OCD & The impact of the COVID-19 pandemic on those with OCDs

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OCD & The impact of the COVID-19 pandemic on those with OCDs

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The impact of the COVID-19 pandemic on those with OCDs

11/19/20


https://www.news-medical.net/news/20201 ... -OCDs.aspx


Researchers from the University Medical Centre Hamburg-Eppendorf and University Hospital, Munich in Germany, have reported their findings on the course of obsessive-compulsive disorders (OCDs) during the coronavirus disease 2019 (COVID-19) pandemic. Their study, titled “Obsessive-compulsive disorder during COVID-19: Turning a problem into an opportunity?,” was published in the latest issue of the Journal of Anxiety Disorders.

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causative pathogen of COVID-19, has infected a large proportion of the global population, with over 56.42 million cases confirmed worldwide. SARS-CoV-2 is a highly infectious virus that spreads via aerosols and airborne droplets from the mouth and nose. These microbe-laden droplets may also contaminate surfaces. Recent research suggests that the viral microbes landing on surfaces can survive on them for up to 72 hours, increasing the risk of surface (or fomite) transmission. Hand hygiene and mask-wearing are therefore among the primary preventative measures used to curb the spread of SARS-CoV-2.

The study’s authors state that these measures are particularly affecting those with obsessive-compulsive disorder (OCD) around sanitation and cleanliness. Those with washing compulsions have been particularly affected, they write. At present, however, there is little empirical evidence regarding how those with washing compulsions are fairing during the ongoing pandemic.

Mental health problems associated with the pandemic

The researchers point out that several mental health problems have been exacerbated by the pandemic and its associated public health measures. Social isolation measures and the economic downturn has also led to the flaring up of pre-existing mental health problems among many.

To study how COVID-19 has affected those with OCDs, the team used the diathesis-stress model to explain the “development and maintenance” of mental health problems among those susceptible to it. The team explains that those at risk suffer from additional contributing factors such as “low resilience, fewer social contacts, and reduced psychiatric care.” Problems aggravated by the pandemic include depression and anxiety disorders as well as associated behavioral problems such as substance abuse disorders, eating disorders and OCD, the team wrote.

Obsessive-compulsive disorder

A common form of OCD, called “contamination-related OCD (C-OCD),” and those with washing compulsions are often among the worst affected during a pandemic. The researchers explain that compulsions of washing and “ritualized washing behaviors,” have been considered to be part of the “new normal.” These behaviors have been advocated by health bodies such as the World Health Organization (WHO).

Fear of not having enough cleaning products has also led to a stockpiling of soaps, sanitizers, disinfectants, toilet papers and other hygiene products. This has been seen not only among those with OCD but also among others as well.

Guidelines and recommendations


According to the consensus statement from the International College of Obsessive Compulsive Spectrum Disorders and the Obsessive-Compulsive Research Network of the European College of Neuropsychopharmacology, patients with OCD need help adapting to the pandemic even with a pause in treatment to allow, “exposure and response prevention (ERP).” The German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN) has also recommended ERP as an effective and recommended treatment for OCD.

The researchers write that what was perceived earlier as exaggerated could be the “new normal” and this may help reduce the stigma. They write, “people with OCD (particularly those with washing compulsions) may also experience relief due to reduced stigmatization or other factors. Some patients may (paradoxically) even experience a sense of competence as a result of their functional beliefs and use of adaptive coping strategies.”

Study design

For this study, a total of 394 persons diagnosed with OCD were included. Of these, 223 had washing compulsions. Persons aged 18 to 80 years were included. Participant recruitment was between March 23rd and May 18th, 2020. During this period, Germany was under a nationwide lockdown.

An assessment of OCD severity was made using the German version of the Obsessive-Compulsive Inventory-Revised (OCI-R). The severity of depression was assessed using the German version of the Patient Health Questionnaire (PHQ-9).

The participant took an online survey with a new set of questions developed by the researchers. Some of the questions were regarding changes in the participants’ OCD symptoms and reasons the participants attributed to this change.

Some participant responses included “reduced mobility, reduced availability of cleaning products, economic factors, lack of availability of doctors/therapist, interpersonal conflicts.” The team of researchers also assessed the beliefs and experiences of the participants of the COVID-19 pandemic.

Findings

The study results showed that most people with OCD were negatively affected by the COVID-19 pandemic. These were most pronounced among “washers,” and the most common cause of worsening symptoms included reduced mobility and interpersonal conflicts.

Overall results were:


At the start of the study, the OCD severity was moderate to severe among participants, with a mean score of 27 on the OCI-R. The average depression severity score was 12.41 on the PHQ-9, indicating that depression levels among the participants were largely moderate.
An increase in OCD symptoms was reported by 71.8 percent
This worsening was more significant among “washers” compared to “non-washers.”
Some patients, however, experienced a decrease in symptoms (6.5 percent), and some saw no change in symptoms (21.7 percent).
Dysfunctional beliefs regarding the pandemic were mainly hygiene-related, and these were more prevalent in “washers” than in “non-washers”. These also led to a rise in OCI-R scores and an increase in OCD symptoms overall.
“Washers” were also were more confident in their rituals and adaptability and provided other people with advice to prevent the spread of SARS-CoV-2 infection. A total of 22.4 percent offered advice to others.
Washers were, unfortunately, more likely to receive poor feedback from the people they provided with advice regarding infection prevention through hygiene. Overall, feedback in response to hygiene advice was 39.7 percent positive and 24.7 percent negative as per the participant survey.

Conclusions and implications

The researchers found that most participants with OCD were negatively affected by the COVID-19 pandemic, and this was more prominent among “washers” than in “non-washers”.

