Cognitive Dysfunction in Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.     

Evidence-Based Treatment for Pediatric Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is marked by incessant distressing thoughts or images (obsessions) and/or overt or covert behaviors (or mental rituals) aimed to reduce anxiety (compulsions). The disorder affects 1-2% of children and adults, with up to 80% of adults reporting symptom onset prior to the age of 18 years. Without appropriate intervention, symptoms tend to run a chronic course from childhood into adulthood. Obsessive-compulsive disorder contributes to considerable impairment across multiple domains of functioning, and as a result calls for effective and efficient treatment. To date, both psychological and pharmacological interventions have shown efficacy for pediatric OCD although there are associated advantages and disadvantages that must be considered in treatment planning. The intent of this review is to discuss the current state of literature regarding treatment for pediatric OCD, highlight efficient and cost-effective means of reducing impairment, and conclude with directions for future study.     

A School-Based Treatment Model for Pediatric Obsessive-Compulsive Disorder

School psychologists have expertise in the realm of school-based assessment and intervention for behavioral, educational, and psychological difficulties. Recent evidence indicates that many school psychologists lack evidenced based knowledge about assessment and treatment of pediatric Obsessive-Compulsive Disorder (OCD). Pediatric OCD is a relatively common disorder that contributes to substantial impairment in educational and psychosocial domains. Evidence based treatment of pediatric OCD, particularly cognitive-behavioral therapy, has shown to be efficacious. Therefore, the aims of this paper are to provide a review of empirically established treatments for pediatric OCD, and present a school-based problem-solving model that school psychologists can utilize to conceptualize, assess, and treat OCD.     

Cost-Effectiveness of Treatment Alternatives for Treatment-Refractory Pediatric Obsessive-Compulsive Disorder

PurposeCurrent guidelines for first-line treatment of childhood OCD are cognitive-behavioral therapy (CBT) utilizing exposure and response prevention (ERP), and/or antidepressant (ADM) pharmacotherapy, specifically serotonin reuptake inhibitors (SRI). Given that first-line are relatively similar in terms of clinical effectiveness, the role of costs to provide such services may help influence treatment decisions. In the case of treatment refractory pediatric OCD, this cost-effectiveness analysis (CEA) aims to further evaluate two additional, higher intensity combination therapies, namely OCD-specific Intensive Outpatient (IOP) and Partial Hospitalization Programs (PHP), to determine the additional benefits, in terms of effectiveness, that may result, and the corresponding increase in costs for these higher-intensity courses of therapy.ResultsIOP was the most cost-effective strategy in terms of change in CY-BOCS, pre/post treatment, equal to 16.42 units, followed by PHP and CBT monotherapy augmented with ADM CBT-monotherapy augmented with additional CBT and ADM-only augmented with CBT followed closely with 15.56 and 14.75 unit improvements in CY-BOCS. IOP accomplished its superior cost-effectiveness with an Incremental Cost-Effectiveness Ratio (ICER), of $48,834, lower than either of the established willingness to Pay thresholds.ConclusionsLack of access to high fidelity, high dose CBT paired with pharmacotherapy is an issue for OCD patients and families. Among youth who were treatment non-responsive, these results indicate the superiority of a high dosage CBT strategy, indicating the need to increase access to these treatments.     

Examining the Evidence for Anxiety-Related Cognitive Biases in Obsessive-Compulsive Disorder

In light of current concerns about the diagnostic classification of obsessive-compulsive disorder (OCD), this article critically examines recent experimental research on anxiety-related cognitive biases in OCD in order to determine whether it provides grounds for OCD’s differentiation from other anxiety disorders. This small body of work is found to be fraught with defects, anomalies, and inconsistencies. These findings contrast dramatically with the robust results obtained with other clinical anxiety disorders. When biases are in evidence it tends to be with a select group of subjects, that is, those with contamination concerns. It is suggested that only this subtype of OCD, or some core characteristic underlying it, may be associated with cognitive tendencies comparable to those found in other anxiety disorders (i.e., biases at the attentional level associated with the emotional tone, or content, of information). Cognitive tendencies in other subtypes likely require different explanatory frameworks. This review provides evidence for the partial uniqueness of OCD from other anxiety disorders.     

Beliefs in Obsessive-Compulsive Disorder

Several types of beliefs have been hypothesized to be associated with obsessive-compulsive disorder (OCD), including responsibility for harm, need to control thoughts, overestimates of threat, intolerance of uncertainty, and beliefs about the consequences of anxiety and capacity to cope. The present study compared 62 subjects with OCD, 45 with other anxiety disorders (AD) and 34 controls, using 3 measures of OCD-related beliefs. OCD subjects scored higher than AD and control samples on 2 general belief measures. A closer analysis of specific belief domains indicated that OCD subjects scored higher than AD and control subjects on all 6 specific belief domains (responsibility, control, estimation of threat, tolerance of uncertainty, beliefs about the consequences of anxiety, and the capacity to cope). Four of the 6 domains showed reasonable convergent and discriminant validity with measures of OCD symptoms compared to other psychopathology; anxiety and coping beliefs were the exceptions. In regression analyses, cognitive measures contributed significant explanatory power beyond mood state and worry with uncertainty predicting severity of OCD symptoms above all other belief domains. Further research on OCD-relevant belief domains in etiology, maintenance and treatment is warranted.     

Reconciliation of Two Cognitive Models in Obsessive-Compulsive Disorder: An fMRI Study

Objective Although cognitive models of obsessive-compulsive disorder (OCD) fall into two categories: cognitive deficit models and dysfunctional belief models, these approaches have their own ways and have hardly been reconciled. Therefore, this study aimed to investigate the potential relationships between cognitive deficit (using the Wisconsin Card Sorting Task, WCST) and dysfunctional belief (measured by scales of dysfunctional beliefs) mediated by neural activity in OCD patients. Methods Thirty OCD patients and 30 healthy participants performed the WCST condition and a baseline MATCH condition during the 3T-functional magnetic resonance imaging (fMRI) acquisition. Results Engagement of additional frontoparietal networks with poorer performance of WCST was found during the fMRI scan in OCD patients. Selected regions of interest from activated regions have positive relationships with dysfunctional beliefs and with the unacceptable thoughts symptom dimension in the OCD group. Conclusion Findings suggest that alteration in frontoparietal networks related to cognitive deficits can be associated with dysfunctional beliefs while performing conventional neurocognitive tasks and this association with dysfunctional beliefs may be pronounced in the unacceptable thoughts domain-dominant OCD patients.     

Modular Cognitive Therapy for Obsessive-Compulsive Disorder: A Wait-List Controlled Trial

The current study examined the efficacy of cognitive therapy (CT) in reducing symptoms of obsessive-compulsive disorder (OCD). Twenty-nine individuals with OCD were assigned according to therapist availability to a 12-week wait period or the immediate start of 22 sessions (over 24 weeks) of flexible, modular CT. After 12 weeks of treatment, the CT group, but not the wait-list group, exhibited significant improvement in OCD symptoms. The combined sample of patients who underwent 24 weeks of CT improved significantly from pre- to post-treatment and symptoms remained significantly improved at 3-month follow-up. OCD symptoms rose slightly between posttreatment and 12-month follow-up, but, remained significantly lower than at pretreatment. Overall, modular CT appears to be an effective and acceptable treatment for OCD.