Publications by authors named "Noam Soreni"

41 Publications

Exposure to stressful and traumatic life events in hoarding: Comparison to clinical controls.

J Clin Psychol 2021 Oct 8;77(10):2216-2227. Epub 2021 May 8.

Anxiety Treatment and Research Clinic, St. Joseph's Healthcare, Hamilton, Ontario, Canada.

Background: Individuals with hoarding report stressful and traumatic life events at an elevated rate compared with those with obsessive-compulsive disorder and healthy controls, but have not been compared with other clinical groups. This study compared rates of traumatic life events between those with clinically significant hoarding, anxiety disorders, or posttraumatic stress disorder (PTSD), hypothesizing that rates would be higher in the hoarding and PTSD groups than the anxiety group.

Methods: Rates of traumatic and stressful events were compared across groups.

Results: All comparisons across groups on types of events were significant (partial-eta squared 0.051-0.162). The hoarding group endorsed significantly more crime-related events but similar rates of other events as compared to the PTSD and anxiety disorder groups.

Conclusion: These findings suggest that many stressful and traumatic life events are not uniquely elevated in hoarding when compared with other clinical populations.
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http://dx.doi.org/10.1002/jclp.23153DOI Listing
October 2021

LIVES for families psychological first aid training programme to address COVID-19 psychological distress: a mixed methods acceptability and feasibility protocol.

BMJ Open 2021 05 5;11(5):e049995. Epub 2021 May 5.

Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada.

Introduction: Best practice approaches for addressing COVID-19-related psychological distress among young people (<25 years) and their families remain unclear. Psychological first aid (PFA) is promoted by public health authorities to provide psychological support in the context of extreme events; however, there is limited evidence for its effectiveness. As a prerequisite to conducting a randomised controlled trial to examine programme effectiveness, this project is evaluating the acceptability and feasibility of implementing and evaluating a PFA training programme ('LIVES for Families') for mental health (MH) practitioners to improve their ability to recognise and respond to COVID-19-related psychological distress among their clients.

Methods And Analysis: We are using a triangulation mixed methods research design; complementary strands of quantitative and qualitative data are being collected in parallel and will be merged at the interpretation phase of the project. The quantitative strand uses a repeated measures design; a consecutive sample of MH practitioners (n=80) providing MH support to young people or their families are being recruited to participate in the LIVES for Families PFA training programme and complete quantitative measures at baseline (pretraining), 2-week and 6-month follow-up time points. The qualitative strand uses fundamental description and semistructured interviews with a subset of practitioners (n=30), as well as managers of MH agencies (n=20). A mixed methods joint display and associated narrative will generate a comprehensive understanding regarding acceptability and feasibility.

Ethics And Dissemination: The Hamilton Integrated Research Ethics Board approved the study (project number: 11295). Results will be shared broadly with the policy and practice community through publications, presentations and public webinars. As a brief, evidence-informed intervention, the LIVES for Families PFA training programme is suitable in its mode of delivery across care settings. The outcomes of this study could have international implications for mitigating the MH impacts of viral pandemics.
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http://dx.doi.org/10.1136/bmjopen-2021-049995DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102861PMC
May 2021

White matter microstructure and its relation to clinical features of obsessive-compulsive disorder: findings from the ENIGMA OCD Working Group.

Transl Psychiatry 2021 03 17;11(1):173. Epub 2021 Mar 17.

Department of Psychiatry, Oxford University, Oxford, UK.

Microstructural alterations in cortico-subcortical connections are thought to be present in obsessive-compulsive disorder (OCD). However, prior studies have yielded inconsistent findings, perhaps because small sample sizes provided insufficient power to detect subtle abnormalities. Here we investigated microstructural white matter alterations and their relation to clinical features in the largest dataset of adult and pediatric OCD to date. We analyzed diffusion tensor imaging metrics from 700 adult patients and 645 adult controls, as well as 174 pediatric patients and 144 pediatric controls across 19 sites participating in the ENIGMA OCD Working Group, in a cross-sectional case-control magnetic resonance study. We extracted measures of fractional anisotropy (FA) as main outcome, and mean diffusivity, radial diffusivity, and axial diffusivity as secondary outcomes for 25 white matter regions. We meta-analyzed patient-control group differences (Cohen's d) across sites, after adjusting for age and sex, and investigated associations with clinical characteristics. Adult OCD patients showed significant FA reduction in the sagittal stratum (d = -0.21, z = -3.21, p = 0.001) and posterior thalamic radiation (d = -0.26, z = -4.57, p < 0.0001). In the sagittal stratum, lower FA was associated with a younger age of onset (z = 2.71, p = 0.006), longer duration of illness (z = -2.086, p = 0.036), and a higher percentage of medicated patients in the cohorts studied (z = -1.98, p = 0.047). No significant association with symptom severity was found. Pediatric OCD patients did not show any detectable microstructural abnormalities compared to controls. Our findings of microstructural alterations in projection and association fibers to posterior brain regions in OCD are consistent with models emphasizing deficits in connectivity as an important feature of this disorder.
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http://dx.doi.org/10.1038/s41398-021-01276-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7969744PMC
March 2021

Genome-wide association study of pediatric obsessive-compulsive traits: shared genetic risk between traits and disorder.

Transl Psychiatry 2021 02 2;11(1):91. Epub 2021 Feb 2.

Genetics and Genome Biology Hospital for Sick Children, Toronto, Canada.

Using a novel trait-based measure, we examined genetic variants associated with obsessive-compulsive (OC) traits and tested whether OC traits and obsessive-compulsive disorder (OCD) shared genetic risk. We conducted a genome-wide association analysis (GWAS) of OC traits using the Toronto Obsessive-Compulsive Scale (TOCS) in 5018 unrelated Caucasian children and adolescents from the community (Spit for Science sample). We tested the hypothesis that genetic variants associated with OC traits from the community would be associated with clinical OCD using a meta-analysis of all currently available OCD cases. Shared genetic risk was examined between OC traits and OCD in the respective samples using polygenic risk score and genetic correlation analyses. A locus tagged by rs7856850 in an intron of PTPRD (protein tyrosine phosphatase δ) was significantly associated with OC traits at the genome-wide significance level (p = 2.48 × 10). rs7856850 was also associated with OCD in a meta-analysis of OCD case/control genome-wide datasets (p = 0.0069). The direction of effect was the same as in the community sample. Polygenic risk scores from OC traits were significantly associated with OCD in case/control datasets and vice versa (p's < 0.01). OC traits were highly, but not significantly, genetically correlated with OCD (r = 0.71, p = 0.062). We report the first validated genome-wide significant variant for OC traits in PTPRD, downstream of the most significant locus in a previous OCD GWAS. OC traits measured in the community sample shared genetic risk with OCD case/control status. Our results demonstrate the feasibility and power of using trait-based approaches in community samples for genetic discovery.
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http://dx.doi.org/10.1038/s41398-020-01121-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7870035PMC
February 2021

Structural neuroimaging biomarkers for obsessive-compulsive disorder in the ENIGMA-OCD consortium: medication matters.

