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DIRT IS NOT DANGEROUS
European Neuropsychopharmacology (2018) 28, 775–782
www.elsevier.com/locate/euroneuro
Abstracts of the ICOCS 13th Scientific Meeting In conjunction with the ECNP OCRN meeting, Wednesday, 6 September 2017, Paris DIRT IS NOT DANGEROUS
Lidewij H. Wolters, Dr.a,b, Elske Salemink, Dr.b,c, Annelieke Hagen, Drs.c, Vivian op de Beek, Drs.a,b, Pascalle Dol, Drs.a,b, Else de Haan (Prof.), Dr.b a Academic Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands b Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands c Addiction, Development and Psychopathology Lab (Adapt Lab), Department of Developmental Psychology, Research Priority Areas ‘Yield’, and ‘Amsterdam Brain and Cognition’, University of Amsterdam, The Netherlands
Dysfunctional beliefs are assumed to play an important role in OCD. A new type of treatment is the Cognitive Bias Modification of Interpretation (CBM-I) training: a computerized paradigm developed to modify dysfunctional interpretations in for example OCD, anxiety, and depression. A meta-analysis focusing on adult samples revealed that CBM-I training was successful in increasing positive interpretations and decreasing negative mood states (Menne-Lothmann et al., 2014). A recent meta-analysis on the effect of CBM in child samples also shows a positive effect on interpretations, but not on mental health outcomes (Cristea, Mogoase, David, & Cuijpers, 2015). However, effects of CBM-I in children are not unequivocal. Due to a lack of studies in this field, and methodological differences and limitations it is too early to draw conclusions about the effect of CBM-I for children and adolescents with emotional disorders. Our pilot study (Salemink, Wolters, & de Haan, 2015) was the first study examining the effect of a CBM-I in children with clinical OCD. The results of this study showed that patients who received eight sessions of CBM-I training reported fewer obsessive compulsive symptoms after training, and clinicians’ ratings showed fewer obsessive symptoms, in contrast to the placebo group. As a next step, we improved the training and conducted a larger randomized
0924-977X
controlled trial to further examine the effectiveness of a CBM-I training in children and adolescents with OCD. Participants were 79 children and adolescents between 8 and 18 years old (M 13.7; SD 3.0) referred for outpatient treatment of OCD. Participants were randomly assigned to 12 sessions of CBM-I in 4 weeks (N = 39) or to a waitlist of 4 weeks (N = 40). In the second part of the study, all participants received manualized cognitive behavioral therapy. Among other measurements, the CY-BOCS, a clinicianrated semi-structured interview, was used to assess severity of OC symptoms. Results showed a significant decrease of OCD severity (CY-BOCS score) in the CBM-I condition, but not in the waitlist condition. These results are promising and possible applications of the CBM-I training in the treatment of pediatric OCD will be discussed. The authors declare that this research is conducted in accordance with the relevant ethical standards. The research is approved by the Medical Ethical Committee of the Academic Medical Centre of Amsterdam. This study was supported by Fonds NutsOhra with a grant.
Disclosure of interest The authors declare that they had no competing interests.
References Cristea, I. A., Mogoase, C., David, D., Cuijpers, P. (2015). Practitioner review: Cognitive bias modification for mental health problems in children and adolescents: a metaanalysis. Journal of Child Psychology and Psychiatry, 56, 723–734. Menne-Lothmann, C., Viechtbauer, W., Höhn, P., Kasanova, Z., Haller, S. P., Drukker, M., et al. (2014). Salemink, E., Wolters, L., de Haan, E. (2015). Augmentation of treatment as usual with online cognitive bias modification of interpretation training in adolescents with obsessive compulsive disorder: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 49, 112–119.