They called for rapid and specific interventions against OCD to prevent long-term and long-lasting implications of this pandemic-induced aggravation of symptoms among those with OCD.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Cognitive Dysfunction in Obsessive-Compulsive Disorder

published 7/16/16

https://link.springer.com/article/10.10 ... 016-0720-3

Abstract

Obsessive-compulsive disorder (OCD) is a mental disorder featuring obsessions (intrusive thoughts) and compulsions (repetitive behaviors performed in the context of rigid rituals). There is strong evidence for a neurobiological basis of this disorder, involving limbic cortical regions and related basal ganglion areas. However, more research is needed to lift the veil on the precise nature of that involvement and the way it drives the clinical expression of OCD. Altered cognitive functions may underlie the symptoms and thus draw a link between the clinical expression of the disorder and its neurobiological etiology. Our extensive review demonstrates that OCD patients do present a broad range of neuropsychological dysfunctions across all cognitive domains (memory, attention, flexibility, inhibition, verbal fluency, planning, decision-making), but some methodological issues temper this observation. Thus, future research should have a more integrative approach to cognitive functioning, gathering contributions of both experimental psychology and more fundamental neurosciences.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Exploring the neurobiology of OCD: clinical implications

published March 2, 2020

Introduction

Obsessive-compulsive disorder (OCD) is a common neuropsychiatric condition, affecting 1-2% of the population globally. Despite considerable heterogeneity in the precise symptoms experienced across different patients (e.g., some patients are preoccupied with worries of contamination, whereas others obsess about symmetry), there is growing realization that common neurobiological processes may contribute to vulnerability towards OCD and its persistence. OCD is regarded as the archetypal disorder of compulsivity (i.e. a tendency towards repetitive habitual actions that a person feels a need to perform, with these tendencies having untoward functional consequences, such as detracting from overall life goals, or quality of life). Although the optimal definition of compulsivity likely depends upon perspective and context1, within this broad clinical framework, disorders of compulsivity include OCD and related disorders such as hoarding disorder, body dysmorphic disorder, trichotillomania, skin picking disorder, and Tourette’s2. Here we focus on recent advances in understanding the neurobiology of OCD, and the clinical implications of such knowledge viewed in the context of prevailing disease models.


Brain circuitry in OCD

Case vignette: Claire, a 21 year-old student, reports a five-year history of moderately severe OCD, mainly relating to taboo sexual thoughts and the repeated need to confess. Claire signs up for a research study exploring the neurobiology of OCD, in which she undertakes a clinical assessment, cognitive tests, and a structural brain scan. At the end of the session, Claire asks whether her brain scan can be used to help confirm that she has OCD. She says she has read on the Internet about research that can accurately diagnose OCD using brain scans. She asks if she can have a picture of her brain to see the changes that happen in OCD.

Structural and functional changes within the brain have long been implicated in the pathophysiology of OCD. Cortical and sub-cortical brain regions comprise a series of functionally relatively segregated circuits, that may play different roles in thoughts and behaviors3. Neuroimaging work in OCD has commonly identified structural and functional abnormalities, most typically involving the orbitofrontal cortices and basal ganglia (caudate nucleus), known as the ‘orbitofrontal circuit’ (for recent reviews see 4–6). These findings support the classical model that OCD can be considered a disorder of maladaptive habit circuitry7, a model that has gained traction and evolved into more recent conceptualizations focusing on habit8,9 and loss of top-down control by cortically-mediated inhibitory mechanisms (referred to as ‘disinhibition’)10.

In recent years, it has become apparent that OCD involves changes across a broad range of fronto-striatal loop circuits11, though abnormalities of the orbitofrontal cortices and basal ganglia have commonly been reported. OCD has typically been associated with grey matter volume increases in sub-cortical structures (such as the putamen and globus pallidus), and with grey matter reductions in the cortex (especially ventral and dorsal medial cortex, and inferior frontal cortex)12. In terms of measures of cortical thickness (a proxy for the number of neurons in a particular brain region), more widespread reductions have been typically observed, including not only in the frontal but also in the parietal and temporal parts of the brain. Another common finding reported in OCD has been reduced fractional anisotropy (a measure of fiber density, axonal diameter, and myelination in white matter) in anterior midline tracts (including parts of the corpus callosum and cingulate bundle)12. Collectively, these neuroimaging data suggest OCD is associated distributed changes across anatomically disparate brain structures, both in terms of grey matter and white matter tracts.

One approach used more recently to explore brain structure in OCD has been to pool structural neuroimaging scans from many diverse group case-control studies, a technique referred to as ‘mega-analysis’. This approach has found that OCD is associated with smaller hippocampal volumes and larger pallidum volumes, versus controls, but failed to find any significant differences in the caudate or putamen13. Furthermore, OCD was associated with decreased cortical thickness in various frontal, parietal, and temporal cortical regions, versus controls14. These mega-analytic results highlight the existence of structural brain abnormalities outside of the classic orbitofrontal loop circuit.

We can also think of the neurobiological underpinnings of OCD in terms of function of distributed brain networks, whether in the so-called resting state, or during cognitive tasks. Indeed, a meta-analysis of available resting state functional connectivity neuroimaging studies in OCD identified hypo-connectivity within and across some circuits; with dysconnectivity (no particular direction of connectivity changes) in other circuits15.

Cognitive neuroimaging studies in OCD have typically focused on domains previously found to be impaired in the disorder, such as motor inhibitory control, cognitive flexibility, and executive planning. Imaging can be used to assess neurobiological underpinnings of cognitive task performance in two ways: firstly, by measuring activation in particular brain regions; and secondly, by examining functional connectivity or ‘coupling’ between such brain regions. In a meta-analysis of functional neuroimaging studies using inhibitory control tasks, patients with OCD versus controls exhibited under-activation in several brain areas (rostral and ventral anterior cingulate cortices, bilateral thalamus/caudate, right anterior insula/frontal operculum, supramarginal gyus, and orbitofrontal cortex)16.

In terms of functional connectivity, there are recent findings from case-control studies. One study found that OCD patients and their clinically asymptomatic first-degree relatives had reduced functional connectivity between anterior and posterior cortical regions during a motor inhibition task (the stop-signal task)17 (Figure 1). In another study, this time focusing on connectivity between cortex and sub-cortical regions, reduced resting state functional connectivity between the ventrolateral prefrontal cortex and dorsal caudate nucleus was linked with worse cognitive flexibility in OCD compared to controls18. Elsewhere, on a neuroimaging executive planning task, dysconnectivity was identified between cortex and basal ganglia (putamen) in both OCD patients and their clinically asymptomatic first-degree relatives, versus controls with no known family history of OCD19. Because some of these brain changes extend to first-degree family members, they may represent vulnerability markers for OCD.

