings of doubt, worry, and repetitive behavior, key symptoms of OCD, have been linked to hyperactive error signals in the brain. The error‐related negativity (ERN) represents a validated marker of error processing in the ERP. Increased ERN amplitudes in OCD have been reported very robustly over the last 20 years. This article integrates results from 38 studies analyzing the ERN in OCD, using a quantitative meta‐analysis. Meta‐regressions were used to examine potential moderators such as task type, symptom severity, age, and sample size. The meta‐analysis reveals a robust increase of ERN in OCD patients compared to healthy participants in response‐conflict tasks (SMD ?0.55) that is not modulated by symptom severity and age. No increase in ERN in OCD was observed in tasks that do not induce response conflict (SMD ?0.10). In addition to the meta‐analysis, the current article reviews evidence supporting that increased ERN amplitudes in OCD fulfill central criteria for an endophenotype. Further, the specificity of increased ERN amplitudes for OCD and its suitability as a potential transdiagnostic endophenotype is discussed. Finally, the clinical utility and clinical applications are examined. Overall, the evidence that increased ERN amplitudes represent a promising endophenotype indicating vulnerability for OCD is compelling. Furthermore, alterations in ERN are not limited to OCD and may constitute a transdiagnostic endophenotype. Altered neural error signals might serve as a diagnostic or predictive marker and represent a promising target for interventions.     

Genetic meta‐analysis of obsessive–compulsive disorder and self‐report compulsive symptoms

We investigated whether obsessive–compulsive (OC) symptoms from a population‐based sample could be analyzed to detect genetic variants influencing obsessive–compulsive disorder (OCD). We performed a genome‐wide association studies (GWAS) on the obsession (rumination and impulsions) and compulsion (checking, washing, and ordering/precision) subscales of an abbreviated version of the Padua Inventory (N = 8,267 with genome‐wide genotyping and phenotyping). The compulsion subscale showed a substantial and significant positive genetic correlation with an OCD case–control GWAS (r _G = 0.61, p = .017) previously published by the Psychiatric Genomics Consortium (PGC‐OCD). The obsession subscale and the total Padua score showed no significant genetic correlations (r _G = ?0.02 and r _G = 0.42, respectively). A meta‐analysis of the compulsive symptoms GWAS with the PGC‐OCD revealed no genome‐wide significant Single‐Nucleotide Polymorphisms (SNPs combined N = 17,992, indicating that the power is still low for individual SNP effects). A gene‐based association analysis, however, yielded two novel genes (WDR7 and ADCK1). The top 250 genes in the gene‐based test also showed a significant increase in enrichment for psychiatric and brain‐expressed genes. S‐Predixcan testing showed that for genes expressed in hippocampus, amygdala, and caudate nucleus significance increased in the meta‐analysis with compulsive symptoms compared to the original PGC‐OCD GWAS. Thus, the inclusion of dimensional symptom data in genome‐wide association on clinical case–control GWAS of OCD may be useful to find genes for OCD if the data are based on quantitative indices of compulsive behavior. SNP‐level power increases were limited, but aggregate, gene‐level analyses showed increased enrichment for brain‐expressed genes related to psychiatric disorders, and increased association with gene expression in brain tissues with known emotional, reward processing, memory, and fear‐formation functions.     

Obsessive beliefs and their relation to obsessive–compulsive symptoms

Relationships between obsessive–compulsive symptoms and beliefs identified as relevant to obsessive–compulsive disorder (OCD) are investigated among university students and a small clinical sample. One hundred and fifty‐four participants completed measures of OCD‐related beliefs, OCD symptoms, and anxiety and depression symptoms. Results showed that belief domains were strongly interrelated and were not sufficiently separate to use individually in further analysis. The summed obsessive beliefs score was significantly correlated with all measured obsessional symptom subtypes, after controlling for anxiety and depression. Possible explanations and clinical implications of the results are discussed. Copyright © 2004 John Wiley & Sons, Ltd.     

Additional evidence that genetic variation of MAO‐A gene supports a gender subtype in obsessive‐compulsive disorder

Studies have recently reported a sexually dimorphic association between obsessive‐compulsive disorder (OCD) and a polymorphism related with variations in MAO‐A activity. These observations suggest the possibility of gender differences in genetic susceptibility for OCD. We thus reexamined the MAO‐A/EcoRV polymorphism in a sample of 122 OCD patients and 124 healthy subjects. An excess of allele 1 in OCD females with major depression disorder was confirmed as previously reported. This difference was more strongly associated with OCD females than males in the total sample. Finally, we analyzed a sample of 51 OCD trios. Haplotype‐based haplotype relative risk (HHRR) analysis of the inheritance of the MAO‐A variants revealed in the female probands that 14 out of 19 transmitted the allele 1, providing significant evidence for an allelic association between OCD and MAO‐A gene. In conclusion, our findings may provide molecular evidence to identify a clinically meaningful gender subtype. However, an effort should be made to replicate the analysis in larger samples of informative parents using strategies such as transmission disequilibrium test to allow definite conclusions. © 2001 Wiley‐Liss, Inc.     