776 How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation. PloS one, 9, e100925. Salemink, E., Wolters, L., de Haan, E. (2015). Augmentation of treatment as usual with online cognitive bias modification of interpretation training in adolescents with obsessive compulsive http://dx.doi.org/10.1016/j.euroneuro.2017.10.020
EFFECTIVENESS OF A CLOZAPINE–ARIPIPRAZOLE COMBINATION IN TOURETTE SYNDROME AND BIPOLAR SPECTRUM DISORDER Armando Piccinni, Federico Mucci, Ilenia Moroni, Donatella Marazziti
Discussion: Clozapine is considered a standard treatment for schizophrenia and bipolar disorder, whereas it has been reported to exacerbate obsessions and tics, although this topic is controversial. The effectiveness of aripiprazole in bipolar disorder is well documented, and preliminary data do exist for its possible use in obsessive-compulsive (OCD) and related disorders. Conclusions: Our case report highlights the possible usefulness of combining clozapine and aripiprazole in TS comorbid with bipolar spectrum disorders, perhaps due to the different and not overlapping pharmacological profile of these two antipsychotics. Aripiprazole has much higher affinity for D2 receptors than clozapine and, since it behaves as a 5-HT2A antagonist and 5-HT2C partial agonist, may have a robust anti-obsessional (and perhaps anti-tic) activity. Further controlled studies are necessary to investigate the benefits of antipsychotic polypharmacy in patients suffering from both bipolar and OCD spectrum disorders. http://dx.doi.org/10.1016/j.euroneuro.2017.10.021
Introduction: Antipsychotic combination is a common strategy used in both bipolar disorder and schizophrenia, although just a few trials are available exploring its effectiveness. We report herein the case of a patient suffering from severe Tourette syndrome (TS) and bipolar spectrum disorder who benefited from a combination of clozapine and aripiprazole. Case report: “Mr. FS,”a 39-year-old art-craft worker, had been suffering from TS since his early childhood. During the adolescence, TS was character-ized by mouth opening and shoulder rotation, complex motor tics, such as trunk-bending or gyrating, screaming, and complex phonic tics. He was treated with pimozide 8 mg/day, which led to a complete remission of tics for about 20 years, although the clinical picture was complicated by the onset of mood shifts associated with impulsive behaviors and obsessions (numerical obsessions, rituals of order and symmetry, disproportionate aggressiveness). In 2007, when he was 35, he visited us for a major depressive episode with suicidal thoughts, panic attacks, and agoraphobic avoidance. Paroxetine (20 mg/ day) led to a fast improvement of mood and anxiety symptoms, albeit being ineffective on tics. Only transient responses were obtained with the association of various drugs (haloperidol, risperidone, olanzapine, amisulpiride) to paroxetine and mood stabilizers (valproic acid, 600 mg/day). After about 2 years of different combinations, a significant improvement was obtained with tetrabenazine 75 mg/day1 clozapine 25mg/day1valproic acid 600 mg/day and fluvoxamine 150 mg/day. This strategy had a good impact only on the affective and obsessive symptoms, while tics remained stable. Therefore, tetra-benazine, fluvoxamine, and valproic acid were tapered down. At the same time, aripiprazole (15 mg/day) was introduced, and, after about 1month, we observed a dramatic improve-ment of TS symptoms. The improvement is still maintained at 2-year follow-up, so that currently the patient, who is regularly taking clozapine 25 mg/day and aripiprazole 15 mg/day with no significant side effects, shows a good affective balance, with no impulsive behavior, obsessions, or tics.
THE ROLE OF GUILT SENSITIVITY IN OCD SYMPTOM DIMENSIONS Gabriele Melli, Federico Mucci, Donatella Marazziti Introduction: Although some studies have found that guilt may precede, motivate, or be a consequence of obsessive– compulsive disorder (OCD), the relationship between guilt and OCD has been under-investigated. Since it has been suggested that OCD patients perceive guilt in a more threatening manner, it might also be relevant to test to what extent they negatively evaluate the experience of guilt (i.e., guilt sensitivity; GS). Methods: Study 1 investigated the psychometric properties of a new 10‐item Italian measure developed to assess GS— named Guilt Sensitivity Questionnaire—in a nonclinical sample (N = 473). Study 2 investigated the role of GS in OCD symptoms, in particular with regard to responsibility for harm obsessions and checking compulsions, using a heterogeneous OCD sample (N = 61) and a control group of patients with anxiety disorders (N = 47). Results: Results from exploratory factor