Collectively, what take home messages can be gleaned from the above? The imaging evidence to date suggests that OCD is associated with distributed, subtle, structural and functional brain changes involving not only the orbito-frontal loop but also other circuits. This information, including awareness of what the literature does and does not demonstrate, can be helpful when asked questions from patients, such as in the case of Claire in the vignette above. To address Claire’s question as to whether her brain scan would “show” OCD, we would explain that although brain changes have been reported when comparing groups of people with OCD to groups of people without OCD, these are ‘average’ differences and are very subtle. They cannot be seen ‘by eye’ on a person’s brain scan.

To address Claire’s other question, as to whether OCD can be diagnosed using a brain scan, the answer is no: there is no appropriately validated algorithm that can be used to diagnose OCD based on a brain scan. There have been studies using a technique called ‘multivariate pattern analysis’ to build predictive models that are capable of classifying scans (e.g. into OCD or control groups)20; however, one cannot conclude from this that these algorithms would generalize to OCD at large, or to other research or clinical settings. For example, smaller studies can result in model ‘over-fit’ – a statistical issue whereby a model can apparently give astoundingly high accuracy; but this just reflects statistical fallacy and results would not generalize. Also, in one of the largest classifier studies to date, using pooled mega-analysis data and high-quality methodology, machine learning classifiers based on neuroimaging measures were found to be poor and no better than chance at identifying OCD when applied to an independent set of data21. There were more promising results when such techniques were applied to a subset of the data, albeit some caution is needed due to the negative overall findings in the primary analysis.

Have advances in the neurobiology of OCD affected treatments?

Case vignette: Joseph is a 28 year-old man with a ten-year history of severe OCD, with contamination obsessions and washing compulsions, extensive procrastination, and repetitive list-making/doodling. He has received appropriate treatment trials with various serotonin reuptake inhibitors, including augmentation strategies using other agents (such as low dose antipsychotic medication, and n-acetyl cysteine), and extensive cognitive behavioral therapy (CBT) using exposure response prevention (ERP). His OCD symptoms remain severe; he is incapacitated by his illness and is not able to leave the house often, work, or socialize. Following approval by an ethics board, and careful discussion of the benefits and risks, Joseph underwent a neurosurgical procedure to implant electrodes targeting the nucleus accumbens. Approximately 6 months following Deep Brain Stimulation (DBS), and continuation of pharmacotherapy and CBT, Joseph reported a significant improvement in OCD symptoms, and he was able to work again and socialize. Three years post-surgery, his symptoms remained much improved with continuation of DBS treatment.

Given the changes across distributed brain circuits described previously, an interesting question is to what extent neurobiological knowledge of OCD has changed treatment approaches for patients. Current first-line, evidence-based treatments for OCD include serotonin reuptake inhibitor medications and/or CBT with ERP. In a recent systematic review and network meta-analysis22 serotonin reuptake inhibitors showed superiority over placebo in treating adult OCD; and all the examined psychological therapies had greater efficacy than drug placebo in adult OCD. These first-line treatments for OCD have been used for >30 years and have not practically been influenced or altered by neurobiological research into OCD.

However, imaging has yielded insights into brain mechanisms by which treatments may improve OCD. There are quite a few studies now that have found that structural and functional brain changes associated with OCD symptoms normalize to some extent with successful medication treatment. Such partial normalization also occurs with psychotherapy in OCD, as revealed in a recent systematic review of the literature23. At the same time, as noted in this review and others, there are some caveats – such as often small sample sizes, lack of suitable control conditions/groups, etc. Overall, successful treatment with medication or psychotherapy does seem to normalize at least some of the brain changes associated with OCD. This leads to the question of whether imaging could be used to direct or predict treatment response. As with diagnosing OCD at the individual patient level using a brain scan, there is no evidence that treatment can be usefully predicted at the individual subject level. Again, studies suggest that algorithms to predict treatment response using baseline scans can be built, including to predict response to psychotherapy24, but these approaches have yet to be shown to generalize or be useful at the individual subject level in clinical practice.

As indicated by the case vignette of Joseph above, DBS, or other ablative techniques such as gamma ventral capsulotomy25 are sometimes used in the most extreme cases of treatment-resistant OCD. These neurosurgical interventions, however, do not help everyone and when successful, may result only in reduction of OCD symptoms, not remission. This has led research into improving these interventions on the individual level based on more detailed neurobiological understanding of OCD. For example, one recent study used a clinical assessment and symptomatic provocation during functional MRI to enhance electrode placement for DBS in a small sample of patients26.

Concluding remarks

Substantive advances have been made in understanding the neurobiology of OCD. We have seen that OCD is often associated with structural brain changes implicating not only the classic orbitofrontal circuit but other regions too – including relative reductions in cortical thickness across multiple regions, which may contribute to the clinical picture of disinhibition and a loss of ‘top-down control’ governing basal-ganglia driven habitual response patterns. Functional imaging has revealed hypo-activation during tasks of inhibitory control, as well as (typically) reduced functional connectivity between key brain regions, during these and other types of cognitive tasks. While some OCD related brain changes appear to normalize with successful treatment, cognitive and neural changes have also been identified in first-degree relatives of OCD patients without symptoms. This indicates that some feature may be vulnerability markers, whereas others may reflect symptoms.

Longitudinal research is needed to better delineate vulnerability versus chronicity markers in OCD, and to translate these research findings into meaningful changes in daily clinical practice.
To date, first line treatments for OCD are essentially unchanged for >30 years. Neurobiological advances are useful as they can help clinicians and patients understand the illness and how treatments work when they successfully improve symptoms. With time, the hope is that predictive algorithms could be developed and validated in order to help refine diagnosis and treatment prediction at the individual patient level; but this remains a hope rather than a present day reality.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Pandemic-related selective increase in obsessive-compulsive symptoms in UK study

12/11/20


https://www.news-medical.net/news/20201 ... study.aspx


COVID-19 has now been around for almost a year and has caused enormous stress among the developed nations of the Western world. A devastating new study shows how a large-scale wave of increased obsessive-compulsive (OC) symptoms affected public behavior, such as seeking information about the pandemic and following government guidelines. This could predict long-term sustained disruptions of mental health as an unexpected sequel to the pandemic.

