Search Results (185)

Background/Objectives: Juvenile idiopathic arthritis (JIA) and inflammatory bowel disease (IBD) are chronic autoimmune conditions that impact the physical and psychological well-being of pediatric patients. While previous studies have shown a high prevalence of mental health challenges among youth with chronic conditions, the prevalence of mental health issues in Canadian pediatric patients with JIA and IBD remains unclear. We aimed to estimate the prevalence of documented mental health disorders and related medication use of youth with JIA or IBD at a tertiary care centre. Methods: We conducted a retrospective chart review of youths aged 12–17 diagnosed with JIA or IBD at McMaster Children’s Hospital (MCH) to understand the prevalence of generalized anxiety disorder (GAD), separation anxiety disorder, social anxiety disorder (SAD), obsessive–compulsive disorders (OCD), eating disorders, major depressive disorder (MDD), adolescent adjustment disorder, suicide attempt/suicide ideation, self-harm behaviour, substance use disorder, and attention deficit disorders (ADD). Results: We reviewed 429 patient charts, including 303 patients with IBD and 126 with JIA. Our findings identified 90 IBD patients and 20 JIA patients who had one or more documented mental health conditions. Proportionately, there was a higher prevalence of mental health conditions among IBD patients (30%) compared to JIA patients (16%). The most frequently observed conditions in both IBD and JIA patients were GAD (63%, 50%), ADD (33%, 35%), and MDD (29%, 15%). Conclusions: These findings highlight the critical need for early mental health screening and integrated care approaches that address both medical and psychosocial needs in adolescents with chronic illnesses. Future research should incorporate prospective study designs, include diverse geographic and demographic populations, and explore targeted interventions to improve mental and physical health outcomes in this vulnerable group. Full article

Background/Objectives: The objective of this study was to validate a new parent-reported scale for tracking Pediatric Acute-onset Neuropsychiatric Syndrome (PANS). PANS is a condition characterized by a sudden and severe onset of neuropsychiatric symptoms. To meet diagnostic criteria, an individual must present with either obsessive–compulsive disorder (OCD) or severely restricted food intake, accompanied by at least two additional cognitive, behavioral, or emotional symptoms. These may include anxiety, emotional instability, depression, irritability, aggression, oppositional behaviors, developmental or behavioral regression, a decline in academic skills such as handwriting or math, sensory abnormalities, frequent urination, and enuresis. The onset of symptoms is usually triggered by an infection or an abnormal immune/inflammatory response. Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections (PANDAS) is a subtype of PANS specifically linked to strep infections. Methods: We developed a 101-item PANS/PANDAS and Related Inflammatory Brain Disorders Treatment Evaluation Checklist (PTEC) designed to assess changes to a patient’s symptoms over time along 10 subscales: Behavior/Mood, OCD, Anxiety, Food intake, Tics, Cognitive/Developmental, Sensory, Other, Sleep, and Health. The psychometric quality of PTEC was tested with 225 participants. Results: The internal reliability of the PTEC was excellent (Cronbach’s alpha = 0.96). PTEC exhibited adequate test–retest reliability (r = 0.6) and excellent construct validity, supported by a strong correlation with the Health subscale of the Autism Treatment Evaluation Checklist (r = 0.8). Conclusions: We hope that PTEC will assist parents and clinicians in the monitoring and treatment of PANS. The PTEC questionnaire is freely available at neuroimmune.org/PTEC. Full article