analyses supported the unidimensionality of the scale. It also showed excellent internal consistency and good discriminant validity. GS was the unique significant predictor of checking related OCD symptoms independent of negative mood states and obsessive beliefs. Discussion: Guilt Sensitivity Questionnaire scores of patients with responsibility for harm concerns were significantly higher than those of patients with other kinds of obsessive concerns and with anxiety disorders. Conclusions: Findings supported the hypothesis that GS plays a relevant role inOCD symptoms when checking rituals are primarily involved. Implications for current cognitive behavioral models are discussed. http://dx.doi.org/10.1016/j.euroneuro.2017.10.022
www.elsevier.com/locate/euroneuro
Abstracts of the ICOCS 13th Scientific Meeting In conjunction with the ECNP OCRN meeting, Wednesday, 6 September 2017, Paris DIRT IS NOT DANGEROUS
Lidewij H. Wolters, Dr.a,b, Elske Salemink, Dr.b,c, Annelieke Hagen, Drs.c, Vivian op de Beek, Drs.a,b, Pascalle Dol, Drs.a,b, Else de Haan (Prof.), Dr.b a Academic Medical Center, Department of Child and Adolescent Psychiatry, Amsterdam, The Netherlands b Department of Obsessive Compulsive-, Anxiety- and Tic Disorders, Academic Center for Child and Adolescent Psychiatry, de Bascule, Amsterdam, The Netherlands c Addiction, Development and Psychopathology Lab (Adapt Lab), Department of Developmental Psychology, Research Priority Areas ‘Yield’, and ‘Amsterdam Brain and Cognition’, University of Amsterdam, The Netherlands
Dysfunctional beliefs are assumed to play an important role in OCD. A new type of treatment is the Cognitive Bias Modification of Interpretation (CBM-I) training: a computerized paradigm developed to modify dysfunctional interpretations in for example OCD, anxiety, and depression. A meta-analysis focusing on adult samples revealed that CBM-I training was successful in increasing positive interpretations and decreasing negative mood states (Menne-Lothmann et al., 2014). A recent meta-analysis on the effect of CBM in child samples also shows a positive effect on interpretations, but not on mental health outcomes (Cristea, Mogoase, David, & Cuijpers, 2015). However, effects of CBM-I in children are not unequivocal. Due to a lack of studies in this field, and methodological differences and limitations it is too early to draw conclusions about the effect of CBM-I for children and adolescents with emotional disorders. Our pilot study (Salemink, Wolters, & de Haan, 2015) was the first study examining the effect of a CBM-I in children with clinical OCD. The results of this study showed that patients who received eight sessions of CBM-I training reported fewer obsessive compulsive symptoms after training, and clinicians’ ratings showed fewer obsessive symptoms, in contrast to the placebo group. As a next step, we improved the training and conducted a larger randomized
0924-977X
controlled trial to further examine the effectiveness of a CBM-I training in children and adolescents with OCD. Participants were 79 children and adolescents between 8 and 18 years old (M 13.7; SD 3.0) referred for outpatient treatment of OCD. Participants were randomly assigned to 12 sessions of CBM-I in 4 weeks (N = 39) or to a waitlist of 4 weeks (N = 40). In the second part of the study, all participants received manualized cognitive behavioral therapy. Among other measurements, the CY-BOCS, a clinicianrated semi-structured interview, was used to assess severity of OC symptoms. Results showed a significant decrease of OCD severity (CY-BOCS score) in the CBM-I condition, but not in the waitlist condition. These results are promising and possible applications of the CBM-I training in the treatment of pediatric OCD will be discussed. The authors declare that this research is conducted in accordance with the relevant ethical standards. The research is approved by the Medical Ethical Committee of the Academic Medical Centre of Amsterdam. This study was supported by Fonds NutsOhra with a grant.
Disclosure of interest The authors declare that they had no competing interests.
References Cristea, I. A., Mogoase, C., David, D., Cuijpers, P. (2015). Practitioner review: Cognitive bias modification for mental health problems in children and adolescents: a metaanalysis. Journal of Child Psychology and Psychiatry, 56, 723–734. Menne-Lothmann, C., Viechtbauer, W., Höhn, P., Kasanova, Z., Haller, S. P., Drukker, M., et al. (2014). Salemink, E., Wolters, L., de Haan, E. (2015). Augmentation of treatment as usual with online cognitive bias modification of interpretation training in adolescents with obsessive compulsive disorder: A pilot study. Journal of Behavior Therapy and Experimental Psychiatry, 49, 112–119.
