A strong week for CBT-treatment of pediatric OCD

It has been an intense week for those involved in the treatment of OCD in children and adolescents. Fabian Lenhard has successfully defended his thesis, congratulations Fabian! His opponent was Professor John Piacentini from University of California, Los Angeles. Professor Piacentini is an experienced clinician and researcher in pediatric OCD. Yesterday he gave a lecture on the research frontiers in this field.

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Fabian and his supervisors. From left to right: Erik Andersson, Eva Serlachius, Fabian Lenhard, Christian Rück, and David Mataix-Cols

Internet-delivered CBT for adolescents with OCD

The topic of Dr. Lenhard’s thesis is Internet-delivered Cognitive Behavior Therapy for Adolescents with Obsessive-Compulsive Disorder. You can find the thesis here: https://openarchive.ki.se/xmlui/handle/10616/45535

He has developed and tested the treatment in an open trial and a randomized controlled trial. Analyses on cost-effectiveness and predictors of outcome are underway.

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Fabian during his dissertation

The results from both the open trial and the randomized trial indicate that internet-delivered CBT is an effective treatment for adolescents with OCD. The pre-post within-group effect sizes were large in both trials.

Link to the open trial: http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0100773

Link to the randomized trial: http://www.jaacap.com/article/S0890-8567(16)31857-3/abstract

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Main results from the open trial.

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Main results from the randomized trial

Professor John Piacentini: Optimizing Outcomes for Pediatric OCD

During his visit to Sweden, Professor Piacentini talked about research that aims to optimize outcomes in pediatric OCD. After receiving CBT, around 40 % of patients are in remission. While our treatments are effective for some, we still have a long way to go in order to treat every child and adolescent with OCD. Looking into specific mechanisms of change might be a way to optimize the current treatments.

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Professor Piacentini of UCLA

Some suggested mechanisms include expectations of recovery (which might be mediated by home work compliance), the ability of a therapist to push exposures, and affect labeling (”I feel scared”) rather than cognitive restructuring during exposure.

Professor Piacentini also discussed recent work on neurotransmitters that directly target the underlying brain correlates of OCD. For example, glutamate levels might serve as a possible moderator of treatment outcome. We are awaiting the results from trials that aim to change glutamate levels pre-treatment to enhance the outcomes of CBT.

New PhD student at Rücklab: Oskar Flygare

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Hi! My name is Oskar Flygare and I’m the latest addition to the group of PhD students at Rücklab. I have been working in the group for a year and am now a registered doctoral student with Christian Rück as main supervisor. Co-supervisors are David Mataix-Cols and Erik Andersson.

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Photo: Martin Hammar

The focus of my PhD thesis is the psychological treatment of OCD

Lina Lundström and I are the project managers of a randomised controlled trial that compares two types of internet-delivered cognitive behavioural therapy (ICBT) with face-to-face cognitive behavioural therapy for adults with OCD. The three treatments are:

  • Individual face-to-face CBT
  • Therapist-guided ICBT
  • Self-guided ICBT

120 individuals will be randomised to receive one of the treatments, i.e. 40 patients in each treatment arm. Treatment lasts for 14 weeks. We are recruiting participants and you can register here.

Our main goal is to evaluate the treatments on how well they provide symptom relief. In addition to this, I will also perform cost-effectiveness analyses on the three treatments, i.e. evaluate the benefits in relation to costs. My study plan also contains research on predictors and moderators of treatment outcome.

When I’m not doing a deep-dive in obscure research, I enjoy playing and listening to music. I have been playing the saxophone for 15 years and wanted to become a professional musician when I was a teenager. I came to my senses after three years of intense music studies in high school and switched to psychology.

Please get in touch if you want to exchange ideas or talk about interesting research! I am always curious, sometimes thoughtful and never indifferent.

Visit from Blake Dear of eCentreClinic, Australia

Dr. Blake F. Dear, Co-Director of the eCentreClinic in Australia, recently visited Karolinska Institutet to partake in the dissertation of Marianne Bonnert. While in Sweden, he also gave a talk on recent updates from the Australian eCentreClinic. They develop internet-delivered psychological treatments for common mental health and physical health conditions.