Transl Psychiatry 2020 10 8;10(1):342. Epub 2020 Oct 8.

Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06510, USA.

No diagnostic biomarkers are available for obsessive-compulsive disorder (OCD). Here, we aimed to identify magnetic resonance imaging (MRI) biomarkers for OCD, using 46 data sets with 2304 OCD patients and 2068 healthy controls from the ENIGMA consortium. We performed machine learning analysis of regional measures of cortical thickness, surface area and subcortical volume and tested classification performance using cross-validation. Classification performance for OCD vs. controls using the complete sample with different classifiers and cross-validation strategies was poor. When models were validated on data from other sites, model performance did not exceed chance-level. In contrast, fair classification performance was achieved when patients were grouped according to their medication status. These results indicate that medication use is associated with substantial differences in brain anatomy that are widely distributed, and indicate that clinical heterogeneity contributes to the poor performance of structural MRI as a disease marker.
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http://dx.doi.org/10.1038/s41398-020-01013-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7598942PMC
October 2020

Virtual Histology of Cortical Thickness and Shared Neurobiology in 6 Psychiatric Disorders.

JAMA Psychiatry 2021 Jan;78(1):47-63

Department of Psychiatry and Neuropsychology, School of Mental Health and Neuroscience, Maastricht University, the Netherlands.

Importance: Large-scale neuroimaging studies have revealed group differences in cortical thickness across many psychiatric disorders. The underlying neurobiology behind these differences is not well understood.

Objective: To determine neurobiologic correlates of group differences in cortical thickness between cases and controls in 6 disorders: attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), bipolar disorder (BD), major depressive disorder (MDD), obsessive-compulsive disorder (OCD), and schizophrenia.

Design, Setting, And Participants: Profiles of group differences in cortical thickness between cases and controls were generated using T1-weighted magnetic resonance images. Similarity between interregional profiles of cell-specific gene expression and those in the group differences in cortical thickness were investigated in each disorder. Next, principal component analysis was used to reveal a shared profile of group difference in thickness across the disorders. Analysis for gene coexpression, clustering, and enrichment for genes associated with these disorders were conducted. Data analysis was conducted between June and December 2019. The analysis included 145 cohorts across 6 psychiatric disorders drawn from the ENIGMA consortium. The numbers of cases and controls in each of the 6 disorders were as follows: ADHD: 1814 and 1602; ASD: 1748 and 1770; BD: 1547 and 3405; MDD: 2658 and 3572; OCD: 2266 and 2007; and schizophrenia: 2688 and 3244.

Main Outcomes And Measures: Interregional profiles of group difference in cortical thickness between cases and controls.

Results: A total of 12 721 cases and 15 600 controls, ranging from ages 2 to 89 years, were included in this study. Interregional profiles of group differences in cortical thickness for each of the 6 psychiatric disorders were associated with profiles of gene expression specific to pyramidal (CA1) cells, astrocytes (except for BD), and microglia (except for OCD); collectively, gene-expression profiles of the 3 cell types explain between 25% and 54% of variance in interregional profiles of group differences in cortical thickness. Principal component analysis revealed a shared profile of difference in cortical thickness across the 6 disorders (48% variance explained); interregional profile of this principal component 1 was associated with that of the pyramidal-cell gene expression (explaining 56% of interregional variation). Coexpression analyses of these genes revealed 2 clusters: (1) a prenatal cluster enriched with genes involved in neurodevelopmental (axon guidance) processes and (2) a postnatal cluster enriched with genes involved in synaptic activity and plasticity-related processes. These clusters were enriched with genes associated with all 6 psychiatric disorders.

Conclusions And Relevance: In this study, shared neurobiologic processes were associated with differences in cortical thickness across multiple psychiatric disorders. These processes implicate a common role of prenatal development and postnatal functioning of the cerebral cortex in these disorders.
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http://dx.doi.org/10.1001/jamapsychiatry.2020.2694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450410PMC
January 2021

Obsessive-compulsive disorder and attention-deficit/hyperactivity disorder: distinct associations with DNA methylation and genetic variation.

J Neurodev Disord 2020 08 16;12(1):23. Epub 2020 Aug 16.

Genetics and Genome Biology, SickKids Hospital, Toronto, ON, Canada.

Background: A growing body of research has demonstrated associations between specific neurodevelopmental disorders and variation in DNA methylation (DNAm), implicating this molecular mark as a possible contributor to the molecular etiology of these disorders and/or as a novel disease biomarker. Furthermore, genetic risk variants of neurodevelopmental disorders have been found to be enriched at loci associated with DNAm patterns, referred to as methylation quantitative trait loci (mQTLs).

Methods: We conducted two epigenome-wide association studies in individuals with attention-deficit/hyperactivity disorder (ADHD) or obsessive-compulsive disorder (OCD) (aged 4-18 years) using DNA extracted from saliva. DNAm data generated on the Illumina Human Methylation 450 K array were used to examine the interaction between genetic variation and DNAm patterns associated with these disorders.

Results: Using linear regression followed by principal component analysis, individuals with the most endorsed symptoms of ADHD or OCD were found to have significantly more distinct DNAm patterns from controls, as compared to all cases. This suggested that the phenotypic heterogeneity of these disorders is reflected in altered DNAm at specific sites. Further investigations of the DNAm sites associated with each disorder revealed that despite little overlap of these DNAm sites across the two disorders, both disorders were significantly enriched for mQTLs within our sample.

Conclusions: Our DNAm data provide insights into the regulatory changes associated with genetic variation, highlighting their potential utility both in directing GWAS and in elucidating the pathophysiology of neurodevelopmental disorders.
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http://dx.doi.org/10.1186/s11689-020-09324-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7429807PMC
August 2020

Subcortical Brain Volume, Regional Cortical Thickness, and Cortical Surface Area Across Disorders: Findings From the ENIGMA ADHD, ASD, and OCD Working Groups.

Am J Psychiatry 2020 09 16;177(9):834-843. Epub 2020 Jun 16.

The full list of authors in the ENIGMA working groups, author affiliations, author disclosures, and acknowledgments are provided in online supplements.

Objective: Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and obsessive-compulsive disorder (OCD) are common neurodevelopmental disorders that frequently co-occur. The authors sought to directly compare these disorders using structural brain imaging data from ENIGMA consortium data.

Methods: Structural T-weighted whole-brain MRI data from healthy control subjects (N=5,827) and from patients with ADHD (N=2,271), ASD (N=1,777), and OCD (N=2,323) from 151 cohorts worldwide were analyzed using standardized processing protocols. The authors examined subcortical volume, cortical thickness, and cortical surface area differences within a mega-analytical framework, pooling measures extracted from each cohort. Analyses were performed separately for children, adolescents, and adults, using linear mixed-effects models adjusting for age, sex, and site (and intracranial volume for subcortical and surface area measures).