Background. Cognitive-behavioral theories suggest that obsessions in obsessive-compulsive disorder (OCD) develop from maladaptive misinterpretations and coping strategies of unwanted intrusive thoughts (UITs). Models of Body Dysmorphic Disorder (BDD) and Illness Anxiety Disorder (IAD) propose that these symptoms stem from similar misinterpretations of common UITs relating to perceived defects in appearance and illness. This study examines whether maladaptive misinterpretations and control strategies leading to the escalation of obsessional UITs to OCD symptoms also have a similar effect on the development of BDD and IAD. More specifically, we examined whether misinterpretations and neutralizing responses mediate the associations between the frequency of disorder-specific UITs and symptoms of these disorders. Method. A total of 625 non-clinical participants from four countries completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) that assesses OCD, BDD and IAD-related UITs and their associated misinterpretations and neutralizing strategies, as well as self-report measures of OCD, BDD, and IAD symptoms. Parallel multiple mediation models were conducted. Results. The frequency of OCD, BDD and IAD-related UITs predicted symptoms of each disorder. Dysfunctional appraisals and neutralizing behaviors mediated the associations between disorder-specific UITs and symptoms in OCD and IAD. The IAD model accounted for a smaller proportion of variance than the OCD model. No mediating effects were found for BDD symptoms. Conclusions. Experiencing disturbing UITs is a transdiagnostic risk factor of OCD, BDD and IAD, and is associated with symptoms of these disorders. Maladaptive interpretation of UITs and neutralizing strategies should be specific targets in the assessment and treatment of OCD and IAD. The absence of mediation effects for BDD could be due to the limitations observed on the self-report used to assess BDD symptoms and/or the low relevance of the misinterpretations and control strategies assessed by the QUIT, which are more typically endorsed by individuals with OCD. Full article

Obsessive–compulsive disorder (OCD) has an estimated prevalence between 1 and 2.3%. Existing treatments may not be suitable or effective for all people with OCD, and there is increasing interest in whether these individuals may benefit from the use of cannabis-based medical products (CBMPs). We document the characteristics of 257 people reporting a diagnosis of OCD within Project T21, a study of medical cannabis patients, and examined whether the use of prescribed cannabinoids improves quality of life. Individuals with OCD were prescribed an average of 2.2 CBMPs, with most products classified as THC-dominant flowers (73.7%). Three months after initiating treatment, there were substantial improvements in quality of life (Cohen’s d = 0.48; 95% CI = 0.29–0.65), general health (Cohen’s d = 0.43; 95% CI = 0.26–0.61), mood/depression (Cohen’s d = 0.85; 95% CI = 0.65–1.04), and sleep (Cohen’s d = 0.61; 95% CI = 0.43–0.79). There was a corresponding reduction in anxiety symptoms among the subsample who completed the GAD-7 (Cohen’s d = 1.14; 95% CI = 0.84–1.44). Eight individuals (5.7%) reported a total of 14 adverse effects, with the majority of these (57%) being described as mild. Given emerging evidence that those with OCD can benefit from CBMPs, coupled with the increased availability of these unlicensed products internationally, there is a need for more research, including clinical trials, to identify those who may benefit most from the use of these medicines. Full article

Background/Objectives: Deep Brain Stimulation (DBS) of the subthalamic nucleus (STN) is a widely used intervention for Parkinson’s disease (PD) and obsessive-compulsive disorder (OCD). While motor and OCD symptom benefits are established, increasing evidence highlights psychiatric side effects. The underlying mechanisms involve stimulation parameters, electrode positioning, and medication adjustments. This systematic review aims to evaluate the short-term and long-term psychiatric effects of STN-DBS and identify influencing factors. Methods: A systematic literature search (PubMed, Scopus, Web of Science, Embase; 2015–2024) was conducted following PRISMA guidelines. Studies examining psychiatric effects of STN-DBS in PD or OCD, reporting quantitative/qualitative psychiatric measures, and specifying stimulation parameters were included. Risk of bias was assessed using the Newcastle-Ottawa Scale (NOS) for observational studies and the Cochrane Risk of Bias Tool for randomized controlled trials (RCTs). Results: A total of 16 studies met the inclusion criteria, with sample sizes from 10 to 149 patients and short- to long-term follow-ups (up to 17 years). Short-term effects included transient hypomania, euphoria, increased impulsivity (especially with medial STN stimulation), and sometimes anxiety reduction. Long-term effects showed a tendency towards apathy and depression (apathy increased significantly in one large cohort), particularly linked to ventromedial STN stimulation or dopaminergic medication reduction. Impulse control disorders (ICDs) improved long-term in one study following medication reduction, while impulsivity slightly worsened in another. Verbal fluency decline was commonly reported, though global cognition often remained stable. Psychiatric outcomes (mood/apathy, attention/memory) depended on stimulation location within STN subregions. Higher total electrical energy delivered (TEED) correlated with depressive trait shifts in one study. Conclusions: STN-DBS has complex psychiatric consequences. Electrode positioning, stimulation parameters (including location within STN subregions and possibly TEED), and medication adjustments significantly influence outcomes. Careful patient selection, preoperative psychiatric screening, optimized programming targeting specific STN subregions, and cautious medication management are essential to minimize psychiatric risks while maximizing therapeutic benefits for motor and OCD symptoms. Full article

