A trans-diagnostic perspective on obsessive-compulsive disorder

In the paper

“DSM-5 acknowledges that these symptoms are not unique to OCD; outlining 14 other disorders (or disorder classes) whose symptoms also broadly fit these criteria, which the clinician must consider in the context of differential diagnosis.”

What the sources say

• Not checked yetcites APA, 2013

In the paper

“Obsessive-compulsive disorder (OCD), is a chronic, costly and disabling brain disorder for which existing treatments usually produce disappointing outcomes (Fineberg et al. 2014).”

What the sources say

• Not checked yetcites Fineberg et al. 2014

In the paper

“it has been suggested that shortcomings in the use of these categories for basic research are at least partly responsible for the lack of specific and robust associations between psychopathology and underlying neurobiological processes (Hyman, 2007; Sanislow et al. 2010).”

What the sources say

• Not checked yetcites Hyman, 2007
• Not checked yetcites Sanislow et al. 2010

In the paper

“In a wider context, improved nosology based on more objective tests and criteria would lead to more homogeneous populations of patients for clinical trials, more accurate phenotypes for psychiatric genetics, and the potential for detection of early vulnerability, allowing for early therapeutic interventions that prevent progression to chronic illness.”

In the paper

“The issue of homogeneity across diagnostic categories is coupled with a related problem, heterogeneity within diagnostic categories.”

In the paper

“It is typically measured using electroencephalogram, but functional imaging has been coupled with this technique to confirm that the ERN has its source in the anterior cingulate cortex (ACC) (Debener et al. 2005).”

What the sources say

• Not checked yetcites Debener et al. 2005

In the paper

“These findings indicate quite clearly that these and other disorders are not discrete entities, and that the lines between different DSM diagnoses are often blurred (Fig. 1).”

In the paper

“What we will consider in the following sections is an admittedly well-trodden alternative: that it is our psychiatric taxonomy, not our neurocognitive models, that presents a problem for research and that the specificity of any neurocognitive model of a psychiatric diagnosis is fundamentally limited by the extent to which that diagnosis is biologically valid.”

In the paper

“In response, some researchers have called for a shift away from the use of DSM categories, in favour of establishing new and biologically relevant trans-diagnostic traits that may play an important role in multiple disorders, as we currently define them (Robbins et al. 2012; Cuthbert & Kozak, 2013).”

What the sources say

• Not checked yetcites Robbins et al. 2012
• Not checked yetcites Cuthbert & Kozak, 2013

In the paper

“For example, agoraphobia and GAD were associated with increased OCD severity; bipolar disorder was associated with suicidal acts and panic disorder increased treatment-seeking behaviour (Fineberg et al. 2013a).”

What the sources say

• Not checked yetcites Fineberg et al. 2013a

In the paper

“The ERN is a negative deflection of the event-related potential (ERP) when subjects make an error (Falkenstein et al. 1991), listed as the RDoC sub-construct ‘Performance Monitoring’.”

What the sources say

• Not checked yetcites Falkenstein et al. 1991

In the paper

“The National Institute of Mental Health (NIMH) has been an important leader in this regard, launching its Research Domain Criteria (RDoC) initiative (Insel et al. 2010), a framework based on the premise that clinical constructs should be defined (and therefore investigated) on the basis of their neurobiological validity.”

What the sources say

• Not checked yetcites Insel et al. 2010

In the paper

“This particularly impactful finding has provoked a change in DSM-5, such that hoarding symptoms no longer exclusively contribute to a diagnosis of OCD, and are additionally captured by a separate category, ‘hoarding disorder’.”

In the paper

“studies have shown that the ERN primes defensive responses, for example by potentiating startle responses (Hajcak & Foti, 2008) and encouraging avoidance behaviour (Frank et al. 2005).”

What the sources say

• Not checked yetcites Hajcak & Foti, 2008
• Not checked yetcites Frank et al. 2005

In the paper

“GAD (Ladouceur et al. 2006; Weinberg et al. 2012, 2015, 2010) (but see Xiao et al. 2011), social anxiety disorder (Endrass et al. 2014) and depression (Chiu & Deldin, 2007; Holmes & Pizzagalli, 2008, 2010; Georgiadi et al. 2011; Aarts et al. 2013; Tang et al. 2013; Mueller et al. 2015) (although less consistently than in generalized anxiety or OCD, see Ruchsow et al. 2004, 2006; Olvet et al. 2010;”

What the sources say

• Not checked yetcites Ladouceur et al. 2006
• Not checked yetcites Endrass et al. 2014
• Not checked yetcites Chiu & Deldin, 2007

In the paper

“The effect appears to be trait (rather than state) dependent; the ERN remains enhanced following successful treatment in both adult and paediatric OCD (Hajcak et al. 2008; Riesel et al. 2015), does not differ as a result of chronic medication (Stern et al. 2010) and an enhanced ERN has been observed in unaffected first-degree relatives of both adult and paediatric OCD sufferers (Riesel et al. 2011”

What the sources say

• Not checked yetcites Hajcak et al. 2008
• Not checked yetcites Riesel et al. 2015
• Not checked yetcites Stern et al. 2010

In the paper

“This thesis is supported by work in non-clinical samples, wherein the magnitude of the ERN is associated with self-reported worry (Hajcak et al. 2003; Zambrano-Vazquez & Allen, 2014), high levels of trait anxiety (Paulus et al. 2004) and OC-symptoms (Hajcak & Simons, 2002; Zambrano-Vazquez & Allen, 2014).”