Results: No shared differences were found among all three disorders, and shared differences between any two disorders did not survive correction for multiple comparisons. Children with ADHD compared with those with OCD had smaller hippocampal volumes, possibly influenced by IQ. Children and adolescents with ADHD also had smaller intracranial volume than control subjects and those with OCD or ASD. Adults with ASD showed thicker frontal cortices compared with adult control subjects and other clinical groups. No OCD-specific differences were observed across different age groups and surface area differences among all disorders in childhood and adulthood.

Conclusions: The study findings suggest robust but subtle differences across different age groups among ADHD, ASD, and OCD. ADHD-specific intracranial volume and hippocampal differences in children and adolescents, and ASD-specific cortical thickness differences in the frontal cortex in adults, support previous work emphasizing structural brain differences in these disorders.
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http://dx.doi.org/10.1176/appi.ajp.2020.19030331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296070PMC
September 2020

An overview of the first 5 years of the ENIGMA obsessive-compulsive disorder working group: The power of worldwide collaboration.

Hum Brain Mapp 2020 Mar 10. Epub 2020 Mar 10.

McLean Hospital, Harvard Medical School, Belmont, Massachusetts.

Neuroimaging has played an important part in advancing our understanding of the neurobiology of obsessive-compulsive disorder (OCD). At the same time, neuroimaging studies of OCD have had notable limitations, including reliance on relatively small samples. International collaborative efforts to increase statistical power by combining samples from across sites have been bolstered by the ENIGMA consortium; this provides specific technical expertise for conducting multi-site analyses, as well as access to a collaborative community of neuroimaging scientists. In this article, we outline the background to, development of, and initial findings from ENIGMA's OCD working group, which currently consists of 47 samples from 34 institutes in 15 countries on 5 continents, with a total sample of 2,323 OCD patients and 2,325 healthy controls. Initial work has focused on studies of cortical thickness and subcortical volumes, structural connectivity, and brain lateralization in children, adolescents and adults with OCD, also including the study on the commonalities and distinctions across different neurodevelopment disorders. Additional work is ongoing, employing machine learning techniques. Findings to date have contributed to the development of neurobiological models of OCD, have provided an important model of global scientific collaboration, and have had a number of clinical implications. Importantly, our work has shed new light on questions about whether structural and functional alterations found in OCD reflect neurodevelopmental changes, effects of the disease process, or medication impacts. We conclude with a summary of ongoing work by ENIGMA-OCD, and a consideration of future directions for neuroimaging research on OCD within and beyond ENIGMA.
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http://dx.doi.org/10.1002/hbm.24972DOI Listing
March 2020

Brain structural covariance networks in obsessive-compulsive disorder: a graph analysis from the ENIGMA Consortium.

Brain 2020 02;143(2):684-700

Department of Psychology, Humboldt-Universität zu Berlin, Berlin, Germany.

Brain structural covariance networks reflect covariation in morphology of different brain areas and are thought to reflect common trajectories in brain development and maturation. Large-scale investigation of structural covariance networks in obsessive-compulsive disorder (OCD) may provide clues to the pathophysiology of this neurodevelopmental disorder. Using T1-weighted MRI scans acquired from 1616 individuals with OCD and 1463 healthy controls across 37 datasets participating in the ENIGMA-OCD Working Group, we calculated intra-individual brain structural covariance networks (using the bilaterally-averaged values of 33 cortical surface areas, 33 cortical thickness values, and six subcortical volumes), in which edge weights were proportional to the similarity between two brain morphological features in terms of deviation from healthy controls (i.e. z-score transformed). Global networks were characterized using measures of network segregation (clustering and modularity), network integration (global efficiency), and their balance (small-worldness), and their community membership was assessed. Hub profiling of regional networks was undertaken using measures of betweenness, closeness, and eigenvector centrality. Individually calculated network measures were integrated across the 37 datasets using a meta-analytical approach. These network measures were summated across the network density range of K = 0.10-0.25 per participant, and were integrated across the 37 datasets using a meta-analytical approach. Compared with healthy controls, at a global level, the structural covariance networks of OCD showed lower clustering (P < 0.0001), lower modularity (P < 0.0001), and lower small-worldness (P = 0.017). Detection of community membership emphasized lower network segregation in OCD compared to healthy controls. At the regional level, there were lower (rank-transformed) centrality values in OCD for volume of caudate nucleus and thalamus, and surface area of paracentral cortex, indicative of altered distribution of brain hubs. Centrality of cingulate and orbito-frontal as well as other brain areas was associated with OCD illness duration, suggesting greater involvement of these brain areas with illness chronicity. In summary, the findings of this study, the largest brain structural covariance study of OCD to date, point to a less segregated organization of structural covariance networks in OCD, and reorganization of brain hubs. The segregation findings suggest a possible signature of altered brain morphometry in OCD, while the hub findings point to OCD-related alterations in trajectories of brain development and maturation, particularly in cingulate and orbitofrontal regions.
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http://dx.doi.org/10.1093/brain/awaa001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7009583PMC
February 2020

Higher prevalence of irritable bowel syndrome and greater gastrointestinal symptoms in obsessive-compulsive disorder.

J Psychiatr Res 2019 11 13;118:1-6. Epub 2019 Aug 13.

MacAnxiety Research Centre, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada. Electronic address:

Background: Anxiety and mood symptoms often co-occur with gastrointestinal problems, such as irritable bowel syndrome (IBS). The extent to which these relate to Obsessive-Compulsive Disorder (OCD) is unclear, despite anxiety being a prominent symptom of this disorder. The purpose of this analysis was to examine gastrointestinal symptoms in unmedicated, non-depressed adult OCD patients compared to age- and sex-matched community controls.

Methods: Twenty-one OCD patients and 22 controls were recruited from the community (Hamilton, ON, Canada) and enrolled in this cross-sectional study. In addition to a standardized psychiatric assessment, participants completed clinician- and self-rated psychiatric and gastrointestinal symptom severity measures. Presence of IBS was assessed using Rome III criteria.

Results: Gastrointestinal symptom severity (GSRS total; OCD = 8.67 ± 6.72 vs. controls = 2.32 ± 2.12) and prevalence of IBS (OCD = 47.6%; Controls = 4.5%) was higher in OCD patients than in controls. A comparison of OCD patients based on IBS status revealed greater depressive symptom severity (total MADRS: 12.60 ± 1.89 vs 6.91 ± 2.77), p < 0.001) among those with IBS.

Conclusions: High prevalence and severity of gastrointestinal symptoms may be an important clinical consideration when treating OCD patients. More specifically, assessment of IBS and gastrointestinal symptoms may be useful when considering pharmacotherapeutic treatments options for patients. Given the high comorbidity noted with IBS, a disorder of the "gut-brain axis", results may suggest a shared pathophysiological mechanism between psychiatric and gastrointestinal disorders which should be explored in future research.
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http://dx.doi.org/10.1016/j.jpsychires.2019.08.004DOI Listing
November 2019

Mapping Cortical and Subcortical Asymmetry in Obsessive-Compulsive Disorder: Findings From the ENIGMA Consortium.

Biol Psychiatry 2020 06 30;87(12):1022-1034. Epub 2019 Apr 30.

Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zürich, Zürich, Switzerland; Max Planck UCL Centre for Computational Psychiatry and Ageing Research, University College London, London, United Kingdom; Wellcome Centre for Human Neuroimaging, University College London, London, United Kingdom.

Background: Lateralized dysfunction has been suggested in obsessive-compulsive disorder (OCD). However, it is currently unclear whether OCD is characterized by abnormal patterns of brain structural asymmetry. Here we carried out what is by far the largest study of brain structural asymmetry in OCD.

Methods: We studied a collection of 16 pediatric datasets (501 patients with OCD and 439 healthy control subjects), as well as 30 adult datasets (1777 patients and 1654 control subjects) from the OCD Working Group within the ENIGMA (Enhancing Neuro Imaging Genetics through Meta Analysis) Consortium. Asymmetries of the volumes of subcortical structures, and of measures of regional cortical thickness and surface areas, were assessed based on T1-weighted magnetic resonance imaging scans, using harmonized image analysis and quality control protocols. We investigated possible alterations of brain asymmetry in patients with OCD. We also explored potential associations of asymmetry with specific aspects of the disorder and medication status.

Results: In the pediatric datasets, the largest case-control differences were observed for volume asymmetry of the thalamus (more leftward; Cohen's d = 0.19) and the pallidum (less leftward; d = -0.21). Additional analyses suggested putative links between these asymmetry patterns and medication status, OCD severity, or anxiety and depression comorbidities. No significant case-control differences were found in the adult datasets.

Conclusions: The results suggest subtle changes of the average asymmetry of subcortical structures in pediatric OCD, which are not detectable in adults with the disorder. These findings may reflect altered neurodevelopmental processes in OCD.
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http://dx.doi.org/10.1016/j.biopsych.2019.04.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7094802PMC
June 2020

Seasonality Patterns of Internet Searches on Mental Health: Exploratory Infodemiology Study.

JMIR Ment Health 2019 Apr 24;6(4):e12974. Epub 2019 Apr 24.

Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada.

Background: The study of seasonal patterns of public interest in psychiatric disorders has important theoretical and practical implications for service planning and delivery. The recent explosion of internet searches suggests that mining search databases yields unique information on public interest in mental health disorders, which is a significantly more affordable approach than population health studies.

Objective: This study aimed to investigate seasonal patterns of internet mental health queries in Ontario, Canada.

Methods: Weekly data on health queries in Ontario from Google Trends were downloaded for a 5-year period (2012-2017) for the terms "schizophrenia," "autism," "bipolar," "depression," "anxiety," "OCD" (obsessive-compulsive disorder), and "suicide." Control terms were overall search results for the terms "health" and "how." Time-series analyses using a continuous wavelet transform were performed to isolate seasonal components in the search volume for each term.

Results: All mental health queries showed significant seasonal patterns with peak periodicity occurring over the winter months and troughs occurring during summer, except for "suicide." The comparison term "health" also exhibited seasonal periodicity, while the term "how" did not, indicating that general information seeking may not follow a seasonal trend in the way that mental health information seeking does.

Conclusions: Seasonal patterns of internet search volume in a wide range of mental health terms were observed, with the exception of "suicide." Our study demonstrates that monitoring internet search trends is an affordable, instantaneous, and naturalistic method to sample public interest in large populations and inform health policy planners.
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http://dx.doi.org/10.2196/12974DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6505370PMC
April 2019

Hoarding: A meta-analysis of age of onset.

Depress Anxiety 2019 06 8;36(6):552-564. Epub 2019 Apr 8.

Department of Psychiatry, Center for OCD, Anxiety, and Related Disorders, McKnight Brain Institute, College of Medicine, University of Florida, Gainesville, Florida.

Hoarding disorder is present in 2-6% of the population and can have an immense impact on the lives of patients and their families. Before its inclusion the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, pathological hoarding was often characterized as a symptom of obsessive-compulsive disorder, and several different diagnostic assessment methods were used to identify and characterize it. Although the age of onset of pathological hoarding is an important epidemiological measure, as clarifying the age of onset of hoarding symptoms may allow for early identification and implementation of evidence-based treatments before symptoms become clinically significant, the typical age of onset of hoarding is still uncertain. To that end, this study is a systematic review and meta-analysis of research published in English between the years 1900 and 2016 containing information on age of onset of hoarding symptoms. Twenty-five studies met inclusion criteria. The mean age of onset of hoarding symptoms across studies was 16.7 years old, with evidence of a bimodal distribution of onset. The authors conclude by discussing practice implications for early identification and treatment.
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http://dx.doi.org/10.1002/da.22896DOI Listing
June 2019

An Empirical Comparison of Meta- and Mega-Analysis With Data From the ENIGMA Obsessive-Compulsive Disorder Working Group.

Front Neuroinform 2018 8;12:102. Epub 2019 Jan 8.

Shanghai Mental Health Center Shanghai Jiao Tong University School of Medicine, Shanghai, China.

Brain imaging communities focusing on different diseases have increasingly started to collaborate and to pool data to perform well-powered meta- and mega-analyses. Some methodologists claim that a one-stage individual-participant data (IPD) mega-analysis can be superior to a two-stage aggregated data meta-analysis, since more detailed computations can be performed in a mega-analysis. Before definitive conclusions regarding the performance of either method can be drawn, it is necessary to critically evaluate the methodology of, and results obtained by, meta- and mega-analyses. Here, we compare the inverse variance weighted random-effect meta-analysis model with a multiple linear regression mega-analysis model, as well as with a linear mixed-effects random-intercept mega-analysis model, using data from 38 cohorts including 3,665 participants of the ENIGMA-OCD consortium. We assessed the effect sizes and standard errors, and the fit of the models, to evaluate the performance of the different methods. The mega-analytical models showed lower standard errors and narrower confidence intervals than the meta-analysis. Similar standard errors and confidence intervals were found for the linear regression and linear mixed-effects random-intercept models. Moreover, the linear mixed-effects random-intercept models showed better fit indices compared to linear regression mega-analytical models. Our findings indicate that results obtained by meta- and mega-analysis differ, in favor of the latter. In multi-center studies with a moderate amount of variation between cohorts, a linear mixed-effects random-intercept mega-analytical framework appears to be the better approach to investigate structural neuroimaging data.
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http://dx.doi.org/10.3389/fninf.2018.00102DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6331928PMC
January 2019

Symptom Insight in Pediatric Obsessive-Compulsive Disorder: Outcomes of an International Aggregated Cross-Sectional Sample.

J Am Acad Child Adolesc Psychiatry 2018 08;57(8):615-619.e5

University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada.

Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors. It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight. Identified correlates of poor insight include younger age, increased OCD severity, impairment, and family accommodation; lower intellectual and adaptive functioning; and greater depressive symptoms. Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo)..
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http://dx.doi.org/10.1016/j.jaac.2018.04.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7176075PMC
August 2018

Psychometric Evaluation of a Revised Scoring Approach for the Children's Saving Inventory in a Canadian Sample of Youth With Obsessive-Compulsive Disorder.