Introduction: Obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) are neuropsychiatric diagnoses that commonly co-occur, as approximately 25% of youth with OCD also have a diagnosis of ADHD and 11% of youth with ADHD have OCD. Individuals with ADHD and OCD are also commonly treated for symptoms of depression, anxiety, and traumatic experiences. Conversely, Black and Latiné youth in the United States have limited access to culturally responsive providers to address these conditions due to systemic racism; the lower rates of appropriate diagnosis, treatment, and inclusion in research create worsening symptoms of OCD. Thus, we sought to understand how ADHD symptoms affect OCD symptoms and how these comorbid diagnoses, in addition to anxiety disorders, affect reported anxiety, depression, and trauma for Black and/or Latiné teens. Procedures: Participants (N = 48) are Black and/or Latina/é/o youth with ADHD in the United States. Self and parent-report measures were completed for ADHD, anxiety, and depression, and a semi-structured interview was conducted to assess current mental health diagnoses (OCD, ADHD, trauma). Results: A path analysis showed higher levels of ADHD inattentive (ADHDI) symptoms (β = 0.34) were positively associated with obsessions. In contrast, higher ADHD hyperactive/impulsivity symptoms (ADHDHI) (β = −0.11) were negatively associated with obsessions. Neither ADHDI nor ADHDHI symptoms were associated with compulsions. Interestingly, ADHDI (β = 0.33) & obsessions (β = 0.28) were both associated with depression; however, ADHDHI was negatively associated with depression (β = −0.29). Importantly, ADHDI was associated with trauma (β = 0.13) and obsessions were strongly associated with anxiety (β = 0.38). Conclusions: These findings may allow for better screenings and treatments for co-occurring OCD and ADHD symptoms and a greater understanding of the impact depression, anxiety, and trauma have on neurodivergent Black and/or Latiné youth. Full article

Background/Objectives: Compulsive rituals in Obsessive–Compulsive Disorder (OCD) are characterized by a specific motor structure, built upon the fragmentation of action flow, obtained through act repetitions and the intrusion of non-functional acts. No study to date has adopted a hierarchical analysis to subtype OCD according to specific behavioral patterns, nor has a possible association between motor profiles and psychopathology been investigated. Methods: This study involved 31 OCD patients (11 female, 35%) and 31 healthy controls (11 female, 35%). The participants were asked to provide videotapes of their behaviors (OCD compulsions for patients and corresponding normal behaviors for healthy controls). BORIS software version 2.84.1 was adopted to analyze the recorded videos. Psychopathology was assessed through the Yale–Brown Obsessive–Compulsive Scale, the Childhood Trauma Questionnaire, the Frankfurt Complaint Questionnaire, and the Social and Occupational Functioning Assessment Scale. Results: Hierarchical analysis revealed three behavioral clusters based on motor profile: Cluster 1 included OCD compulsions structurally characterized by act repetitions (“iterative” rituals); Cluster 2 was represented by OCD compulsions mainly built upon non-functional acts (“idiosyncratic” rituals); and Cluster 3 comprised routinized and normative behaviors, without behavioral ritualization (no act repetitions and few non-functional acts). No significant differences were found in age, age at onset, and OCD severity between “iterative” and “idiosyncratic” rituals. However, patients with “iterative” rituals showed both more severe pre-psychotic symptoms and childhood trauma experiences than patients with “idiosyncratic” rituals. Conclusions: These findings may have significant clinical implications as they hint at a relationship between specific behavioral patterns of OCD compulsions and different underlying psychopathologies and/or vulnerabilities. Full article