This study was published in the pre-print server medRxiv*.

Stress and Psychiatric Symptoms

All life events associated with significant stress cause an upsurge of ill mental health. The COVID-19 pandemic was no exception. It ushered in an era of disrupted finances, social interactions, and health. Predictably, all psychiatric symptoms increased over the first wave of the pandemic. This includes symptoms in already diagnosed patients with anxiety, depression, bipolar disease, schizophrenia, and obsessive-compulsive disorders (OCD).

Members of the general public also showed a significant increase in symptoms of anxiety and depression. However, in typical situations, once the individual adapts to the situation, such symptoms return to the baseline. This is mediated by the re-appraisal of the situation and the evolution of coping strategies.

OCD is a mental condition that is selectively cultivated by pandemic conditions because the campaign to contain severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread pivots around the need to prevent and remove contamination by cleaning. This pervasive fear of an invisible foe which spreads by contamination and is combated by cleaning and other non-pharmaceutical interventions (NPIs), including face mask use and social distancing, caters to OCD behavior.

“These news coverages and governmental guidelines may thus give validity to OCD-symptomatic behavior, potentially intensifying or triggering them.”

This may lead to a wave of OC symptoms in the general public as well, as more attention is paid to the area of contamination and cleaning.

Study Details

To assess this risk, the researchers carried out a longitudinal study on the impact of COVID-19 on OC, anxiety, and depression. They followed psychiatric scores in these three areas for several months from May to August 2020. They also observed any correlations between OC symptoms, information-seeking about COVID-19, and the following government guidelines.

The first data collection was from April 24, 2020, to May 7, 2020, the peak of the first wave. Here, standardized questionnaires were used to record the three types of symptoms among 416 participants, and information-seeking behavior, along with their use of news and social media. They also had a mental ability test.

This assessment was repeated at the second time point, between July 15 and August 15, 2020, with an additional assessment of how well they followed COVID-19 guidelines. At this time, the largest relaxation of pandemic restrictions had just occurred, and thus the effects of a significant change in the environment could also be measured. At this point, there were 304 participants.

The researchers used self-administered questionnaires to measure OC (Padua Inventory-Washington State University Revision (PI-WSUR)), with anxiety and depression (Hospital Anxiety and Depression Scale (HADS)). They also asked about the average use of news and social media pre-pandemic. At the second assessment, they asked also how far the respondents observed pandemic-related recommendations by the authorities.

Initial Rise in Psychiatric Scores


The investigators found that all psychiatric scores were initially elevated, some components of the PI-WSUR being scored at OCD level. With the HADS, too, about half and 40%, respectively, met the cut-off for anxiety and depression, respectively.

The corresponding population-level rates for the latter conditions before the pandemic, in one of the largest studies, was around 20% for both, showing high symptoms scores during the first wave of COVID-19.

Selective Increase in OC Symptoms in Later Phase

Over time, however, only the OC symptoms showed a further rise, even when items related to contamination and cleaning were excluded from the analysis. Thus, normal adaptation did not occur concerning OC symptoms during the lockdown, but instead, they continued to rise. Curiously, anxiety, and depression showed the expected drop, due to adaptation.

Increased Adherence to Guidelines

The third area of investigation was the role of these symptoms in causing pandemic-related behavior, especially since people with high OC symptoms were seen to be engaged in increased information-seeking behavior. They found that most of such behavior in respondents occurred at the beginning of the lockdown, and was due to the lack of knowledge about the pandemic.

The researchers also looked at the link between information seeking and psychiatric symptoms. They found that OC symptoms were related to a higher expression of this behavior at both early and late time points. The same was also true of anxiety scores but to a smaller extent. This was true even after adjusting for age, gender, and social media use unrelated to the pandemic.

What are the Implications?

When analyzed using all the psychiatric symptoms as potential predictors for information-seeking behavior, the only consistent association was found to be with OC symptoms. The association with anxiety disappeared in this analysis. Thus, although information-seeking decreased over time, the reverse was observed in connection with OC symptoms. This favors the role of OC symptoms as the main reason for pandemic-related information seeking.

Again, the increase in information seeking related to OC symptoms was found to result in the increased tendency to adhere to government COVID-19 guidelines even after the relaxation of restrictions. Both these behaviors were independently predictive of the tendency to follow these guidelines.

The benefit to society from such OC symptoms is obvious, with respect to viral containment, though they do impose a burden of care on the individual. On the other hand, the rise and prolonged duration of such symptoms suggest the need to put policies in place to follow up on individuals with a high risk of developing OCD. Interventions are necessary to prevent and treat the condition before long-term mental ill-health sets in.

Our findings highlight that OC symptoms are disproportionally affected by the pandemic by documenting their selective increase throughout the pandemic for the first time, which may result in serious adverse long-term consequences.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal reference:


Loosen, A. M. et al. (2020). Current Testing-Isolation Policies Effectively Prevent Campus Transmission of COVID-19. medRxiv preprint. doi: https://doi.org/10.1101/2020.12.08.20245803. https://www.medrxiv.org/content/10.1101 ... 20245803v1
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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A Promising New Therapy Against OCD?

1/19/21


https://consumer.healthday.com/1-19-a-p ... 16865.html


TUESDAY, Jan. 19, 2021 (HealthDay News) -- Noninvasive electrical stimulation of the brain, fine-tuned to specific "circuitry" gone awry, might help ease obsessive-compulsive behaviors, an early study hints.

Researchers found that the brain stimulation, delivered over five days, reduced obsessive-compulsive tendencies for three months, though in people who did not have full-blown obsessive-compulsive disorder (OCD).

