Publications by authors named "Eric A Storch"

496 Publications

Building brain capital.

Neuron 2021 May;109(9):1430-1432

Organisation for Economic Co-operation and Development (OECD), Paris, France.

Brains are indispensable drivers of human progress. Why not invest more heavily in them? We seek to place Brain Capital at the center of a new narrative to fuel economic and societal recovery and resilience.
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http://dx.doi.org/10.1016/j.neuron.2021.04.007DOI Listing
May 2021

Addressing the mental health needs of learners and nonlearners in an academic medical center during COVID-19.

Bull Menninger Clin 2021 May 3:1-15. Epub 2021 May 3.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.

The Coronavirus Disease (COVID-19) has impacted life for people throughout the world, especially for those in health care who experience unique stressors. To support the psychological needs of staff, faculty, and learners at a biomedical sciences university, faculty at Baylor College of Medicine created a mental health and wellness support program consisting of multiple behavioral health care pathways, including phone support, a self-guided mental health app, a coping skills group, and individual therapy services. The authors present this program as a model for academic institutions to support the well-being of faculty, staff, and learners.
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http://dx.doi.org/10.1521/bumc_2021_85_02DOI Listing
May 2021

Psychometric Properties of the Persian Version of the Teasing Questionnaire 23.

Front Psychol 2021 15;12:664736. Epub 2021 Apr 15.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States.

The current study was a cross-sectional research and aimed to investigate the factor structure, internal consistency, and validities of the Persian version of the Teasing Questionnaire-Revised (TQ-R). Forward and backward translations of the TQ-R were performed; face and content validities were determined based on comments by a sample of psychology students and specialists. Using the cluster sampling method, 290 participants were recruited, and 201 valid data ( = 23.53, SD = 3.53, 64.2% men) were analyzed. The factor structure was assessed by confirmatory and exploratory factor analysis (EFA). The result of the confirmatory factor analysis(es) did not confirm the proposed three, four, and five-factor models. EFA revealed four factors with 23 items, explaining 52.03% of the total variance. The internal consistency of the Persian version of Teasing Questionnaire 23 was in the excellent range (α = 0.92), and its expected associations with external correlates (e.g., depression and anxiety) supported the measure's convergent validity. The findings indicated that the Persian version of the TQ-R has sound psychometric properties and can be used as a valid and reliable tool in research and clinical outcomes.
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http://dx.doi.org/10.3389/fpsyg.2021.664736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8081849PMC
April 2021

Defining functional brain networks underlying obsessive-compulsive disorder (OCD) using treatment-induced neuroimaging changes: a systematic review of the literature.

J Neurol Neurosurg Psychiatry 2021 Apr 27. Epub 2021 Apr 27.

Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA

Approximately 2%-3% of the population suffers from obsessive-compulsive disorder (OCD). Several brain regions have been implicated in the pathophysiology of OCD, but their various contributions remain unclear. We examined changes in structural and functional neuroimaging before and after a variety of therapeutic interventions as an index into identifying the underlying networks involved. We identified 64 studies from 1990 to 2020 comparing pretreatment and post-treatment imaging of patients with OCD, including metabolic and perfusion, neurochemical, structural, functional and connectivity-based modalities. Treatment class included pharmacotherapy, cognitive-behavioural therapy/exposure and response prevention, stereotactic lesions, deep brain stimulation and transcranial magnetic stimulation. Changes in several brain regions are consistent and correspond with treatment response despite the heterogeneity in treatments and neuroimaging modalities. Most notable are decreases in metabolism and perfusion of the caudate, anterior cingulate cortex, thalamus and regions of prefrontal cortex (PFC) including the orbitofrontal cortex (OFC), dorsolateral PFC (DLPFC), ventromedial PFC (VMPFC) and ventrolateral PFC (VLPFC). Modulating activity within regions of the cortico-striato-thalamo-cortical system may be a common therapeutic mechanism across treatments. We identify future needs and current knowledge gaps that can be mitigated by implementing integrative methods. Future studies should incorporate a systematic, analytical approach to testing objective correlates of treatment response to better understand neurophysiological mechanisms of dysfunction.
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http://dx.doi.org/10.1136/jnnp-2020-324478DOI Listing
April 2021

Behavioral activation and inhibition in compulsive buying and obsessive-compulsive disorder.

Ann Clin Psychiatry 2021 05;33(2):e2-e7

Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, Illinois, USA.