Nonclinical populations in research on obsessive-compulsive disorder: A critical review

This article provides a review of the literature on nonclinical obsessive-compulsives (NCOCs). The main areas of focus include: (a) prevalence of obsessive-compulsive symptoms in nonclinical populations, (b) symptom profile, (c) associated psychopathology, (d) personality and psychological characteristics, (e) cognitive dysfunction, and (f) coping styles. For all six areas, findings on NCOCs are compared with research on clinical samples. Results suggest that: (a) lowlevel obsessive compulsive symptoms, as well as OCD, occur frequently in the general population; (b) a comparison of the symptom profile of NCOCs and OCD patients reveals both similarities and differences; (c) levels of associated anxiety, depression, and personality traits are consistent across studies and indicate that the scores of NCOCs fall between those of normal controls and OCD patients; (d) basic research on personality and psychological aspects of NCOCs has identified potential etiological factors in the development of OCD, including inflated responsibility and guilt, obsessive-compulsive personality traits, excessive need for control over the environment, and exaggerated responsiveness to emotional provocation; (e) NCOCs perform significantly worse on measures of executive functioning, memory, and information processing in comparison to control subjects, but unlike their OCD counterparts, their scores lie within the normal range; (f) the most common types of strategies employed by NCOCs and OCD patients in an effort to cope with obsessive-compulsive symptoms are qualitatively similar but less effective for OCD patients. The nature of the relationship between nonclinical obsessive-compulsive symptomatology and OCD is discussed with these findings in mind. In addition, critical commentary regarding methodological issues, as well as unanswered research questions which await empirical research, are addressed.     

Compulsive behaviours and levels of belief in obsessive–compulsive disorder: a case‐series analysis of their interrelationships

This study examined interrelationships of changes in compulsive behaviours and two levels of belief over treatment of obsessive–compulsive disorder (OCD). Levels were individual‐specific obsessive beliefs (termed here manifest beliefs) and OCD‐relevant general beliefs. If OCD‐relevant general beliefs are functionally linked to manifest beliefs and compulsive behaviours, changes in compulsive behaviours and both belief types should occur mostly in tandem, even if only one or two of these three elements are explicitly targeted. Baselines consisting of time performing compulsive behaviours, strength of manifest belief and strength of OCD‐relevant general beliefs were monitored daily by six participants over three phases in an A/B/B + C design. (A = no treatment, B = exposure/response prevention and C = cognitive therapy targeting only OCD‐relevant general beliefs.) Changes in compulsive behaviours, manifest beliefs and OCD‐relevant general beliefs moved primarily in tandem over treatment phases, suggesting functional links between these elements. Copyright © 2006 John Wiley & Sons, Ltd.     

Altered frontal EEG asymmetry in obsessive‐compulsive disorder

Hemispheric topography of alpha band power in the electroencephalogram has been linked to approach/avoidance motivation and may index the risk for anxiety disorders and depression. We quantified lower alpha band power (8–10 Hz) in 20 patients with obsessive‐compulsive disorder (OCD) and 20 matched healthy controls during blocks of rest and presentation of neutral, aversive, and OCD‐related pictures. Compared to the control group, OCD patients showed altered asymmetry, with frontal alpha power in the 8–10 Hz band being more dominant in the left hemisphere across all conditions. This alteration was not observed over parietal areas, and also did not show in the upper alpha, and the theta and beta bands. This change in hemispheric topography of lower alpha band power supports the hypothesis of relatively increased avoidance motivation in OCD. Altered asymmetry appears to be traitlike in OCD, suggesting a link to depressive disorders.     

Community attitudes towards culture‐influenced mental illness: scrupulosity vs. nonreligious OCD among orthodox jews

Culture may particularly influence community attitudes towards mental illness, when the illness itself is shaped by a cultural context. To explore the influence of culture‐specific, religious symptoms on Orthodox Jewish community attitudes, the authors compared the attitudes of 169 Orthodox Jews, who randomly viewed one of two vignettes describing either religious or nonreligious obsessive–compulsive disorder (OCD). Results indicate that though participants were equally likely to perceive both vignettes as mental illness, they were less likely to endorse psychological/medical explanatory models and help‐seeking, and conversely more likely to endorse social–religious explanations, religious help‐seeking, and stigma in relation to religious OCD. Nevertheless, psychological/medical models and help‐seeking were more strongly endorsed for both religious and nonreligious OCD. Beyond implications for Orthodox Jewish community actions, these findings suggest that attitudes towards mental illness may depend on how symptoms relate to community culture. © 2009 Wiley Periodicals, Inc.     