It's too early to say whether the approach can be translated into an OCD therapy, said researcher Shrey Grover, a PhD student in psychological and brain sciences at Boston University. "We need more research to replicate these findings. It will take time before this is widely available."

But the work, described online Jan. 18 in Nature Medicine, builds on a body of research into the underpinnings of OCD.

Research has shown that people with OCD have difficulty processing "rewards" from the environment, Grover explained. So they become reliant on certain rituals, whether it's compulsively washing their hands, making sure household items are placed a particular way or checking that appliances are turned off.

Scientists have also found that certain brain activity patterns are associated with those symptoms.

In fact, abnormalities in the brain's circuitry are involved in a number of psychiatric conditions, according to Dr. Alon Mogilner, director of the Center for Neuromodulation at NYU Langone Health, in New York City.

"Neuromodulation" is a broad term for therapies that use electrical pulses to alter the firing patterns of nerves.

Mogilner, who was not involved in the new study, sometimes treats OCD using deep brain stimulation (DBS), which involves surgical implantation of electrodes into the brain, with the goal of interfering with abnormal electrical activity in specific brain areas.

DBS is reserved for the toughest cases of OCD, Mogilner said, where people have debilitating symptoms that fail to respond to standard behavioral therapy and medication (usually SSRI antidepressants).

"It's for the situations where people can't leave the house because they have to keep washing their hands," Mogilner said.

DBS helps about 50% to 60% of the time, according to Mogilner. But that leaves a significant portion who do not improve.

And for some people with OCD, the idea of having electrodes implanted in the brain is one more thing to obsess over, Mogilner noted.

Noninvasive brain stimulation would avoid the risks of surgery, he said, and possibly give some patients an option they could live with.

One noninvasive approach -- transcranial magnetic stimulation -- was recently approved in the United States for OCD. It's typically done in daily sessions, five days a week, for about six weeks, according to the National Alliance on Mental Illness.

For the new study, the Boston researchers recruited 124 volunteers. None had OCD, but many scored high on the obsessive-compulsive scale. Those behaviors, Grover explained, exist on a spectrum: It's not that people either have OCD or no symptoms at all.

The researchers used a newer neuromodulation technique called transcranial alternating current stimulation (tACS), where electrodes on the scalp deliver an oscillating current at a chosen frequency that interacts with the brain's natural activity.

First, the researchers found they were able to influence volunteers' "reward-based" behavior during a standard test, by using tACS currents that were individualized to each person's natural frequency in the brain's reward-processing network.

Then, in a separate experiment, the investigators found that applying the brain stimulation for 30 minutes on five consecutive days reduced participants' obsessive-compulsive behaviors for up to three months.

There are plenty of questions ahead, including whether those effects can be replicated in OCD patients, Grover said.

Mogilner said the "personalized" aspect of the tACS approach is interesting: He likened it to tuning in to not only the brain circuits involved in the behavior, but the "sounds" in those circuits. Still, he said, the degree to which that improves the effectiveness for any one person remains to be seen.

Another big question, Mogilner said, is what happens in the long run: How long could any benefits from tACS last, and how often would sessions need to be repeated?

Grover agreed. "We want strong effects that are sustainable," he said. "We don't know if this will be as effective as DBS."

On the big-picture side, the precise causes of OCD remain unknown. The current findings, Grover said, do not prove that abnormal brain activity patterns are the "origin" of OCD: They might reflect some other root cause.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Are we all OCD now? Coronavirus fears blur the line between obsessive-compulsive and safety amid a dangerous pandemic

6/15/20


https://theconversation.com/are-we-all- ... mic-140205


One of the hallmarks of obsessive-compulsive disorder is contamination fears and excessive hand-washing. Years ago, a patient with severe OCD came to my office wearing gloves and a mask and refused to sit on any of the “contaminated” chairs. Now, these same behaviors are accepted and even encouraged to keep everyone healthy.

This new normal in the face of a deadly pandemic has permeated our culture and will continue to influence it. Many stores now prominently post rules mandating face masks and hand sanitizer use and limit the number of customers allowed inside at one time. Walkers and joggers politely cross the street to avoid proximity to each other.

Only a few months ago, this type of behavior would have been considered excessive and certainly not healthy.

So, where do doctors draw the line between vigilance to avoid being infected with the coronavirus and obsessive-compulsive disorder that can be harmful?

This is an important question that I, a psychiatrist, and my co-author, a wellness and parenting coach, often hear.

Adaptation or internet addiction?


Since the start of the pandemic, it has become more challenging to assess behaviors that were once considered excessive. Many behaviors previously considered pathological are now considered essential to protect human health and are applauded as adaptive and resourceful.

Before COVID-19, concerns about compulsive use of the internet or internet addiction, characterized by overuse and overdependence on digital devices, were growing.

During the pandemic, however, society has quickly adapted online opportunities. Whenever possible, people are working from home, attending school online and socializing through online book clubs. Even certain health care needs are increasingly being met remotely through telehealth and telemedicine.

Overnight, digital connections have become commonplace, with many of us feeling fortunate to have this access. Similar to contamination fears, some digital behaviors that were once questioned have become adaptive behaviors that keep us healthy – but not all of them.

Is it obsessive-compulsive or protective?


While COVID-19-era behaviors may look like clinical OCD, there are key distinctions between protective behaviors in the face of a clear and present danger like a pandemic and a clinical diagnosis of OCD.

The repetitive, ritualistic thoughts, ideas and behaviors seen in clinical OCD are very time-consuming for people dealing with them, and they significantly interfere with several important areas of the person’s life, including work, school and social interactions.

Some people have obsessive-compulsive traits that are less severe. These traits are often observed in high-achieving people and are not clinically debilitating. Such “keep the eye on the prize” behaviors are recognized in nearly 20% of the population. A talented chef who is very attentive to detail may be referred to as “obsessive-compulsive.” So may a detail-oriented engineer building a bridge or an accountant doing taxes by examining files from many different angles.

The critical difference is that the persistent, repetitive, ritualistic thoughts, ideas and behaviors seen in those suffering from clinical OCD often take over the person’s life.