Child Psychiatry Hum Dev 2018 12;49(6):966-973

Anxiety Treatment and Research Centre, St. Joseph's Healthcare, 100 West 5th Street, Hamilton, ON, L8N 3K7, Canada.

The Children's Saving Inventory (CSI) was introduced in 2011 and is the first parent-rated questionnaire specifically designed to measure the severity of hoarding symptoms in youth. To date, however, no replication studies of the CSI have been published. Additionally, the total CSI score includes several items measuring acquisition, a behavioural dimension that has since been excluded from DSM-5's hoarding disorder criteria. Given these limitations, the primary goal of the present study was to test a modified, DSM-5-consistent, total score of the CSI. Because a confirmatory factor analysis did not support the 2011 four-factor model of the CSI, we reviewed the original CSI and excluded all acquisition items. An exploratory factor analysis yielded a strong three-factor solution (difficulty discarding, Clutter, and distress/impairment) with good reliability and validity for a 15-item version of the CSI. Overall, our results support the use of the 15-item CSI in youth with OCD.
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http://dx.doi.org/10.1007/s10578-018-0811-yDOI Listing
December 2018

Cortical Abnormalities Associated With Pediatric and Adult Obsessive-Compulsive Disorder: Findings From the ENIGMA Obsessive-Compulsive Disorder Working Group.

Am J Psychiatry 2018 05 15;175(5):453-462. Epub 2017 Dec 15.

From the Department of Psychiatry and the Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam; Amsterdam Neuroscience, Amsterdam; Orygen, National Centre of Excellence in Youth Mental Health, Melbourne; the Centre for Youth Mental Health, University of Melbourne, Melbourne; the Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; the Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomèdica en Red de Salud Mental (CIBERSAM), Barcelona; the Department of Clinical Sciences, University of Barcelona, Barcelona; the Margaret and Wallace McCain Centre for Child, Youth, and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto; the Centre for Brain and Mental Health, Hospital for Sick Children, Toronto; the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; the Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute and Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, Canada; the Department of Psychiatry, Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil; Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan, Italy; the Department of Psychology, Humboldt-Universität zu Berlin, Berlin; the Obsessive-Compulsive Disorder (OCD) Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich; the Magnetic Resonance Image Core Facility, IDIBAPS (Institut d'Investigacions Biomèdiques August Pi i Sunyer), Barcelona; the Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona; the Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China; the Institute of Human Behavioral Medicine, SNU-MRC, Seoul, Republic of Korea; the Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome; the Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam; the Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, University of Cape Town, Cape Town, South Africa; Yeongeon Student Support Center, Seoul National University College of Medicine, Seoul, Republic of Korea; Imaging Genetics Center, Mark and Mary Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Marina del Rey; Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; the Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam; the Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Department of Psychiatry, Oxford University, Oxford, U.K.; the Department of Neuroradiology and the TUM-Neuroimaging Center (TUM-NIC), Klinikum rechts der Isar, Technische Universität München, Munich; the Department of Psychiatry, Seoul National University College of Medicine, Seoul, Republic of Korea; the Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea; Institut d'Investigacions Biomèdiques, August Pi i Sunyer (IDIBAPS), Barcelona; the Department of Medicine, University of Barcelona, Barcelona; the SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Stellenbosch, South Africa; the Department of Psychiatry, Columbia University Medical College, and New York State Psychiatric Institute, New York; the Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm; the Mood Disorders Clinic and the Anxiety Treatment and Research Center, St. Joseph's HealthCare, Hamilton, Ontario; the Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Centro Fermi-Enrico Fermi Historical Museum of Physics and Study and Research Center, Rome; ATR Brain Information Communication Research Laboratory Group, Kyoto, Japan; the Center for Mathematics, Computing, and Cognition, Universidade Federal do ABC, Santo Andre, Brazil; the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York; the Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona; the Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Clinical Neuroscience and Development Laboratory, Olin Neuropsychiatry Research Center, Hartford, Conn.; the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the James J. Peters VA Medical Center, Bronx, N.Y.; the Institute of Living, Hartford Hospital, Hartford, Conn.; the Shanghai Key Laboratory of Psychotic Disorders, Shanghai, China; and the Department of Psychiatry, Seoul National University Hospital, Seoul, Republic of Korea.

Objective: Brain imaging studies of structural abnormalities in OCD have yielded inconsistent results, partly because of limited statistical power, clinical heterogeneity, and methodological differences. The authors conducted meta- and mega-analyses comprising the largest study of cortical morphometry in OCD ever undertaken.

Method: T-weighted MRI scans of 1,905 OCD patients and 1,760 healthy controls from 27 sites worldwide were processed locally using FreeSurfer to assess cortical thickness and surface area. Effect sizes for differences between patients and controls, and associations with clinical characteristics, were calculated using linear regression models controlling for age, sex, site, and intracranial volume.

Results: In adult OCD patients versus controls, we found a significantly lower surface area for the transverse temporal cortex and a thinner inferior parietal cortex. Medicated adult OCD patients also showed thinner cortices throughout the brain. In pediatric OCD patients compared with controls, we found significantly thinner inferior and superior parietal cortices, but none of the regions analyzed showed significant differences in surface area. However, medicated pediatric OCD patients had lower surface area in frontal regions. Cohen's d effect sizes varied from -0.10 to -0.33.

Conclusions: The parietal cortex was consistently implicated in both adults and children with OCD. More widespread cortical thickness abnormalities were found in medicated adult OCD patients, and more pronounced surface area deficits (mainly in frontal regions) were found in medicated pediatric OCD patients. These cortical measures represent distinct morphological features and may be differentially affected during different stages of development and illness, and possibly moderated by disease profile and medication.
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http://dx.doi.org/10.1176/appi.ajp.2017.17050485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7106947PMC
May 2018

Uncovering obsessive-compulsive disorder risk genes in a pediatric cohort by high-resolution analysis of copy number variation.

J Neurodev Disord 2016 18;8:36. Epub 2016 Oct 18.

The Centre for Applied Genomics and Program in Genetics and Genome Biology, The Hospital for Sick Children, Toronto, ON Canada.

Background: Obsessive-compulsive disorder (OCD) is a heterogeneous neuropsychiatric condition, thought to have a significant genetic component. When onset occurs in childhood, affected individuals generally exhibit different characteristics from adult-onset OCD, including higher prevalence in males and increased heritability. Since neuropsychiatric conditions are associated with copy number variations (CNVs), we considered their potential role in the etiology of OCD.

Methods: We genotyped 307 unrelated pediatric probands with idiopathic OCD (including 174 that were part of complete parent-child trios) and compared their genotypes with those of 3861 population controls, to identify rare CNVs (<0.5 % frequency) of at least 15 kb in size that might contribute to OCD.