Background/Objectives: Obsessive–compulsive disorder (OCD) is a complex psychiatric condition often associated with alterations in cognitive processes, including memory. Although memory dysfunction has been proposed as a contributing factor to the onset and maintenance of OCD symptoms, it remains debated whether these deficits reflect genuine cognitive impairments or maladaptive metacognitive processes, such as pathological doubt and memory distrust. This review aims to synthesize current findings on memory functioning in OCD, focusing on distinct memory systems and the role of metacognition. Methods: A comprehensive literature search was conducted across five databases (PubMed, Scopus, Embase, PsycINFO, and Google Scholar), covering studies up to April 2025. Search terms included “Obsessive-compulsive disorder”; “OCD”; “Memory dysfunction”; “Episodic memory”; “Working memory impairment”; “Prospective memory deficits”; “Checking compulsions”; “Memory confidence”; “Cognitive biases”. Results: Short-term memory appears generally preserved in OCD. Working memory deficits are consistently reported, especially in the visuospatial domain, and they are associated with difficulties in updating and clearing irrelevant information. Episodic memory impairments are common and often linked to inefficient encoding strategies and heightened cognitive self-consciousness. Prospective memory is frequently compromised under neutral conditions. Individuals with checking symptoms tend to show intact objective memory performance, despite reporting low memory confidence, supporting the concept of memory distrust. Conclusions: Memory dysfunction in OCD is multifaceted, involving both cognitive and metacognitive alterations. The evidence supports a model in which executive dysfunctions and memory-related beliefs contribute to compulsive behaviors more than objective memory failure. These insights highlight the need for integrative assessment protocols and personalized interventions targeting both cognitive performance and metacognitive appraisals. Full article

Psychiatric disorders are a major cause of illness in the world. Unfortunately, many patients are resistant to treatment and present serious complications. Schizophrenia is refractory to treatment in about one-third of patients. Antidepressants are effective in about half of patients. Suicidal ideation is an increasing issue in patients with mixed features in bipolar disorder (BD). Therefore, there is a need to develop and test new drugs or new indications of available medications for the treatment of psychiatric disorders through evidence-based investigations. This narrative review aims to present the molecules approved by the main drug agencies, the Food and Drug Administration (FDA) and the European Medicines Agency (EMA), from 2018 to date, along with new indications and new formulations of existing medications. We searched PubMed for new drugs approved for schizophrenia, BD, major depressive disorder (MDD), anxiety disorders, and obsessive-compulsive disorder (OCD). We evaluated their clinical benefits, safety, and tolerability profiles. Finally, we considered studies on the main molecules that have shown initial evidence of efficacy and are in the process of obtaining approval. Our search suggested that a new antipsychotic, lumateperone, and two drug combinations, olanzapine/samidorphan (OLZ/SAM) and xanomeline/trospium (KarXT), were approved for schizophrenia. In addition, some new methods of administration—monthly risperidone administration, subcutaneous risperidone administration, and transdermal asenapine administration—obtained approval from the main drug agencies. Lumateperone and OLZ/SAM were also approved in BD. Esketamine, a compound that modulates glutamatergic transmission, was approved to treat treatment-resistant depression and acute suicidal ideation. The dextromethorphan/bupropion combination was approved for MDD. Two new agents, brexanolone and zuranolone, were approved for treatment of postpartum depression. On the other hand, no new drugs received approval for anxiety disorders or OCD. In summary, some new psychotropic medications have been developed, in particular with the aim to improve the symptoms of resistant patients and to decrease the incidence of adverse effects. It is necessary to continue testing the effectiveness of new compounds in methodologically rigorous studies. Full article