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Rücklab retreat 2017

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From left to right: Josef Isung, Diana Radu Djurfeldt, Gustaf Brander, Volen Ivanov, James Crowley, Christian Rück, Lina Lundström, Oskar Flygare, Andrew Gentile, Evelyn Andersson, Julia Boberg, Mia Asplund and Jesper Enander.

It’s officially 2017, and the members of our group took to Yasuragi spa & bath outside Stockholm for this year’s retreat! Although some were more devoted to the Yasuragi-outfits than others (see above), everyone participated in the different activities with enthusiasm.

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Rücklab at EABCT 2016

EABCT, or European Association for Behaviourial and Cognitive Therapies, is hosting their 46th conference this weekend. The conference takes place at the Waterfront Congress Centre in Stockholm, Sweden. Representatives from our team will of course be present at the congress, see you there!

Thursday

Symposium

New Developments in Hoarding Disorder: Heritability, Developmental Course, Risk Factors, and Treatment Approaches

Volen Ivanov will present findings from his research and join the discussion in this symposium, which is hosted by Lorena Fernandez de la Cruz in our close research network. David Mataix-Cols will participate as a discussant at this symposium.

Friday

Panel Discussion

Vård av Psykisk Ohälsa i Sverige – Aktuell Situation och Framtida Utmaningar

Group Leader Christian Rück participates in this discussion, which will be held in Swedish.

Saturday

Poster

Lina Lundström and Oskar Flygare will present their poster at Saturday’s poster session. Come talk to them and ask critical questions about their study protocol!

Symposium

Recent Advances on Cognitive-Behavioural Mechanisms and Treatment of Body Dysmorphic Disorder

Jesper Enander from our team will join the panel discussion at this symposium, together with David Mataix-Cols in our near network.

Increased risk of suicide in patients with obsessive-compulsive disorder

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In a recent study published in Molecular Psychiatry, members of our group and colleagues at Karolinska Institutet have looked at suicide in obsessive-compulsive disorder (OCD). The study compared rates of suicide among 36 788 patients with OCD and matched controls without an OCD diagnosis.

The risk of dying by suicide was found to be about 10 times higher in patients with OCD (OR = 9.83 (95% CI, 8.72-11.08). Patients with OCD were also about 5 times more likely to attempt suicide (OR = 5.45 (05% CI, 5.24-5.67). The risk was marginally attenuated in women compared to men.

Lorena Fernández de la Cruz and her co-authors also note that the increased risk of death by suicide

“… remained substantial after adjusting for different groups of psychiatric comorbidities that are already known to be associated with suicide. In fact, 43% of the individuals from the OCD cohort who died by suicide did not have any other recorded psychiatric comorbidity.” (p. 4)

They argue that OCD is associated with an increased risk of death by suicide in its own right. The main predictor for dying by suicide was a previous suicide attempt.

The message for clinicians is clear:

“OCD should be added to the list of psychiatric disorders that are known to increase the risk of suicide in their own right. Suicide risk needs to be carefully monitored in these patients, particularly in those who have previously attempted suicide.” (p. 6)

The paper is freely available here.

 

 

Kick-off meeting for Swedish OCD Genetics project at Hesselby Slott

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English summary

During March 16th & 17th, clinicians and researchers from across Sweden gathered at Hesselby Slott to facilitate the launch of a big OCD genetics project. The goal is to gather DNA from 5000 Swedish pediatric and adult patients in order to gain new insights regarding the etiology of OCD and related disorders. The event was organized by Assoc. Prof. Christian Rück & Prof. David Mataix-Cols, principal investigators in the project.

Special guest Associate Professor Jim Crowley (University of North Carolina) gave an introduction to genetic research in OCD and other psychiatric disorders. Clinicians & researchers from all over Sweden also presented their work on OCD and related disorders.

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Svenska OCD nätverksmötet 2016

16-17 mars arrangerades ett nätverksmöte för kliniker och forskare inom OCD och relaterade tillstånd. Mötet ägde rum på Hesselby Slott utanför Stockholm med docent Christian Rück och professor David Mataix-Cols som värdar.

Målet för mötet var dels att knyta nya kontakter mellan verksamma inom området och dra lärdomar av varandras arbeten. Nätverksmötet innebar också starten för en stor insamling av genetiska data för patienter med OCD och relaterade tillstånd.

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