What the sources say

• Not checked yetcites Hajcak et al. 2003
• Not checked yetcites Paulus et al. 2004
• Not checked yetcites Hajcak & Simons, 2002

In the paper

“These disorders include addiction (Everitt & Robbins, 2005), eating disorders (Godier & Park, 2014) and Tourette's syndrome (Groenewegen et al. 2003), and although this area of research is still in its infancy, the first empirical investigations have found evidence for goal-directed deficits in these disorders (Sjoerds et al. 2013; Voon et al. 2014; Delorme et al. 2015; Ersche et al. 2016) (Table”

What the sources say

• Not checked yetcites Everitt & Robbins, 2005
• Not checked yetcites Godier & Park, 2014
• Not checked yetcites Groenewegen et al. 2003

In the paper

“Clinically, these habits might manifest as compulsive behaviours and/or higher-order habitual needs or goals (Cushman & Morris, 2015).”

What the sources say

• Not checked yetcites Cushman & Morris, 2015

In the paper

“Moreover, the amplitude of the ERN was found to predict treatment adherence for substance abuse (Steele et al. 2014) and decreases in the ERN are associated with self-reported impulsivity (Potts et al. 2006).”

What the sources say

• Not checked yetcites Steele et al. 2014
• Not checked yetcites Potts et al. 2006

In the paper

“Addressing the trans-diagnostic potential of this neurocognitive mechanism, goal-directed control has been suggested to play a role in a range of disorders that are clinically characterized by repetitive behaviours that persist despite negative events, or are experienced as ‘out of control’ (Gillan et al. 2016a).”

What the sources say

• Not checked yetcites Gillan et al. 2016a

In the paper

“Results in ADHD are mixed with some studies showing decreased ERN (Liotti et al. 2005; van Meel et al. 2007; Groen et al. 2008; Herrmann et al. 2010; Groom et al. 2013), but most reporting no differences (Wiersema et al. 2005, 2009; Groen et al. 2008; Wild-Wall et al. 2009; Zhang et al. 2009; Groom et al. 2010; Sokhadze et al. 2012) and only one study reporting an increase (Burgio-Murphy et al. 20”

What the sources say

• Not checked yetcites Liotti et al. 2005
• Not checked yetcites Wiersema et al. 2005
• Not checked yetcites Burgio-Murphy et al. 2007

In the paper

“such that compulsive behaviours in OCD are not goal-directed responses to anxiety/perceived threat, but are in fact stimulus-evoked, goal-insensitive habits (Dickinson, 1985).”

What the sources say

• Not checked yetcites Dickinson, 1985

In the paper

“Together, these data provide convergent evidence that an enhancement of the ERN is not ubiquitous in psychiatry, but rather appears to be directionally specific to disorders characterized predominantly by anxiety.”

In the paper

“Indeed, like most disorders, OCD rates are higher in the social anxiety population (Grant et al. 2005).”

What the sources say

• Not checked yetcites Grant et al. 2005

In the paper

“However, studies have recently been published showing similar deficits in goal-directed control in schizophrenia (Morris et al. 2015), autism spectrum disorder (Alvares et al. 2016), and most problematically, social anxiety disorder (Alvares et al. 2014, 2016), which is not considered clinically to be a ‘compulsive’ disorder (Table 2).”

What the sources say

• Not checked yetcites Morris et al. 2015
• Not checked yetcites Alvares et al. 2016
• Not checked yetcites Alvares et al. 2014

In the paper

“This approach showcases how in an appropriately powered general population sample, a neurocognitive model can be tested for both generalizability and specificity, leading to a data-driven definition of a neurobiologically validated clinical phenotype.”

What the sources say

• Not checked yetcites Gillan et al. 2016b

In the paper

“the relationship exhibits excellent specificity with respect to ‘non-compulsive’ aspects of psychopathology, i.e. Factor 1 (‘Anxious Depression’) and Factor 3 (‘Social Withdrawal’).”

• Also stated in: § Validating a trans-diagnostic mechanism: goal-directed learning and compulsivity · plain

  “this relationship was dissociable from other trans-diagnostic phenotypes identified in this study, ‘Anxious-Depression’ and ‘Social Withdrawal’ (which showed no relation to goal-directed deficits)”

What the sources say

• Not checked yetcites Gillan et al. 2016b

In the paper

“to date this approach has yet to facilitate gene discovery or the development of new, better treatments.”

In the paper

“Thus, the question of how an ERN measurement can help inform treatment response across disorders is far from clear.”

In the paper

“If these figures hold up to replication using the same analysis pipeline, the interpretation is that if this marker were used to determine whether or not an SRI is prescribed to a drug-naive individual, just two out of every 10 people assigned to SSRI would not respond, while another two of the 10 not assigned the treatment would have missed out on the benefits of the SSRI (Hoexter et al. 2015).”

What the sources say

• Not checked yetcites Hoexter et al. 2015

In the paper

“GAD does not respond to antipsychotics (Ravindran & Stein, 2010).”

What the sources say

• Not checked yetcites Ravindran & Stein, 2010

In the paper

“Although antipsychotics can be useful for OCD in particularly treatment resistant cases”

In the paper

“This means that not only is the same drug effective in treating distinct psychiatric problems, its efficacy at treating depression and OCD symptoms (sometimes in the same individual) is predicted by dissociable patterns of abnormal baseline neural activity.”

What the sources say

• Not checked yetcites Saxena et al. 2003

In the paper

“breaking OCD down into orthogonal trans-diagnostic mechanisms may be of benefit for developing translational models – particularly for animal models that are crucial for causal mechanistic investigations.”

In the paper

“This research initiative has just begun for OCD, and many candidate dimensions await empirical validation or rejection.”

In the paper

“avoidance compulsions, obsessions and anxiety are the defining clinical features of OCD according to DSM-5 (APA, 2013).”

What the sources say

• Not checked yetcites APA, 2013

In the paper

“As the symptom complex that this triad produces is unlikely to be underpinned by one specific cognitive/neural mechanism”