Background: Compulsive buying (CB) is characterized by intrusive thoughts and behaviors related to the purchase of items, whereas obsessive-compulsive disorder (OCD) seems to arise from misattributed anxiety to a neutral stimulus resulting in the avoidance of the feared stimuli. Examining the triggers for the behaviors may provide useful information to possible shared etiology.

Methods: A total of 528 participants (age: mean = 20.97, SD = 5.15 years) were recruited through an online volunteer pool at a large university. Each participant completed demographic and clinical measures as well as the Behavioral Inhibition and Activation Sensitivities (BIS/BAS) self-report questionnaire.

Results: The OCD group (n = 101) endorsed the highest scores on BAS Reward Responsivity, which were statistically comparable to the control (n = 365) and CB groups (n = 27), yet significantly higher than the CB/OCD group (n = 35) (P < .007). The CB group did not differ from any group with regard to the BAS. The OCD group scored significantly higher than controls (P < .001), but did not differ significantly from the CB group (P = .05) on the BIS.

Conclusions: OCD and CB/OCD endorsed the highest sensitivity to threat and motivation to reduce distress. Together, these results convey anxiety and motivation to reduce distress as factors that differentiate groups and likely motivation to engage in compulsive behaviors.
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http://dx.doi.org/10.12788/acp.0030DOI Listing
May 2021

Deep Brain Stimulation for Parkinson's Disease During the COVID-19 Pandemic: Patient Perspective.

Front Hum Neurosci 2021 1;15:628105. Epub 2021 Apr 1.

Department of Neurosurgery, Ruijin Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.

Background: Public health guidelines have recommended that elective medical procedures, including deep brain stimulation (DBS) surgery for Parkinson's disease (PD), should not be scheduled during the coronavirus (COVID-19) pandemic to prevent further virus spread and overload on health care systems. However, delaying DBS surgery for PD may not be in the best interest of individual patients and is not called for in regions where virus spread is under control and inpatient facilities are not overloaded.

Methods: We administered a newly developed phone questionnaire to 20 consecutive patients with PD who received DBS surgery in Ruijin Hospital in Shanghai during the COVID-19 pandemic. The questionnaire was designed to gather the patients' experiences and perceptions on the impact of COVID-19 on their everyday activities and access to medical care.

Results: Most of the patients felt confident about the preventive measures taken by the government and hospitals, and they have changed their daily living activities accordingly. Moreover, a large majority of patients felt confident obtaining access to regular and COVID-19-related health care services if needed. Routine clinical referral, sense of security in the hospital during the outbreak, and poor control of PD symptoms were the three main reasons given by patients for seeking DBS surgery during the COVID-19 pandemic.

Conclusion: The COVID-19 pandemic has considerably impacted medical care and patients' lives but elective procedures, such as DBS surgery for PD, do not need to be rescheduled when the health care system is not overloaded and adequate public health regulations are in place.
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http://dx.doi.org/10.3389/fnhum.2021.628105DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8046912PMC
April 2021

Years of life lost associated with COVID-19 deaths in the USA during the first year of the pandemic.

J Public Health (Oxf) 2021 Apr 12. Epub 2021 Apr 12.

Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA.

Background: Years of Life Lost (YLLs) measure the shortfall in life expectancy due to a medical condition and have been used in multiple contexts. Previously it was estimated that there were 1.2 million YLLs associated with coronavirus disease 2019 (COVID-19) deaths in the USA through 11 July 2020. The aim of this study is to update YLL estimates for the first full year of the pandemic.

Methods: We employed data regarding COVID-19 deaths in the USA through 31 January 2021 by jurisdiction, gender and age group. We used actuarial life expectancy tables by gender and age to estimate YLLs.

Results: We estimated roughly 3.9 million YLLs due to COVID-19 deaths, which correspond to roughly 9.2 YLLs per death. We observed a large range across states in YLLs per 10 000 capita, with New York City at 298 and Vermont at 12. Nationally, the YLLs per 10 000 capita were greater for males than females (136.3 versus 102.3), but there was significant variation in the differences across states.

Conclusions: Our estimates provide further insight into the mortality effects of COVID-19. The observed differences across states and genders demonstrate the need for disaggregated analyses of the pandemic's effects.
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http://dx.doi.org/10.1093/pubmed/fdab123DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8083296PMC
April 2021

Moderators of Response to Personalized and Standard Care Cognitive-Behavioral Therapy for Youth with Autism Spectrum Disorder and Comorbid Anxiety.

J Autism Dev Disord 2021 Apr 7. Epub 2021 Apr 7.