Results: We uncovered de novo CNVs in 4/174 probands (2.3 %). Our case cohort was enriched for CNVs in genes that encode targets of the fragile X mental retardation protein (nominal  = 1.85 × 10; FDR=0.09), similar to previous findings in autism and schizophrenia. These results also identified deletions or duplications of exons in genes involved in neuronal migration (), synapse formation ( and ), and postsynaptic scaffolding ( and ), which may be relevant to the pathogenesis of OCD. Four cases had CNVs involving known genomic disorder loci (1q21.1-21.2, 15q11.2-q13.1, 16p13.11, and 17p12). Further, we identified as a candidate gene for OCD. We also sequenced exomes of ten "CNV positive" trios and identified in one an additional plausibly relevant mutation: a 13 bp exonic deletion in .

Conclusions: Our findings suggest that rare CNVs may contribute to the etiology of OCD.
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http://dx.doi.org/10.1186/s11689-016-9170-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5070001PMC
October 2016

Distinct Subcortical Volume Alterations in Pediatric and Adult OCD: A Worldwide Meta- and Mega-Analysis.

Am J Psychiatry 2017 01 9;174(1):60-69. Epub 2016 Sep 9.

From the Department of Psychiatry and the Department of Anatomy and Neurosciences, VU University Medical Center, Amsterdam; Neuroscience Campus Amsterdam, Free University/VU University Medical Center, Amsterdam; the Department of Psychiatry, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan; the Centre for Addiction and Mental Health and Hospital for Sick Children, Toronto; the Mathison Centre for Mental Health Research and Education, Cumming School of Medicine, University of Calgary, Calgary, Canada; the Department of Psychiatry, Institute of Psychiatry, University of São Paulo School of Medicine, São Paulo, Brazil; Clinical Research Group Psychiatry and Clinical Psychobiology, Division of Neuroscience, Scientific Institute Ospedale San Raffaele, Milan; the Department of Psychology, Humboldt-Universität zu Berlin, Berlin; the Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India; the Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric Hospital, University of Zurich, Zurich; Magnetic Resonance Image Core Facility, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain; the Department of Psychiatry, First Affiliated Hospital of Kunming Medical University, Kunming, China; the Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Korea; the Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Netherlands Institute for Neuroscience, Royal Netherlands Academy of Arts and Sciences, Amsterdam; the Department of Psychiatry, University of Michigan, Ann Arbor; the Department of Psychiatry, University of Cape Town, Cape Town, South Africa; the Department of Psychiatry, University of Stellenbosch, Cape Town; the Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain; Centro de Investigación Biomèdica en Red de Salud Mental (CIBERSAM), Barcelona; the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; the Imaging Genetics Center, Mark and Mary Stevens Institute for Neuroimaging and Informatics, Keck School of Medicine, University of Southern California, Marina del Rey; De Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam; the Department of Child and Adolescent Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam; the Department of Neuropsychiatry, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; the Department of Neuroradiology, Klinikum rechts der Isar, Technische Universität München, Munich; TUM-Neuroimaging Center (TUM-NIC) of Klinikum rechts der Isar, Technische Universität München, Munich; the Department of Psychiatry, Seoul National University College of Medicine, Seoul, Korea; the Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, Hospital Clínic Universitari, Barcelona, Spain; Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona; the Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain; SU/UCT MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, University of Stellenbosch, Cape Town, South Africa; Columbia University Medical Center, New York; the Division of Child and Adolescent Psychiatry, New York State Psychiatric Institute and Columbia University, New York; the Department of Clinical Neuroscience, Center for Psychiatric Research and Education, Karolinska Institutet, Stockholm; the Department of Clinical Sciences, University of Barcelona, Barcelona, Spain; the Mood Disorders Clinic and the Anxiety Treatment and Research Center, St. Joseph's HealthCare, Hamilton, Canada; the Department of Neural Computation for Decision Making, ATR Brain Information Communiciation Research Laboratory Group, Kyoto, Japan; the Laboratory of Neuropsychiatry, Department of Clinical and Behavioral Neurology, IRCCS Santa Lucia Foundation, Rome; the Center of Mathematics, Computation, and Cognition, Universidade Federal Do ABC, Santo Andre, Brazil; the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York; the Department of Psychobiology and Methodology of Health Sciences, Universitat Autònoma de Barcelona, Barcelona, Spain; the Beth K. and Stuart C. Yudofsky Division of Neuropsychiatry, Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston; the Department of Psychiatry, Yale University School of Medicine, New Haven, Conn.; the Clinical Neuroscience and Development Laboratory, Olin Neuropsychiatry Research Center, Hartford, Conn.; the Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York; the James J. Peters VA Medical Center, Bronx, New York; the Institute of Living/Hartford Hospital, Hartford, Conn.; the Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China; the Shanghai Key Laboratory of Psychotic Disorders, Shanghai; and the Department of Internal Medicine, First Affiliated Hospital of Kunming Medical University, Kunming, China.

Objective: Structural brain imaging studies in obsessive-compulsive disorder (OCD) have produced inconsistent findings. This may be partially due to limited statistical power from relatively small samples and clinical heterogeneity related to variation in illness profile and developmental stage. To address these limitations, the authors conducted meta- and mega-analyses of data from OCD sites worldwide.

Method: T images from 1,830 OCD patients and 1,759 control subjects were analyzed, using coordinated and standardized processing, to identify subcortical brain volumes that differ between OCD patients and healthy subjects. The authors performed a meta-analysis on the mean of the left and right hemisphere measures of each subcortical structure, and they performed a mega-analysis by pooling these volumetric measurements from each site. The authors additionally examined potential modulating effects of clinical characteristics on morphological differences in OCD patients.

Results: The meta-analysis indicated that adult patients had significantly smaller hippocampal volumes (Cohen's d=-0.13; % difference=-2.80) and larger pallidum volumes (d=0.16; % difference=3.16) compared with adult controls. Both effects were stronger in medicated patients compared with controls (d=-0.29, % difference=-4.18, and d=0.29, % difference=4.38, respectively). Unmedicated pediatric patients had significantly larger thalamic volumes (d=0.38, % difference=3.08) compared with pediatric controls. None of these findings were mediated by sample characteristics, such as mean age or scanning field strength. The mega-analysis yielded similar results.

Conclusions: The results indicate different patterns of subcortical abnormalities in pediatric and adult OCD patients. The pallidum and hippocampus seem to be of importance in adult OCD, whereas the thalamus seems to be key in pediatric OCD. These findings highlight the potential importance of neurodevelopmental alterations in OCD and suggest that further research on neuroplasticity in OCD may be useful.
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http://dx.doi.org/10.1176/appi.ajp.2016.16020201DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5344782PMC
January 2017

A Diffusion Tensor Imaging Study in Children With ADHD, Autism Spectrum Disorder, OCD, and Matched Controls: Distinct and Non-Distinct White Matter Disruption and Dimensional Brain-Behavior Relationships.

Am J Psychiatry 2016 Dec 1;173(12):1213-1222. Epub 2016 Jul 1.