Self‐compassion and emotion regulation difficulties in obsessive–compulsive disorder

Lack of self‐compassion and deficits in emotion regulation are associated with various psychopathological symptoms and may play a role in the development and maintenance of obsessive–compulsive disorder (OCD). However, further empirical research is still needed to better understand these constructs in the context of this disorder. The present study investigated the relation between self‐compassion, emotion regulation difficulties, obsessive beliefs, and obsessive–compulsive symptom severity in 90 patients with OCD using self‐report questionnaires. Symptom severity and obsessive beliefs were negatively correlated to self‐compassion and positively associated with emotion regulation difficulties. Additionally, self‐compassion showed a negative relation to emotion regulation difficulties. Emotion regulation difficulties—but not self‐compassion—predicted symptom severity when controlling for obsessive beliefs and depression in a hierarchical regression analysis. Further analyses showed that emotion regulation deficits mediated the relationship between self‐compassion and OCD symptom severity. Our results provide preliminary evidence that targeting self‐compassion and putting more emphasis on emotion regulation deficits might be promising treatment approaches for patients with OCD. Future studies could investigate which specific interventions that directly address these variables improve treatment outcome.     

Spanish Version of the Children's Somatization Inventory: Factorial Structure and Psychometric Properties in a Community Sample

Background

The Children's Somatization Inventory (CSI) has proved to be a suitable measure to assess somatic symptoms in pediatric patients, but additional research was needed to evaluate its psychometric properties in community populations.

Purpose

The objective of the present study was to examine psychometric properties and factorial structure of the instrument among a nonclinical sample of Spanish children.

Method

The 24-item version of the CSI and two self-report measures of anxiety and depression were administered to 1,111 Spanish children aged 8 to 12.

Results

Exploratory analysis suggested a factorial structure composed of three factors: pseudoneurologic symptoms, gastrointestinal symptoms, and pain. Due to confirmatory analysis indicating a poor fit for the three-factor model, two alternative models were tested. A six-item single factor identified in a previous study with an American community sample showed the best fit (RMSEA?=?0.04; GFI?=?0.99; AGFI?=?0.98; CFI?=?0.98; χ²/gl?=?2.71). The internal consistency for the six-item version was acceptable (ω?=?.71), and the construct validity with anxiety (r?=?.53) and depression (r?=?.38) measures was adequate.

Conclusion

The six-item version of the CSI demonstrated to be a reliable measure for assessing somatization symptoms in Spanish children.     

Enterovirus 71‐induced autophagy detected in vitro and in vivo promotes viral replication

Enterovirus 71 (EV71) is an important pathogen causing death in children under 5 years old worldwide. However, the underlying pathogenesis remains unclear. This study reveals that EV71 infection in rhabdomyosarcoma (RD) and neuroblastoma (SK‐N‐SH) cells stimulated the autophagic process, which was demonstrated by an increase of punctate GFP‐microtubule‐associated protein 1 light chain 3 (GFP‐LC3), the level of autophagosome‐bound LC3‐II protein and double‐membrane autophagosome formation. EV71‐induced autophagy benefited EV71 replication, which was confirmed by the autophagic inducer rapamycin and the inhibitor 3‐methyladenine. Signaling pathway investigation revealed that the decreased expression of phosphorylated mTOR and phosphorylated p70S6K is involved in EV71‐induced autophagy in a cell‐specific manner. The expression of phosphorylated extracellular signal‐regulated kinase (Erk) was suppressed consistently in EV71‐infected cells. However it did not participate in the autophagic response of the cell. Other signaling pathway molecules, such as Erk, PI3K/Akt, Bcl‐2, BNIP3, and Beclin‐1 were not affected by infection with EV71. Electron microscopy showed co‐localization of autophagosome‐like vesicles with either EV71‐VP1 or LC3 protein in neurons of the cervical spinal cord in ICR mice infected with EV71. In conclusion, EV71 infection triggered autophagic flux and induced autophagosome formation both in vitro and in vivo. Autophagy induced by EV71 is beneficial for viral replication. Understanding the role of autophagy induced by EV71 in vitro and the formation of autophagosome‐like vesicle in vivo provide new insights into the pathogenesis of EV71 infection. J. Med. Virol. 81:1241–1252, 2009. © 2009 Wiley‐Liss, Inc.     

Responsibility attitude,obsession and compulsion: further support in a non‐clinical sample

Responsibility is one of the most investigated constructs in obsessive‐compulsive disorder (OCD). Although there are an increasing number of studies on this topic, results seem to be questionable. Whereas several authors reported a significant link between OC behaviour and responsibility in nonclinical as well as in clinical samples, the findings of many authors failed to demonstrate the presence of such an association. In the current study, we examined the relationship between obsessive‐compulsive behaviour and responsibility. To this aim, participants filled in five inventories: the Responsibility Attitude Scale (RAS), the Responsibility Questionnaire (RQ), the Padua Inventory Revised (PI‐R), the State‐Trait Anxiety Inventory (STAI), and the Beck Depression Inventory (BDI). Results showed a relationship between obsessive‐compulsive behaviour (PI‐R scores) and responsibility, as measured by both RAS and RQ. A principal component analysis showed that RAS can be interpreted as a four‐factor scale, accounting for 63% of the variance overall. Regression analyses showed that responsibility can be considered a significant predictor of obsession and compulsion behaviour, as measured by PI‐R. Furthermore, showing a connection between specific factors of responsibility and certain kinds of obsessive‐compulsive behaviour, results seem to confirm the hypothesis that responsibility is more salient in checking than in cleaning symptoms. Copyright © 2001 John Wiley & Sons, Ltd.