Department of Psychology, Temple University, Philadelphia, PA, USA.

Anxiety/obsessive-compulsive disorders are common among youth with autism spectrum disorder (ASD). Two versions of cognitive behavior therapy (CBT) are effective, with some advantage for a personalized, adapted version. This study evaluated predictors and moderators of standard CBT and adapted CBT. Youth (N = 167) ages 7-13 were randomized to standard or adapted CBT, or treatment-as-usual. Age, IQ, ASD severity, and emotional-behavioral symptom severity were examined. More severe internalizing and emotional-behavioral problems predicted poorer treatment outcomes especially in standard versus personalized CBT. Elevated repetitive behaviors and restricted interests predicted poorer treatment outcomes across treatments, though youth with "moderate" repetitive behaviors and restricted interested experienced poorer outcomes only in standard but not personalized CBT. Externalizing symptoms directly predicted treatment outcomes. Older age predicted improved outcomes in adapted but not standard CBT. Findings highlight the need for further treatment refinements and the value in adapting treatment for youth with more complex presentations. Trial Registration Clinicialtrials.gov: NCT02028247; https://clinicaltrials.gov/ct2/show/NCT02028247 .
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http://dx.doi.org/10.1007/s10803-021-05000-0DOI Listing
April 2021

Response Inhibition, Cognitive Flexibility and Working Memory in Obsessive-Compulsive Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder.

Int J Environ Res Public Health 2021 03 31;18(7). Epub 2021 Mar 31.

Department of Personality, Assessment & Psychological Treatment, University of Murcia, Espinardo, 30100 Murcia, Spain.

This study analyzed response inhibition, cognitive flexibility and working memory in three groups of patients diagnosed with obsessive-compulsive disorder, social anxiety disorder and generalized anxiety disorder, considering some variables that may influence results (nonverbal reasoning, comorbidity, use of pharmacotherapy). Neuropsychological measures were completed using a computerized Wisconsin card sorting test, Stroop color word test, go/no-go task, digits and Corsi. Significant differences were obtained among groups in cognitive flexibility and working memory variables. The obsessive-compulsive disorder (OCD) group showed the worst results. The social anxiety disorder group obtained greater effect sizes in visuospatial memory. However, significant differences between groups in visuospatial memory were no longer present when nonverbal reasoning was controlled. Comorbidity influenced interference in the OCD and generalized anxiety disorder (GAD) groups. In addition, the executive functions were differently influenced by the level of obsessions and anxiety, and the use of pharmacotherapy. Study limitations include a non-random selection of participants, modest sample size and design type (cross-sectional). The OCD group showed the worst results in flexibility cognitive and verbal working memory. Comorbidity, use of pharmacotherapy and level anxiety and obsessions were variables influencing the performance of executive functions.
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http://dx.doi.org/10.3390/ijerph18073642DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8036460PMC
March 2021

Specialty knowledge and competency standards for pharmacotherapy for pediatric obsessive-compulsive disorder.

Psychiatry Res 2021 May 9;299:113858. Epub 2021 Mar 9.

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

Evidence based treatments for pediatric Obsessive-Compulsive Disorder (OCD) are delivered with varying levels of expertise. This paper is part of the phase two series by the International OCD Accreditation Task Force (ATF) to advance a standardized high level of care globally. This paper presents specific knowledge and competencies recommended for specialized practice for pediatric psychopharmacologists working with OCD, developed by an international group of clinicians with extensive expertise in assessment and treatment of OCD. Tabulated knowledge and competency standards are operationalized as clinician abilities with specification of evidence for each standard. The distinction between current practice guidelines and ATF standards is discussed. Drug treatment has a solid evidence base. However, it should not be applied isolated, but informed by broad competence in general child and adolescent psychiatry and pediatrics. Other treatment relevant areas such as specialty CBT, family functioning, developmental issues, and neurobiology require consideration. Drug treatment includes several phases with varying degrees of evidence: Starting up medication, titration to maximum tolerated dose, maintenance, termination, and relapse prevention. In complex cases, pharmacotherapy with weak evidence may be needed to target symptoms and/or co-morbidity. The ATF knowledge and competency standards presented will be reviewed and updated commensurate with research.
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http://dx.doi.org/10.1016/j.psychres.2021.113858DOI Listing
May 2021

Prevalence, severity, and clinical correlates of food neophobia in Salvadorian youth.

Bull Menninger Clin 2021 ;85(1):42-58

McIngvale Presidential Endowed Chair and Professor, Vice Chair and Head of Psychology, Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.