776 How to boost positive interpretations? A meta-analysis of the effectiveness of cognitive bias modification for interpretation. PloS one, 9, e100925. Salemink, E., Wolters, L., de Haan, E. (2015). Augmentation of treatment as usual with online cognitive bias modification of interpretation training in adolescents with obsessive compulsive http://dx.doi.org/10.1016/j.euroneuro.2017.10.020
EFFECTIVENESS OF A CLOZAPINE–ARIPIPRAZOLE COMBINATION IN TOURETTE SYNDROME AND BIPOLAR SPECTRUM DISORDER Armando Piccinni, Federico Mucci, Ilenia Moroni, Donatella Marazziti
Discussion: Clozapine is considered a standard treatment for schizophrenia and bipolar disorder, whereas it has been reported to exacerbate obsessions and tics, although this topic is controversial. The effectiveness of aripiprazole in bipolar disorder is well documented, and preliminary data do exist for its possible use in obsessive-compulsive (OCD) and related disorders. Conclusions: Our case report highlights the possible usefulness of combining clozapine and aripiprazole in TS comorbid with bipolar spectrum disorders, perhaps due to the different and not overlapping pharmacological profile of these two antipsychotics. Aripiprazole has much higher affinity for D2 receptors than clozapine and, since it behaves as a 5-HT2A antagonist and 5-HT2C partial agonist, may have a robust anti-obsessional (and perhaps anti-tic) activity. Further controlled studies are necessary to investigate the benefits of antipsychotic polypharmacy in patients suffering from both bipolar and OCD spectrum disorders. http://dx.doi.org/10.1016/j.euroneuro.2017.10.021
Introduction: Antipsychotic combination is a common strategy used in both bipolar disorder and schizophrenia, although just a few trials are available exploring its effectiveness. We report herein the case of a patient suffering from severe Tourette syndrome (TS) and bipolar spectrum disorder who benefited from a combination of clozapine and aripiprazole. Case report: “Mr. FS,”a 39-year-old art-craft worker, had been suffering from TS since his early childhood. During the adolescence, TS was character-ized by mouth opening and shoulder rotation, complex motor tics, such as trunk-bending or gyrating, screaming, and complex phonic tics. He was treated with pimozide 8 mg/day, which led to a complete remission of tics for about 20 years, although the clinical picture was complicated by the onset of mood shifts associated with impulsive behaviors and obsessions (numerical obsessions, rituals of order and symmetry, disproportionate aggressiveness). In 2007, when he was 35, he visited us for a major depressive episode with suicidal thoughts, panic attacks, and agoraphobic avoidance. Paroxetine (20 mg/ day) led to a fast improvement of mood and anxiety symptoms, albeit being ineffective on tics. Only transient responses were obtained with the association of various drugs (haloperidol, risperidone, olanzapine, amisulpiride) to paroxetine and mood stabilizers (valproic acid, 600 mg/day). After about 2 years of different combinations, a significant improvement was obtained with tetrabenazine 75 mg/day1 clozapine 25mg/day1valproic acid 600 mg/day and fluvoxamine 150 mg/day. This strategy had a good impact only on the affective and obsessive symptoms, while tics remained stable. Therefore, tetra-benazine, fluvoxamine, and valproic acid were tapered down. At the same time, aripiprazole (15 mg/day) was introduced, and, after about 1month, we observed a dramatic improve-ment of TS symptoms. The improvement is still maintained at 2-year follow-up, so that currently the patient, who is regularly taking clozapine 25 mg/day and aripiprazole 15 mg/day with no significant side effects, shows a good affective balance, with no impulsive behavior, obsessions, or tics.
THE ROLE OF GUILT SENSITIVITY IN OCD SYMPTOM DIMENSIONS Gabriele Melli, Federico Mucci, Donatella Marazziti Introduction: Although some studies have found that guilt may precede, motivate, or be a consequence of obsessive– compulsive disorder (OCD), the relationship between guilt and OCD has been under-investigated. Since it has been suggested that OCD patients perceive guilt in a more threatening manner, it might also be relevant to test to what extent they negatively evaluate the experience of guilt (i.e., guilt sensitivity; GS). Methods: Study 1 investigated the psychometric properties of a new 10‐item Italian measure developed to assess GS— named Guilt Sensitivity Questionnaire—in a nonclinical sample (N = 473). Study 2 investigated the role of GS in OCD symptoms, in particular with regard to responsibility for harm obsessions and checking compulsions, using a heterogeneous OCD sample (N = 61) and a control group of patients with anxiety disorders (N = 47). Results: Results from exploratory factor analyses supported the unidimensionality of the scale. It also showed excellent internal consistency and good discriminant validity. GS was the unique significant predictor of checking related OCD symptoms independent of negative mood states and obsessive beliefs. Discussion: Guilt Sensitivity Questionnaire scores of patients with responsibility for harm concerns were significantly higher than those of patients with other kinds of obsessive concerns and with anxiety disorders. Conclusions: Findings supported the hypothesis that GS plays a relevant role inOCD symptoms when checking rituals are primarily involved. Implications for current cognitive behavioral models are discussed. http://dx.doi.org/10.1016/j.euroneuro.2017.10.022