When most of us check the door once or twice to make sure it is locked or wash our hands or use sanitizer after going to the grocery store or using the restroom, our brains send us the “all clear” signal and tell us it is safe to move on to other things.

A person with OCD never gets the “all clear” signal. It is not uncommon for a person with OCD to spend several hours per day washing their hands to the point their skin becomes cracked and bleeds. Some people with OCD have checking rituals that prevent them from ever leaving their home.

OCD triggers have become harder to avoid

The same principles that apply to compulsive hand-washing behaviors also apply to compulsive use of the internet and electronic devices. Excessive use can interfere with work and school and harm psychological and social functioning. Besides social and familial problems, those behaviors can lead to medical problems, including back and neck pain, obesity and eye strain.

The American Pediatric Association recommends that teenagers spend no more than two hours per day using the internet or electronic devices. Some teenagers with internet addiction are spending as many as 80-100 hours per week on the internet, refusing to do anything else, including their schoolwork, outside activities and interacting with their families. The digital world becomes a black hole that is increasingly difficult for them to escape.

For those who struggle with compulsive use of the internet and social media, the new, increased demands to use digital platforms for work, school, grocery shopping and extracurricular activities can open the black hole even further.

People with pre-pandemic contamination fears, or who previously were unable to regulate their use of technology, find trigger situations that were once avoidable have now become even more ubiquitous.

Keeping the threat response in check

As new behavioral norms evolve due to the changing social conditions, the way that certain behaviors are identified and described may also evolve. Expressions such as being “so OCD” or “addicted to the internet” may take on different meanings as frequent hand-washing and online communication become common.

For those of us adapting to our new normal, it is important to recognize that it is healthy to follow new guidelines for social distancing, washing hands and wearing masks, and that it is OK to spend extra time on the internet or other social media with the new limits on personal interactions. However, if internet use or hand-washing becomes uncontrollable or “compulsive,” or if intrusive “obsessive” thoughts about cleanliness and infection become problematic, it’s time to seek help from a mental health professional.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Hoarding, stockpiling, panic buying: What’s normal behavior in an abnormal time?

11/17/20


https://theconversation.com/hoarding-st ... ime-149422


Symptoms of depression, anxiety and obsessive compulsive disorders have emerged or worsened for many during the pandemic. This is no surprise to clinicians and scientists, who have been increasing worldwide access to mental health information and resources.

But what effect has the pandemic had on another common but often misunderstood problem – hoarding? The issue first received attention when people piled up paper towels, toilet tissue and hand sanitizer in their shopping carts at the start of the pandemic, leading some people to wonder whether they or a loved one were showing signs of hoarding disorder.

The short answer is: Probably not. Hoarding disorder goes beyond stockpiling in an emergency. I am a psychiatrist at the University of Florida and the director of the Center for OCD, Anxiety and Related Disorders. I also recently authored a book on hoarding disorder. My work focuses on identifying the causes of hoarding and its impact on individuals and on society.

Millions have hoarding disorder

Although often sensationalized in the popular press as a behavioral oddity, hoarding disorder is a serious psychiatric illness affecting more than 13 million American adults. The cause is a complex interaction of biological and environmental factors. Doctors have known about hoarding for centuries, although the disorder was only formally recognized by the psychiatric community as a distinct psychiatric illness in 2013. Perhaps the most famous person who had a hoarding disorder was Howard Hughes.

The disorder is chronic and often lifelong. Although symptoms typically begin in adolescence, they usually do not become problematic until mid- to late adulthood. No one knows exactly why the disorder takes so long to manifest; perhaps as those with hoarding symptoms get older, their ability to decide what to discard becomes increasingly impaired. Or they might have fewer people around, like parents or spouses, to encourage them to get rid of unneeded items.

What is clear is that the increase in hoarding behaviors across the lifespan is not just a result of a lifetime’s accumulation of clutter. About 7% of adults over age 60 have problematic hoarding; that’s one in every 14 people.

And contrary to popular belief, the defining feature of hoarding disorder is not clutter. Instead, it is the difficulty in discarding what’s no longer needed. The most commonly hoarded items are everyday belongings: clothes, shoes, containers, tools and mechanical objects like nails and screws, household supplies, newspapers, mail and magazines. Those with the disorder report feeling indecision about what to discard, or fear the item will be needed in the future.

This trouble in disposing of items, even common items like junk mail, plastic bags and plastic containers, leads to the accumulation of clutter. Over time, living and work spaces become unusable. In addition to affecting living spaces, hoarding also causes problems between spouses, between parents and their children, and between friends. At its worst, hoarding can also impact one’s ability to work.

Hoarding disorder has a substantial impact on public health, including not only lost work days but also increased rates of medical illness, depression, anxiety, risk of suicide and cognitive impairment. As many as half of those suffering from hoarding disorder will also suffer from depression, and 30% or more will have an anxiety disorder.

Hoarding-related clutter in homes increases the risk of falls, pest or vermin infestation, unstable or unsafe living conditions and difficulty with self-care. It may stun you to know that up to 25% of deaths by house fire are due to hoarding.

Stockpiling and panic buying

What is the difference between stockpiling, panic buying and hoarding? Will someone who stockpiled toilet paper and hand sanitizer in the early days of the pandemic develop hoarding disorder? Or are they instead rational and thoughtful planners?

While these terms are often used interchangeably, stockpiling and panic buying are not symptoms of hoarding disorder. Nor are they necessarily the result of a psychiatric or psychological condition. Instead, stockpiling is a normal behavior that many people practice in preparation for a known or anticipated shortage. The goal of stockpiling is to create a reserve in case there’s a future need.

For example, people who live in cold climates may stock up on wood for fireplaces and salt for driveways before the winter. Similarly, those who live in the southeast U.S. may stock up on gasoline and water before hurricane season.

That said, stockpiling can be excessive. During a crisis, it can lead to national shortages of essential items. This occurred early in the pandemic, when people bought toilet paper in large quantities and emptied store shelves for everyone else.