Food neophobia (FN) describes problematic fear-based avoidance/restriction of novel foods. Using the novel parent-reported Measure of Food Neophobia (MFN), the authors examined FN symptoms and impairment in 305 Salvadorian children and explored clinical correlates. Factor analysis supported the MFN's designed structure to inquire about FN symptoms and FN impairment. At least one FN symptom was observed in 91% of the sample; however, only 9% were rated as having moderate or greater impairment. Demographic variables were not associated with FN; however, FN was positively correlated with internalizing, externalizing, inattention, health anxiety, and obsessive-compulsive symptoms. Inattention symptoms and health anxiety emerged as significant predictors of FN symptoms, while FN symptoms were the only significant predictor of FN impairment. The present study supports the MFN and provides information about FN in a general population, including the prevalence of clinically significant symptoms and association with psychological domains. Continued investigation of FN is still needed.
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http://dx.doi.org/10.1521/bumc.2021.85.1.42DOI Listing
January 2021

2021: A year that compels us to change perspective.

Authors:
Eric A Storch

Bull Menninger Clin 2021 ;85(1):1-2

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.

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http://dx.doi.org/10.1521/bumc.2021.85.1.1DOI Listing
January 2021

Executive Functioning and Clinical Variables in Patients with Obsessive-Compulsive Disorder.

Brain Sci 2021 Feb 20;11(2). Epub 2021 Feb 20.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX 77030, USA.

Background: Cognitive flexibility, response inhibition, and working memory are considered the main mechanisms responsible for executive control. This study examined differences in cognitive flexibility, inhibition, and working memory in patients with obsessive-compulsive disorder (OCD) relative to a control group.

Method: A total of 62 obsessive-compulsive participants (OCD = 32; healthy control = 32) aged between 17 and 56 years old (M = 33.16, SD = 9.23) were administered the computerized Wisconsin Card Sorting Test, Stroop Color-Word Test, Go/No-Go Task, Digit Test, and Corsi Block Test. Clinician-rated and self-reported obsessive-compulsive symptom severity, and anxiety, depression, and obsessive beliefs were evaluated.

Results: The control group performed better than the OCD group in tasks involving cognitive flexibility, inhibition, and visuospatial working memory. Anxiety and obsessive beliefs influenced the participants' performance on inhibition and working memory tasks. Similarly, comorbidity also influenced inhibition and working memory. In addition, the use of pharmacotherapy and the degree of OCD symptom severity influenced verbal working memory.

Conclusions: Cognitive flexibility, inhibition, and visuospatial working memory deficits may be endophenotypes of OCD but require further examination for specificity. OCD severity, comorbidity patterns, anxiety, and obsessive beliefs may influence performance.
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http://dx.doi.org/10.3390/brainsci11020267DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7924057PMC
February 2021

Fearful Temperament and Child Social Anxiety Symptoms: Clarifying the Influence of Maternal Punitive Responses.

Res Child Adolesc Psychopathol 2021 Feb 23. Epub 2021 Feb 23.

Department of Psychology, University of Houston, Houston, TX, USA.

Fearful temperament-the tendency to exhibit apprehension and/or avoidance in novel situations-is a well-established risk factor for childhood anxiety in general, and social anxiety in particular. Yet, there is little understanding of parent emotion socialization strategies that influence the association between fearful temperament and child social anxiety symptoms. The present investigation addresses this gap in the literature by examining maternal punitive responses to clinically anxious children's negative emotions as a moderator of the covariance between fearful temperament and social anxiety symptom severity. Clinically anxious children ages 8-12 years (N = 105; 57.1% female; 61.9% racial/ethnic minority) and their mothers completed measures assessing child fearful temperament, maternal punitive emotion socialization responses, and child social anxiety symptoms. Children also participated in an anxiety-provoking speech task during which manifest social anxiety was coded by trained observers. Children's fearful temperament coupled with greater maternal punitive responses to children's negative emotions was associated with lower child-reported social anxiety symptoms. Models predicting manifest social anxiety were not significant. Maternal punitive responses to children's negative emotions may encourage clinically anxious youth to approach feared situations and therefore result in lower anxiety. Yet, the potentially negative effects of punitive responses on other aspects of anxious children's socioemotional development warrant scientific attention. Future research should examine the phenomenology of punitive parental responses among parents of anxious youth to better understand their effects on child behavior.
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http://dx.doi.org/10.1007/s10802-021-00780-6DOI Listing
February 2021

Child and Adolescent Psychiatrists' Perceptions of Utility and Self-rated Knowledge of Genetic Testing Predict Usage for Autism Spectrum Disorder.