Background: Obsessive–compulsive disorder (OCD) in youth commonly co-occurs with other affective disorders (e.g., anxiety, depression). Exposure and response prevention (ERP) is the front-line treatment for OCD but may require significant adaptation to treat co-occurring symptoms or complex comorbidity patterns. Preliminary evidence suggests that the Unified Protocols for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents (UP-C/A) are effective in reducing OCD symptoms. Still, it is not yet known if the UP-C/A are comparably effective to treat OCD as they are for anxiety and depression, the disorders for which there is the most robust empirical support. Methods: This study compared trajectories of OCD, anxiety, and depression symptom change among 388 youth who received UP-C/A treatment (M = 15 sessions) at a university-based research clinic. We also examined whether youth with (n = 60) and without (n = 328) an OCD diagnosis demonstrated comparable improvements in anxiety, depression, and transdiagnostic treatment targets (i.e., anxiety sensitivity, cognitive flexibility, and distress tolerance). Results: OCD symptoms improved at a slower rate than anxiety and depression symptoms during the first half of UP-C/A treatment but at a comparable rate to anxiety and depression symptoms during the second half of treatment. Youth with and without OCD exhibited comparable improvements in anxiety, depression, anxiety sensitivity, cognitive flexibility, and distress tolerance across the treatment course. Conclusions: Findings support the efficacy of UP-C/A treatment for co-occurring OCD and affective disorders but suggest that initiating exposure earlier in the treatment course may confer additional benefits. Full article

Background: Up to 33% of individuals with obsessive-compulsive disorder (OCD) have scrupulosity symptoms, although less is known regarding the prevalence rates in youth, specifically. Scrupulosity translates to “fearing sin where there is none” and describes pathological guilt and distress related to religion and morality. Disentangling scrupulosity from true religious beliefs and actions may be difficult in youth for a number of reasons, including the nature of youth as a time of developing independent identities and values, expected ritualistic behavior (e.g., confession, ritualistic cleansing), scrupulosity being reinforced in some religious communities, and the discomfort or inexperience of clinicians with both these symptoms and various belief systems. The literature suggests limited knowledge of scrupulosity among mental health providers, including pediatric clinicians, and apprehension to discuss or target scrupulous beliefs and behaviors. Apprehension may be enhanced for providers working with youth populations, particularly given broader misconceptions about the efficacy and safety of gold-standard interventions. Objectives: This narrative review with practice guidelines examines the existing literature related to pediatric scrupulosity and its challenges and describes evidence-based treatments for scrupulosity in pediatric populations. Recommendations for clinical practice and research are discussed. Full article

OCD is a prevalent mental disorder, particularly amongst adolescents, with prevalence rates between 1 and 3 percent globally. This study aimed to explore teachers’ perceptions and experiences of Irish secondary school students with OCD. Interviews were conducted with 15 secondary school (middle school/high school) teachers (4 male, 11 female). The data were analysed using Constant Comparison Analysis. In total, 35 categories emerged from which 10 domains were identified: manifestations of OCD; portrayal of OCD in the media; comorbidity; prevalence and impact; OCD in the classroom; teacher training; role as teachers; perceived ability to identify and support; barriers to identification and support; and importance of awareness and education. Further research on teachers’ understanding of OCD is recommended to inform the design of teacher training programmes to support students affected by OCD. Full article