Ironically, the more media attention on stockpiling, the more it triggers additional stockpiling. People reading about a potential shortage of hand sanitizer will be driven to buy as much as possible until it’s no longer available for weeks or months.

While stockpiling is planned, panic buying is an impulsive and temporary reaction to anxiety caused by an impending crisis. Items, even if unneeded, may be purchased simply because they are available on store shelves. Panic buying may also include purchasing enormous quantities of a particular item, in volumes that will never be needed, or emptying a store shelf of that item. Panic acquiring, which involves getting free things through giveaways, food pantries or scavenging, also occurs during a crisis.

Unlike those with hoarding disorder, panic buyers and stockpilers are able to discard something no longer needed. Usually, after the crisis has passed, they can easily throw or give these items away.

How to get help


For some with hoarding disorder, the pandemic has made it even harder to dispose of unneeded items. Others find their material belongings provide comfort and safety in the face of increased uncertainty. Yet others have used the lockdowns as a reset – time to finally declutter their home.

If you or someone you know has problems with hoarding, help is available. Resources are on the American Psychiatric Association website and at the International Obsessive Compulsive Foundation.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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Digital hoarders: we’ve identified four types – which are you?

1/15/21


https://theconversation.com/digital-hoa ... you-153111


How many emails are in your inbox? If the answer is thousands, or if you often struggle to find a file on your computer among its cluttered hard drive, then you might be classed as a digital hoarder.

In the physical world, hoarding disorder has been recognised as a distinct psychiatric condition among people who accumulate excessive amounts of objects to the point that it prevents them living a normal life. Now, research has begun to recognise that hoarding can be a problem in the digital world, too.

A case study published in the British Medical Journal in 2015 described a 47-year-old man who, as well as hoarding physical objects, took around 1,000 digital photographs every day. He would then spend many hours editing, categorising, and copying the pictures onto various external hard drives. He was autistic, and may have been a collector rather than a hoarder — but his digital OCD tendencies caused him much distress and anxiety.

The authors of this research paper defined digital hoarding as “the accumulation of digital files to the point of loss of perspective which eventually results in stress and disorganisation”. By surveying hundreds of people, my colleagues and I found that digital hoarding is common in the workplace. In a follow-up study, in which we interviewed employees in two large organisations who exhibited lots of digital hoarding behaviours, we identified four types of digital hoarder.

“Collectors” are organised, systematic and in control of their data. “Accidental hoarders” are disorganised, don’t know what they have, and don’t have control over it. The “hoarder by instruction” keeps data on behalf of their company (even when they could delete much of it). Finally, “anxious hoarders” have strong emotional ties to their data — and are worried about deleting it.

Working life

Although digital hoarding doesn’t interfere with personal living space, it can clearly have a negative impact upon daily life. Research also suggests digital hoarding poses a serious problem to businesses and other organisations, and even has a negative impact on the environment.

To assess the extent of digital hoarding, we initially surveyed more than 400 people, many of whom admitted to hoarding behaviour. Some people reported that they kept many thousands of emails in inboxes and archived folders and never deleted their messages. This was especially true of work emails, which were seen as potentially useful as evidence of work undertaken, a reminder of outstanding tasks, or were simply kept “just in case”.

Interestingly, when asked to consider the potentially damaging consequences of not deleting digital information – such as the cybersecurity threat to confidential business information – people were clearly aware of the risks. Yet the respondents still showed a great reluctance to hit the delete button.

At first glance, digital hoarding may not appear much of a problem — especially if digital hoarders work for large organisations. Storage is cheap and effectively limitless thanks to internet “cloud” storage systems. But digital hoarding may still lead to negative consequences.

First, storing thousands of files or emails is inefficient. Wasting large amounts of time looking for the right file can reduce productivity. Second, the more data is kept, the greater the risk that a cyberattack could lead to the loss or theft of information covered by data protection legislation. In the EU, new GDPR rules mean companies that lose customer data to hacking could be hit with hefty fines.

The final consequence of digital hoarding — in the home or at work — is an environmental one. Hoarded data has to be stored somewhere. The reluctance to have a digital clear-out can contribute to the development of increasingly large servers that use considerable amounts of energy to cool and maintain them.

How to tackle digital hoarding

Research has shown that physical hoarders can develop strategies to reduce their accumulation behaviours. While people can be helped to stop accumulating, they are more resistant when it comes to actually getting rid of their cherished possessions — perhaps because they “anthropomorphise” them, treating inanimate objects as if they had thoughts and feelings.

We don’t yet know enough about digital hoarding to see whether similar difficulties apply, or whether existing coping strategies will work in the digital world, too. But we have found that asking people how many files they think they have often surprises and alarms them, forcing them to reflect on their digital accumulation and storing behaviours.

As hoarding is often associated with anxiety and insecurity, addressing the source of these negative emotions may alleviate hoarding behaviours. Workplaces can do more here, by reducing non-essential email traffic, making it very clear what information should be retained or discarded, and by delivering training on workplace data responsibilities.

In doing so, companies can reduce the anxiety and insecurity related to getting rid of obsolete or unnecessary information, helping workers to avoid the compulsion to obsessively save and store the bulk of their digital data.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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OCD patients with psychiatric comorbidities can benefit from deep brain stimulation

3/31/21


https://www.news-medical.net/news/20210 ... ation.aspx


A new study published in Frontiers in Psychiatry finds that patients with Obsessive Compulsive Disorder (OCD) as well as other psychiatric comorbidities, such as autism spectrum or tic disorders, may respond well to Deep Brain Stimulation (DBS).

DBS is a minimally invasive neurosurgical procedure that uses coordinates to target certain areas of the brain, implanting electrodes that can help regulate abnormal brain activity. DBS procedures are rare for OCD in the United States; only a couple hundred patients have received this treatment for OCD management since its FDA approval in 2009 via a Humanitarian Device Exemption. The effectiveness of DBS for OCD has been well-documented in literature, but the interplay with comorbid disorders has not been as thoroughly explored.

" This study helps us understand more about real-world use of DBS for OCD. Most patients seeking treatment don't only have OCD, comorbidities are more the rule than the exception. So it's important to understand how this life-changing procedure can benefit our more typical patients."