J Am Acad Child Adolesc Psychiatry 2021 Feb 18. Epub 2021 Feb 18.

Baylor College of Medicine, Houston, Texas. Electronic address:

Autism spectrum disorder (ASD) is associated with numerous genetic syndromes. Practice guidelines from various medical specialty societies, such as American Academy of Child and Adolescent Psychiatry (AACAP), American College of Medical Genetics, American Neurological Association, and American Academy of Pediatrics, indicate that genetic testing should be part of the evaluation for ASD. Studies have shown, however, that many patients do not receive indicated genetic testing; reported rates of testing vary widely, ranging from 1.5% to 60% of patients receiving genetic testing as part of the evaluation for ASD. Child and adolescent psychiatrists practicing in the United States (approximately 8300) far outnumber developmental behavioral pediatricians (approximately 900) and child neurologists (approximately 900), but in 1 study child and adolescent psychiatrists were the least likely to order genetic testing during the evaluation of patients with ASD diagnoses. Thus, it is critical to understand attitudes of child and adolescent psychiatrists toward genetic testing and other barriers to genetic testing to optimize adherence to practice guidelines for appropriate genetic testing in people with ASD. A survey to capture the current practice, knowledge, and perceptions toward genetic testing was developed by content matter experts that included child and adolescent psychiatrists, psychologists, and genetic counselors as well as lawyers, anthropologists, and bioethicists with expertise in ethical, legal, and social implications of genetics.
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http://dx.doi.org/10.1016/j.jaac.2021.01.022DOI Listing
February 2021

Response to: Optimizing DBS Stimulation Parameters in Obsessive-Compulsive Disorder.

Neuromodulation 2021 Feb;24(2):400

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

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http://dx.doi.org/10.1111/ner.13371DOI Listing
February 2021

Age moderated-anxiety mediation for multimodal treatment outcome among children with obsessive-compulsive disorder: An evaluation with correspondence analysis.

J Affect Disord 2021 03 3;282:766-775. Epub 2021 Jan 3.

Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, U.S.A.

Introduction: Anxiety expression varies by age in youth, and evaluation of putative mechanisms in treatment must consider both conjointly. Accordingly, age would moderate the mediation effect of anxiety in a youth obsessive-compulsive disorder (OCD) treatment trial.

Methods: Fifty-six children ages 7 - 17 participated in an RCT comparing three treatments: CBT with standard dosing of sertraline, CBT with slow dosing of sertraline, and CBT with placebo. To examine the moderated-mediation effects for OCD symptom improvement, we discretized the continuous anxiety and OCD measures into three symptom outcome categories, "improved", "unchanged", and "deteriorated". To evaluate the moderating effect of age, we further examined the association of age and anxiety with the "improved" OCD category. For analysis, the age groups used as rows were cross tabulated with discretized anxiety and OCD measures. To estimate category associations with correlations, we adopted correspondence analysis.

Results: The correlational results indicate that for all treatment conditions, age was a moderator of the mediation effect of physical anxiety symptoms for the improved OCD measures (outcomes). Specifically, age suppressed correlations with OCD outcomes, with Physical Symptoms as a mediator for the outcome measures. This moderated mediation effect was most evident for ages 8-10 in the CBT with placebo group.

Limitations: The moderated mediation effect manifest in this single RCT-based study should be validated in other studies.

Discussion: Future research investigating a wider range of ages as a potential moderator of other symptom and emotion mediators of outcome is warranted, particularly in relation to individual symptom profiles of OCD.
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http://dx.doi.org/10.1016/j.jad.2020.12.198DOI Listing
March 2021

Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature.

J Affect Disord 2021 03 30;282:1288-1307. Epub 2020 Dec 30.

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.

Background: Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning.

Methods: We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response.

Results: A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently.

Limitations: The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature.

Conclusions: Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.
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http://dx.doi.org/10.1016/j.jad.2020.12.182DOI Listing
March 2021

Towards a definitive symptom structure of obsessive-compulsive disorder: a factor and network analysis of 87 distinct symptoms in 1366 individuals.

Psychol Med 2021 Feb 9:1-13. Epub 2021 Feb 9.

Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden.

Background: The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques.

Methods: A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM).

Results: Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables.

Conclusions: Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD.
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http://dx.doi.org/10.1017/S0033291720005437DOI Listing
February 2021

Perceptions of Deep Brain Stimulation for Adolescents with Obsessive-Compulsive Disorder.