From the Centre for Brain and Mental Health and the Department of Diagnostic Imaging, the Hospital for Sick Children, University of Toronto; the Department of Psychology, University of Toronto; the Department of Psychiatry, the Department of Medical Biophysics, the Department of Pediatrics, and the Department of Medical Imaging, Faculty of Medicine, University of Toronto; the Holland Bloorview Kids Rehabilitation Hospital, Bloorview Research Institute, University of Toronto; the Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and the Kimel Family Translational Imaging-Genetics Lab, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health (CAMH), University of Toronto; the Division of Child and Adolescent Psychiatry, Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minn.; the Pediatric OCD Consultation Service, Anxiety Treatment and Research Centre, St. Joseph's HealthCare, McMaster University, Hamilton, Ont., Canada; and the Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, the Department of Psychiatry, and the Department of Medical Genetics, Cumming School of Medicine, University of Calgary, Calgary, Alta., Canada.

Objective: Neurodevelopmental disorders (NDDs) (attention deficit hyperactivity disorder [ADHD], autism spectrum disorder [ASD], and obsessive-compulsive disorder [OCD]) share genetic vulnerability and symptom domains. The authors present direct comparison of structural brain circuitry in children and adolescents with NDDs and control subjects and examine brain circuit-behavior relationships across NDDs using dimensional measures related to each disorder.

Method: Diffusion imaging and behavioral measures were acquired in 200 children and adolescents (ADHD: N=31; OCD: N=36; ASD: N=71; controls: N=62; mean age range: 10.3-12.6 years). Following Tract-Based Spatial Statistics, multigroup comparison of white matter indices was conducted, followed by pairwise comparisons. Relationships of fractional anisotropy with dimensional measures of inattention, social deficits, obsessive-compulsive symptoms, and general adaptive functioning were conducted across the NDD sample.

Results: Lower fractional anisotropy within the splenium of the corpus callosum was found in each NDD group, compared with the control group. Lower fractional anisotropy in additional white matter tracts was found in the ASD and ADHD groups, compared with the control group, but not in the OCD group. Fractional anisotropy was lower in the ASD and ADHD groups compared with the OCD group but was not different in ADHD participants compared with ASD participants. A positive relation between fractional anisotropy (across much of the brain) and general adaptive functioning across NDDs was shown.

Conclusions: This study identified disruption in interhemispheric circuitry (i.e., fractional anisotropy alterations in the corpus callosum) as a shared feature of ASD, ADHD, and OCD. However, fractional anisotropy alterations may be more widespread and severe in ASD and ADHD than in OCD. Higher fractional anisotropy throughout the brain appears to be related to better adaptive function across NDDs.
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http://dx.doi.org/10.1176/appi.ajp.2016.15111435DOI Listing
December 2016

Standards of care for obsessive-compulsive disorder centres.

Int J Psychiatry Clin Pract 2016 Sep;20(3):204-8

a Psychiatry Department , Bellvitge University Hospital_IDIBELL , Barcelona , Spain ;

In recent years, many assessment and care units for obsessive-compulsive disorder (OCD) have been set up in order to detect, diagnose and to properly manage this complex disorder, but there is no consensus regarding the key functions that these units should perform. The International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) together with the Obsessive Compulsive and Related Disorders Network (OCRN) of the European College of Neuropsychopharmacology (ECNP) and the Anxiety and Obsessive Compulsive Disorders Section of the World Psychiaric Association (WPA) has developed a standards of care programme for OCD centres. The goals of this collaborative initiative are promoting basic standards, improving the quality of clinical care and enhance the validity and reliability of research results provided by different facilities and countries.
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http://dx.doi.org/10.1080/13651501.2016.1197275DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4950405PMC
September 2016

The cost and impact of compulsivity: A research perspective.

Eur Neuropsychopharmacol 2016 05 10;26(5):800-9. Epub 2016 Feb 10.

Highly Specialized Obsessive Compulsive Disorder and Body Dysmorphic Disorder Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Parkway, Welwyn Garden City, Hertfordshire AL8 6HG, UK; University of Hertfordshire, College Lane, Hatfield, Hertfordshire AL10 9AB, UK.

Compulsivity is the defining feature of various psychiatric disorders including Obsessive Compulsive Related Disorders (OCRDs), and other compulsive, impulsive, and addictive disorders. These disorders are disabling, chronic conditions with an early onset and high rates of comorbidity, misdiagnoses, and delay in treatment onset. Disorders of compulsivity are responsible for considerable socioeconomic burden to society. We review the costs and impacts of compulsivity. In order to facilitate earlier diagnosis and targeted treatments, we examine the overlapping mechanisms that underlie compulsivity. We reconceptualize psychiatric disorders based on core features of compulsivity, highlight challenges in harmonizing research in children and adults, describe newer research methodologies, and point to future directions that can impact the costs and impact of disorders of compulsivity.
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http://dx.doi.org/10.1016/j.euroneuro.2016.02.006DOI Listing
May 2016

Clinical Correlates of Hoarding With and Without Comorbid Obsessive-Compulsive Symptoms in a Community Pediatric Sample.

J Am Acad Child Adolesc Psychiatry 2016 Feb 2;55(2):114-21.e2. Epub 2015 Dec 2.

Hospital for Sick Children, Toronto, Canada; Mathison Centre for Mental Health Research and Education, The University of Calgary, Calgary, AB, Canada.

Objective: We assessed the prevalence and clinical correlates of hoarding, with and without obsessive-compulsive (OC) symptoms, in a community-based pediatric sample.

Method: We measured hoarding and OC symptoms using the Toronto Obsessive-Compulsive Scale (TOCS) in 16,718 youth aged 6 to 17 years in the community. We classified participants with high and low symptom counts for hoarding and OC into 4 groups: hoarding+OC; hoarding-only; OC-only; and control (no OC or hoarding symptoms). We compared these 4 groups on parent- or self-reported medical and psychiatric conditions, anxiety symptoms measured with the Child Behavior Checklist (CBCL), and attention-deficit/hyperactivity disorder (ADHD) symptoms measured with the Strengths and Weaknesses of Attention-Deficit/Hyperactivity Disorder Symptoms and Normal Behavior Scale (SWAN).

Results: Almost 10% of participants were in the high hoarding group. Of these participants, 40% did not fall into the high OC group. The prevalence of reported psychiatric disorders (e.g., ADHD, autism spectrum disorder, obsessive-compulsive disorder) was greater in the hoarding (hoarding+OC and hoarding-only) and OC groups (hoarding+OC and OC-only) than in the nonhoarding (OC-only and control) and non-OC groups (hoarding-only and control), respectively. ADHD, specifically inattentive, symptoms were more common in the hoarding-only than in the OC-only group while anxiety symptoms were more common in the OC-only than in the hoarding-only group.

Conclusion: In a community pediatric sample, hoarding symptoms occurred in both the presence and absence of obsessive-compulsive symptoms. Hoarding symptoms alone had some unique clinical correlates, in particular, more inattentive ADHD symptoms and fewer anxiety symptoms. These findings suggest that hoarding is distinct from OC traits in youth.
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http://dx.doi.org/10.1016/j.jaac.2015.11.014DOI Listing
February 2016

Frontal EEG alpha activity and obsessive-compulsive behaviors in non-clinical young adults: a pilot study.