- Rachel Davis, MD, Associate Professor, CU Department of Psychiatry and Study Principal Investigator

Davis and clinicians at the University of Colorado Anschutz Medical Campus retrospectively examined five patients seeking DBS for OCD between 2015 and 2019. Patients exhibited comorbidities including substance use disorder, eating disorder, autism spectrum disorder, major depression, ADHD, and tic disorder.

Three patients were awake during DBS surgery, allowing clinicians to check for response to stimulation (improved mood, increased energy, and reduction in anxiety), an additional way to confirm correct electrode placement. After surgery, Davis assessed response and determined the correct settings by asking patients about changes in mood, energy, and anxiety. Improvement in these areas tend to be associated with reduction in OCD symptoms later on. Change over time was monitored with a variety of IRB-approved questionnaires, gauging changes in mood, anxiety, depression and other quality of life elements affected by OCD.

Overall, these patients experienced significant improvement in OCD and mood symptoms. A standard scale for assessing symptom severity and treatment response in OCD, the Yale-Brown Obsessive-Compulsive Scale (YBOCS), measures degree of distress and impairment caused by obsessions and compulsions. A good clinical response is considered to be greater than a 35% reduction. In this study, patients averaged a 44% reduction on this scale; four out of five experienced full response with the fifth having a partial response, with approximately 25% reduction in OCD symptoms. Patients also reported an average of 53% reduction in depression symptoms.

"For these treatment-refractory OCD patients, our Psychiatric DBS program, led by Dr. Davis, is finally providing relief," says John Thompson, PhD, associate professor of neurosurgery at the University of Colorado School of Medicine and one of the co-authors on this manuscript. "While DBS for OCD is rare, this study is a glimpse at its potential. There is much yet to be learned about the complex interplay between circuit modulation and co-morbid symptom management in OCD patients treated with DBS."

Source:

University of Colorado Anschutz Medical Campus

Journal reference:

Kahn, L., et al. (2021) Deep Brain Stimulation for Obsessive-Compulsive Disorder: Real World Experience Post-FDA-Humanitarian Use Device Approval. Frontiers in Psychiatry. doi.org/10.3389/fpsyt.2021.568932.
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Re: OCD & The impact of the COVID-19 pandemic on those with OCDs

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OCD, anxiety and depressive symptoms worsen in young people during COVID-19

11/9/20


https://www.news-medical.net/news/20201 ... ID-19.aspx


Many children and young people with obsessive thoughts and compulsions experience that their OCD, anxiety and depressive symptoms worsen during a crisis such as COVID-19. This is shown by a new research result from Aarhus University and the Centre for Child and Adolescent Psychiatry, Central Denmark Region. The findings have been published in BMC Psychiatry.

Trauma and stress can trigger or worsen OCD. Researchers already know this. They have also shown us that COVID-19 may be associated with adults developing psychiatric disorders. But we do not know much about what the corona crisis means for children and young people.

A team of researchers from Aarhus University and the Centre for Child and Adolescent Psychiatry, Central Denmark Region, therefore decided to examine how children and young people with OCD experience the crisis. Professor, Department Chair Per Hove Thomsen led the research project.

Condition worsened

During the spring of 2020, the researchers sent a questionnaire to two groups of children and young people between the ages of seven and 21. One group had been diagnosed with OCD in a specialised OCD section at the Centre for Child and Adolescent Psychiatry - and all had been in contact with a therapist at the hospital. The other group was identified through the Danish OCD Association. The majority of these children and young people had been diagnosed years ago. A total of 102 children responded to the questionnaire.

" Their experience was that their OCD, anxiety and depressive symptoms worsened during a crisis like COVID-19. This worsening was most pronounced for the group identified through the OCD Association."

- Per Hove Thomsen, Professor, Aarhus University

Almost half of the children and young people who belonged to the first group reported that their symptoms had become worse, while a third of them replied that their anxiety had worsened and a third that their depressive symptoms had worsened. And of these, almost a fifth experienced that both symptoms had got worse. In the other group, 73 per cent reported that their condition had worsened, just over half that their anxiety had worsened, and 43 per cent answered that the depressive symptoms had increased.

Disinfect and wash hands


Judith Nissen, who is a consultant, was also one of the driving forces behind the study. She emphasises that it is no coincidence that the researchers have chosen to study OCD.

"The disorder is particularly interesting to study in relation to the COVID-19 pandemic, because OCD is a disorder with many different clinical expressions, including not least health anxiety, fear of bacteria and dirt, and excessive hand washing/use of disinfection. It's therefore important to examine how such a significant crisis can affect the expression, frequency and progression of the disorder," she explains.

The children and young people who in the questionnaire had described thoughts and anxiety over how something serious could happen, e.g. that they themselves could become ill or lose family members, experienced the most significant worsening of their OCD symptoms. In particular, children who had begun suffering from OCD at an early age experienced the most pronounced worsening.

"For children who are already anxious about loss, the daily descriptions in the media of illness and death and recommendations about isolation and focus on infection can exacerbate these anxious thoughts, perhaps also especially for the youngest children, who may have greater difficulty understanding the significance of the infection, but who are also very dependent on parents and grandparents and thus are most vulnerable to loss," says Judith Nissen.

On the other hand, there is no correlation with anxiety about infection and impulsive hand washing. The study thus indicates that children and young people with OCD may be vulnerable in relation to a crisis such as COVID-19, where anxiety about something serious happening - including the loss of close relatives - characterises a particularly vulnerable group.

"This may be related to both the direct threat of the infection and to the consequences of having to maintain social distancing, social isolation and the significant level of focus on hygiene. The crisis is not over yet, and it's therefore very important that we continue to focus on vulnerable children and young people in the future," says Judith Nissen.

Source:

Aarhus University

Journal reference:


Nissen, J.B., et al. (2020) The immediate effect of COVID-19 pandemic on children and adolescents with obsessive compulsive disorder. BMC Psychiatry. doi.org/10.1186/s12888-020-02905-5.
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