J Child Adolesc Psychopharmacol 2021 Mar 2;31(2):109-117. Epub 2021 Feb 2.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

The present study aims to understand perceptions of deep brain stimulation (DBS) for severe obsessive-compulsive disorder (OCD) in adolescents among two groups: parents of children with a history of OCD and adults with a history of OCD. Two hundred sixty participants completed a questionnaire exploring their treatment history, relevant symptom severity, DBS knowledge, and DBS attitudes using an acceptability scale and a series of statements indicating levels of willingness or reluctance to consider DBS for adolescents with severe OCD or severe epilepsy. Overall, participants found DBS to be fairly acceptable for adolescents with severe OCD, with 63% reporting at least 7/10 on a 0-10 acceptability Likert scale. Respondents were more willing to consider DBS for epilepsy than for OCD. Several factors were associated with greater willingness to consider DBS for OCD, including familiarity with DBS, the presence of suicidal thoughts, assurances of daily functioning improvements, and assurances of substantial symptom reduction. Concerns about safety, personality changes, and long-term effects on the body were associated with greatest reluctance to consider DBS for OCD. Our findings support the importance of increasing parents' familiarity with DBS, monitoring factors participants identified as most important to their DBS perceptions in future DBS research, and communicating benefits and risks clearly. We also highlight the need for further research on perceptions of DBS for severe and refractory OCD in adolescents.
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http://dx.doi.org/10.1089/cap.2020.0166DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7984933PMC
March 2021

The Role of Parental Beliefs About Anxiety and Attachment on Parental Accommodation of Child Anxiety.

Res Child Adolesc Psychopathol 2021 Feb 3. Epub 2021 Feb 3.

Child Study Center, Yale School of Medicine, New Haven, CT, USA.

This study examined: 1) the relationship between negative parental beliefs about child anxiety (i.e., it is harmful), insecure parental attachment and parental accommodation of child anxiety; 2) whether parental attachment insecurity moderates the effect of negative beliefs about anxiety on parent accommodation; and 3) a path model of parental factors affecting accommodation and child anxiety severity. Participants were 139 parents of children (6-18 years) with a primary anxiety disorder. Parents completed measures of parental accommodation of their child's anxiety, beliefs about child anxiety, and attachment security. Child anxiety diagnosis and severity was determined using semi-structured clinical interviews. Negative beliefs about child anxiety were directly associated with levels of parental accommodation. There was no direct relationship between insecure attachment and accommodation; however anxious attachment moderated the effect of parental beliefs about anxiety on parental accommodation. Among parents with more secure attachment, negative beliefs about anxiety were associated with greater parental accommodation. However, among parents with less secure attachment, accommodation was high regardless of beliefs about anxiety. A path model suggested that negative beliefs about anxiety was related to increased parental accommodation, which in turn was related to increased child anxiety severity. Psychoeducation about the nature of anxiety is likely to be beneficial in helping to reduce accommodation among parents with more secure attachment styles. However, among those with greater anxious attachment, psychoeducation may need to be tailored to focus on corrective information about the impact of treatment processes on the parent-child relationship.
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http://dx.doi.org/10.1007/s10802-020-00722-8DOI Listing
February 2021

Family accommodation in Chinese individuals with obsessive-compulsive disorder.

Psych J 2021 Apr 1;10(2):295-304. Epub 2021 Feb 1.

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

Family accommodation is a common, treatment-relevant construct related to obsessive-compulsive disorder (OCD) severity and treatment outcome. This initial study examined the nature, incidence, and clinical correlates of family accommodation in Chinese adults with OCD and their relative or person in a close relationship. One hundred four outpatients diagnosed with OCD completed self-report measures of obsessive-compulsive, anxiety, and depression symptoms. Additionally, the individuals with OCD and a relative completed a measure of family accommodation and impairment. Patient-reports of family accommodation were significantly correlated with OCD symptomology and severity. A multiple linear regression indicated that OCD symptomology was a significant predictor of family accommodation, but anxiety, stress, and depression were not. In addition, the current Chinese sample demonstrated greater levels of family accommodation than previous English-speaking samples. Potential explanations and implications of the high levels of reported family accommodation are discussed. Family accommodation could play a significant role in OCD development and/or maintenance in China. Future research considerations are discussed.
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http://dx.doi.org/10.1002/pchj.425DOI Listing
April 2021

Family accommodation in Chinese individuals with obsessive-compulsive disorder.