Front Psychol 2015 29;6:1480. Epub 2015 Sep 29.

Department of Psychiatry and Behavioural Neurosciences, McMaster University , Hamilton, ON, Canada.

Previous studies have shown that the resting electroencephalogram (EEG) alpha patterns of non-clinical participants who score high on measures of negative affect, such as depression and shyness, are different from those who score low. However, we know relatively little about patterns of resting EEG alpha patterns in a non-clinical sample of individuals with high levels of obsessive-compulsive behaviors indicative of obsessive-compulsive disorder (OCD). Here we measured resting EEG alpha activity in frontal and parietal regions of non-clinical participants who scored high and low on the Padua-R, a measure of the severity of OCD-related behaviors. We found that participants who scored high on the Padua-R exhibited decreased overall activity in frontal regions relative to individuals who scored low on the measure. We speculate that frontal hypoactivity may be a possible marker and/or index of risk for OCD.
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http://dx.doi.org/10.3389/fpsyg.2015.01480DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4586322PMC
October 2015

Three Reasons why Studying Hoarding in Children and Adolescents is Important.

J Can Acad Child Adolesc Psychiatry 2015 31;24(2):128-30. Epub 2015 Aug 31.

Pediatric OCD Consultation Team, Anxiety Treatment and Research Centre, St. Joseph's Healthcare, Hamilton, Ontario ; Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.

Hoarding is traditionally considered a disorder of adulthood but hoarding symptoms often begin in childhood and adolescence. However, there is very little published research into hoarding in youth. As described in this commentary, the study of hoarding in childhood and adolescence is important because hoarding symptoms: 1) often begin in childhood and adolescence; 2) often are chronic and persist into adulthood; and, 3) are associated with a number of negative outcomes and sequelae. Research into hoarding in youth could help identify individuals at risk for chronic and persistent hoarding disorder as well as determine interventions to change their trajectories. Improved understanding of hoarding in children and adolescents could in turn help minimize the negative effect of hoarding on the affected individuals, their families and society.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4558984PMC
September 2015

Examining and comparing social perception abilities across childhood-onset neurodevelopmental disorders.

J Am Acad Child Adolesc Psychiatry 2015 Jun 30;54(6):479-86.e1. Epub 2015 Mar 30.

Bloorview Research Institute and the University of Toronto. Electronic address:

Objective: Several neurodevelopmental disorders are associated with social processing deficits. The objective of this study was to compare patterns of social perception abilities across obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and control participants.

Method: A total of 265 children completed the Reading the Mind in the Eyes Test-Child Version (RMET). Parents or caregivers completed established trait/symptom scales. The predicted percentage of accuracy on the RMET was compared across disorders and by item difficulty and item valence (i.e., positive/negative/neutral mental states), then analyzed for associations with trait/symptom scores.

Results: The percentage of correct RMET scores varied significantly between diagnostic groups (p < .0001). On pairwise group comparisons controlling for age and sex, children with ADHD and ASD scored lower than the other groups (p < .0001). When IQ was also controlled for in the model, participants with OCD performed better than controls (p < .001), although differences between other groups were less pronounced. Participants with ASD scored lowest on easy items. Those with ASD and ADHD scored significantly lower than other groups on items with positive valence (p < .01). Greater social communication impairment and hyperactivity/impulsivity, but not OCD traits/symptoms, were associated with lower scores on the RMET, irrespective of diagnosis.

Conclusion: Social perception abilities in neurodevelopmental disorders exist along a continuum. Children with ASD have the greatest deficits, whereas children with OCD may be hypersensitive to social information. Social communication deficits and hyperactive/impulsive traits are associated with impaired social perception abilities; these findings highlight overlapping cognitive and behavioral manifestations across disorders.
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http://dx.doi.org/10.1016/j.jaac.2015.03.016DOI Listing
June 2015

Dimensions of Perfectionism in Children and Adolescents with Obsessive-compulsive Disorder.

J Can Acad Child Adolesc Psychiatry 2014 May;23(2):136-43

Offord Centre for Child Studies, McMaster University, Chedoke Site, Hamilton, Ontario ; Department of Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario.

Objective: To measure the association of perfectionism with obsessive-compulsive and depressive symptoms in children and adolescents with obsessive-compulsive disorder (OCD).

Method: Sample consisted of 94 youth (44 boys, 49 girls; mean age = 13.2 y, SD = 2.5 y) with a DSM-IV diagnosis of OCD. Perfectionism beliefs were measured with both the Adaptive/Maladaptive Perfectionism Scale (AMPS) and a 14-item version of the Child and Adolescents Perfectionism Scale (CAPS-14). Using a hierarchical linear-regression model, we measured the association of perfectionist beliefs with severity of OCD and depressive symptoms.

Results: Both AMPS and CAPS-14 scores were associated with the severity of OCD symptoms in our sample. In addition, CAPS-14 scores were associated with the severity of depressive symptoms, even when OCD symptoms were taken into account.

Conclusions: Our findings lend further support to the hypothesis that perfectionism in youth with OCD is associated with variation in the severity of OCD and depressive symptoms.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4032082PMC
May 2014

A preliminary study of functional connectivity of medication naïve children with obsessive-compulsive disorder.

Prog Neuropsychopharmacol Biol Psychiatry 2014 Aug 12;53:129-36. Epub 2014 Apr 12.

School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada; Electrical & Computer Engineering, McMaster University, Hamilton, Ontario, Canada; Medical Physics & Applied Radiation Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Radiology, McMaster University, Hamilton, Ontario, Canada.

Background: Evidence suggests that obsessive-compulsive disorder (OCD) is associated with a dysfunction in the cortico-striatal-thalamic-cortical (CSTC) circuitry. Resting state functional connectivity magnetic resonance imaging (rs-fcMRI) allows measurements of resting state networks (RSNs), brain networks that are present at 'rest'. However, although OCD has a typical onset during childhood or adolescence, only two other studies have performed rs-fcMRI comparisons of RSNs in children and adolescents with OCD against healthy controls.

Methods: In the present study, we performed resting state functional magnetic resonance imaging using a 3 Tesla MRI, in 11 medication-naïve children and adolescents with OCD and 9 healthy controls. In contrast to previous studies that relied on a priori determination of RSNs, we determined resting state functional connectivity with a data-driven independent component analysis (ICA).

Results: Consistent with previous reports in healthy adults, we identified 13 RSNs. Case-control un-adjusted statistical significance (p<0.05) was found for two networks. Firstly, increased connectivity (OCD>control) in the right section of Brodmann area 43 of the auditory network; Secondly, decreased connectivity in the right section of Brodmann area 8 and Brodmann area 40 in the cingulate network.

Conclusions: Our preliminary findings of case-control differences in RSNs lend further support to the CSTC hypothesis of OCD, as well as implicating other regions of the brain outside of the CSTC.
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http://dx.doi.org/10.1016/j.pnpbp.2014.04.001DOI Listing
August 2014
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