Background and Clinical Significance: Evaluations of interventions for sexual orientation obsessive–compulsive disorder (SO-OCD) are rare. This study therefore evaluated the effectiveness of cognitive analytic therapy (CAT). Case Presentation: A 28-year-old heterosexual male presented with SO-OCD in the form of obsessions concerning his sexual identity and associated avoidance and reassurance-seeking compulsions. The evaluation was a quasi-experiential A/B single-case experimental design (SCED) with follow-up of the eight-session CAT intervention. The SCED had three phases: baseline ‘A’ (two sessions; 21 days), active treatment ‘B’ (six sessions; 56 days) and follow-up (one session; 44 days). There were seven daily rated idiographic outcome measures (intrusion count as the control, a compulsion count and then intensity measures of checking, worrying, generating evidence, shame and anxiety). Four nomothetic outcome measures (including a primary outcome measure of SO-OCD) were collected at assessment, end of treatment and follow-up. Generalised logistical models were fitted to the idiographic outcomes. Six of the seven idiographic measures responded to treatment, indicating an effective intervention. Idiographic change was non-linear and synchronised with specific psychotherapeutic actions and there was no evidence of relapse. There was a clinically significant and reliable pre–post reduction in SO-OCD with progress sustained over the follow-up period. Conclusions: Overall, the study indicates that CAT was an effective intervention for the SO-OCD. The study methodology is critiqued and guidance on SO-OCD treatment is provided. Full article

Background/Objectives: Residential treatment represents an important level of care for adolescents with severe and/or treatment-refractory obsessive–compulsive disorder (OCD). Despite accumulating evidence supporting the treatment efficacy and cost-effectiveness of insurance-based intensive OCD treatment in residential settings, few data exist that characterize the population of adolescent patients utilizing this level of care. As a result, residential treatment may be poorly understood by patients, their families, and referring providers, which may delay appropriate treatment for adolescents with OCD. Here, we characterize the patient population at an intensive residential treatment center (RTC) and partial hospitalization program (PHP) for adolescents (Mage = 15.23) with a primary diagnosis of OCD. Methods: We examine quantitative data collected from 168 adolescents admitted to the McLean OCD Institute for Children and Adolescents for the treatment of primary OCD or a related disorder over a three-year period. We also conduct analyses on a subset of patients (n = 120) who participated in the Child and Adolescent Routine Evaluation (CARE) Initiative (McLean Child Division-Wide Measurement-Based Care Program) to further characterize this patient population with a lens toward additional comorbidities and factors impacting prognosis. Results: The current paper describes the severity of symptom presentation, comorbidities, psychotropic medication profiles, and disruption to personal and family functioning. Analyses also include the prevalence of OCD subtypes and co-occurrence among varied presentations. Conclusions: In addition to identifying common clinical presentations in an RTC/PHP, this paper further aims to detail best practices and clinical rationale guiding a specialty RTC/PHP to inform families, providers, and payors about the individuals that most benefit from this level of care. Full article

Background: Patients with chronic migraine (CM) associated with medication overuse headache (MOH) often exhibit concomitant psychiatric traits including obsessive-compulsive disorder (OCD). Limited data exist on the impact of migraine therapies on these traits. This study aimed to analyse the influence of onabotulinum toxin A (OBT-A) on OCD in CM + MOH patients. Methods: All CM + MOH patients attending the AOU-Marche Headache Centre and treated with OBT-A over a 9-month period were prospectively analysed. At baseline and every three months, patients completed several questionnaires, including the Obsessive-Compulsive Inventory-Revised (OCI-R), to assess the presence of OCD and its subscales. Results: Thirty patients were enrolled. Repeated measures tests revealed a statistically significant decrease from T0 to T3 in the OCI-R score (p = 0.017) and among the different subscales, specifically the checking score (p = 0.029). The MIDAS (migraine disability assessment score) and HIT-6 (headache impact test) scores exhibited a statistically significant reduction from T0 to T3 (p < 0.0001), similar to the decrease in monthly migraine days and symptomatic medication intake. Conclusions: Patients treated with OBT-A showed significant improvement in OCD, particularly in subscales assessing somatic and aggressive obsessions as well as control compulsions. Several patients transitioned from a CM + MOH condition to an episodic form without drug abuse. The potential impact of OBT-A on psychiatric symptoms warrants further consideration to improve patient management strategies. Full article