Psych J 2021 Apr 1;10(2):295-304. Epub 2021 Feb 1.

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas, USA.

Family accommodation is a common, treatment-relevant construct related to obsessive-compulsive disorder (OCD) severity and treatment outcome. This initial study examined the nature, incidence, and clinical correlates of family accommodation in Chinese adults with OCD and their relative or person in a close relationship. One hundred four outpatients diagnosed with OCD completed self-report measures of obsessive-compulsive, anxiety, and depression symptoms. Additionally, the individuals with OCD and a relative completed a measure of family accommodation and impairment. Patient-reports of family accommodation were significantly correlated with OCD symptomology and severity. A multiple linear regression indicated that OCD symptomology was a significant predictor of family accommodation, but anxiety, stress, and depression were not. In addition, the current Chinese sample demonstrated greater levels of family accommodation than previous English-speaking samples. Potential explanations and implications of the high levels of reported family accommodation are discussed. Family accommodation could play a significant role in OCD development and/or maintenance in China. Future research considerations are discussed.
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http://dx.doi.org/10.1002/pchj.425DOI Listing
April 2021

Psychometric Properties of the Obsessive Compulsive Inventory-Child Version in Iranian Clinical and Community Samples.

Child Psychiatry Hum Dev 2021 Jan 6. Epub 2021 Jan 6.

Department of Psychology, Binghamton University, Binghamton, NY, USA.

This study evaluated the psychometric properties of the Persian version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) in clinical and community samples. Factor structure (confirmatory factor analysis), validity (convergent/discriminant, and predictive), and reliability (internal consistency, and 4-week retest) of the Persian version of the OCI-CV were investigated in a sample of 391 children and adolescents 7-17 years comprised of two groups: a clinical sample of youth with OCD (n = 62), and a community sample (n = 329). Participants completed the OCI-CV, Multidimensional Anxiety Scale for Children (MASC), Children's Depression Inventory (CDI), and Child Behavior Checklist (CBCL). Similar to the English version of the OCI-CV, the Persian version of the scale demonstrated a stable six-factor structure, good convergent and discriminant validity through its correlations with other specific measures of pediatric psychopathology, acceptable sensitivity and specificity for the detection of OCD, and good reliability in terms of internal consistency and temporal stability. These findings suggest that the OCI-CV is a valid and reliable measure to assess obsessive-compulsive symptom dimensions in Iranian youth. Findings provide cross cultural support on the utility of OCI-CV as a self-report measure of obsessive-compulsive symptomology.
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http://dx.doi.org/10.1007/s10578-020-01108-zDOI Listing
January 2021

2021: Finding a Silver Lining.

J Cogn Psychother 2021 Jan 4. Epub 2021 Jan 4.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX.

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http://dx.doi.org/10.1891/JCPSY-D-20-00040DOI Listing
January 2021

Mental Health Literacy and Stigma Among Salvadorian Youth: Anxiety, Depression and Obsessive-Compulsive Related Disorders.

Child Psychiatry Hum Dev 2021 Jan 3. Epub 2021 Jan 3.

Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.

This study examined (1) adolescent mental health literacy (MHL) and stigma for depression, anxiety and obsessive-compulsive and related disorders (OCRDs), and (2) demographic moderators. Participants were 383 high school students (50.9% boys) aged 11-18 years (M = 14.12, SD = 1.91) in El Salvador. Participants read vignettes of adolescents with mental health problems and reported on their beliefs about (1) what was wrong with the young person, (2) expected recovery time, (3) help-seeking beliefs and recommendations, and (4) stigma and preferred social distance associated with each condition. Results suggested that recognition of mental health conditions, especially anxiety disorders and OCRDs, was limited, although one third could recognize depression in a peer. Help-seeking attitudes were favorable. Adolescents were only somewhat willing to be affiliated with someone experiencing a mental health problem. Girls showed better MHL and lower stigma than boys. Stigma was lower among those with exposure to mental health problems.
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http://dx.doi.org/10.1007/s10578-020-01096-0DOI Listing
January 2021

Obsessive-compulsive symptoms and problematic alcohol use: The explanatory role of drinking motives.

Addict Behav 2021 04 19;115:106734. Epub 2020 Nov 19.

Department of Psychology, University of Houston, Houston, TX, United States; Department of Behavioral Science, The University of Texas MD Anderson Cancer Center, Houston, TX, United States; HEALTH Institute, University of Houston, Houston, TX, United States.

The purpose of the present investigation was to examine the unique explanatory role of alcohol use motives above the effects of each other, using a multiple mediation model, for the relationship between obsessive-compulsive symptomatology and problematic alcohol use among a young ethno-racially diverse sample of college students with current (past-month) alcohol use. Participants were 454 college students (81.72% female, Mage = 22.46, SD = 4.71). Results indicated that coping motives significantly explained the relationship between obsessive-compulsive symptoms, and alcohol consumption (past year), risky drinking, and recent alcohol use (past month) as behavioral indices of problematic drinking after controlling for the variance accounted for by recent cannabis use, smoking, and anxiety and depressive symptoms (with small to medium effect sizes). These findings are discussed in terms of the development of specialized treatments to specifically target coping oriented alcohol use motives in the context of obsessive-compulsive symptoms among young adults with clinically significant OCD symptoms and comorbid problematic alcohol use.
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http://dx.doi.org/10.1016/j.addbeh.2020.106734DOI Listing
April 2021

Harmonizing the Neurobiology and Treatment of Obsessive-Compulsive Disorder.

Am J Psychiatry 2021 01;178(1):17-29

Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston.

Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
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http://dx.doi.org/10.1176/appi.ajp.2020.20111601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8091795PMC
January 2021

Defining tic severity and tic impairment in Tourette Disorder.

J Psychiatr Res 2021 01 13;133:93-100. Epub 2020 Dec 13.

Marcus Autism Center, Emory University School of Medicine, USA.

Objective: Treatment guidelines for Tourette's Disorder (TD) are based on patients' degree of tic severity and impairment. However, clear benchmarks for determining tic severity and impairment have not been established. This study examined benchmarks of tic severity and tic impairment using the Yale Global Tic Severity Scale (YGTSS) and the Clinical Global Impression of Severity (CGI-S).

Method: Individuals with TD or another Tic Disorder (N = 519) recruited across nine sites were administered a diagnostic interview, the YGTSS, and the CGI-S. Correlations and trend analyses contrasted YGTSS scores across CGI-S ratings. A logistic regression model examined predictive benchmarks for tic severity, tic impairment, and global severity. Model classifications were compared against CGI-S ratings, and agreement was examined using kappa.

Results: Spearman correlations between the CGI-S and YGTSS scores ranged from 0.54 to 0.63 (p < 0.001). Greater CGI-S ratings were associated with a linear stepwise increase in YGTSS Total Tic scores, Impairment scores, and Global Severity scores. Despite moderate-to-strong associations (ρ = 0.45-0.56, p < 0.001) between the CGI-S and predictive logistical regression models, only fair agreement was achieved when applying classification benchmarks (κ = 0.21-0.32, p < 0.001).

Conclusions: CGI-S ratings are useful to characterize benchmarks for tic severity, tic impairment, and global severity on the YGTSS. Logistic regression model benchmarks had only fair agreement with the CGI-S and underscore the heterogeneity of TD symptoms. Collectively, findings offer guidance on the delineation of tic severity categorizations to apply evidence-based treatment recommendations.
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http://dx.doi.org/10.1016/j.jpsychires.2020.12.040DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7867408PMC
January 2021

Impact of the COVID-19 pandemic on exposure and response prevention outcomes in adults and youth with obsessive-compulsive disorder.

Psychiatry Res 2021 01 26;295:113597. Epub 2020 Nov 26.

Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA.

The COVID-19 pandemic has created novel mental health challenges for those with pre-existing problems including obsessive-compulsive disorder (OCD). Our study reports on clinician perceptions regarding the effect of the COVID-19 pandemic on patients with OCD receiving exposure and response prevention treatment (ERP) prior to and during the pandemic. Participating clinicians completed a survey which included questions adapted from National Institute of Mental Health-Global Obsessive-Compulsive Scale (NIMH-GOCS) and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Clinicians rated clinical features at treatment initiation, just prior to the pandemic, and mid-pandemic (July/August, 2020). Findings suggest that the COVID-19 pandemic was associated with attenuation of ERP progress from expected rates in most patients during first several months of the pandemic; clinicians estimated that 38% of their patients had symptoms worsen during the pandemic and 47% estimated that symptoms remained unchanged despite participating in ERP. Those who endured financial distress or were medically at-risk for severe COVID-19 disease had worse ERP course. Adults also had a worse ERP course during than pandemic than youth. Further research is needed to better understand the effect of the COVID-19 pandemic on OCD symptomatology and treatment trajectory post-pandemic.
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http://dx.doi.org/10.1016/j.psychres.2020.113597DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7688422PMC
January 2021