New study: Adapted CBT for adults with OCD and ASD

We have just released a pre-print1 where we describe an adapted cognitive behavior therapy for adults with obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD). You can find the full paper here.

OCD and ASD often co-occur but effective treatment options for this patient group are sorely lacking. We extended an adapted CBT protocol developed in the UK at our specialist clinic for OCD and related disorders (OCD-programmet).

Our results show that OCD-symptoms (both when rated by a clinician and by the participants themselves) decrease over the course of treatment, but that few participants were completely symptom free.

Results on the main outcome: Yale-Brown Obsessive-compulsive Scale (YBOCS) rated by clinicians.

We discuss three ways to develop the treatment further: adding more support in between sessions to help participants do exposure exercises on their own, including interventions to help participants find meaningful daily activities, and intensifying the treatment over a shorter time span.

If you are interested in learning more, you can find the pre-print at the pre-print server PsyArXiv.

  1. A pre-print is a manuscript that has been read and approved by all authors but has not gone through peer-review yet. It’s a popular way to quickly disseminate results in fields like genetics, physics and mathematics. It is gaining popularity in other fields as well. Wikipedia article ↩︎

Increased risk of suicide in patients with obsessive-compulsive disorder

title Fernández de la Cruz et al

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.



Leder tvångstankar till mord?

Det har vid flera tillfällen på senare tid rapporterats om tvångstankar kring mordfall.

Här har vi samlat några av de artiklar i ämnet som förklarar varför detta är fel, tvångstankar/tvångssyndrom är inte förknippat med fler brott eller något känt mordfall.

En svensk studie som inte såg ökad risk för våldsbrott vid tvångssyndrom hittar du här.

New publication in JAMA Psychiatry: d-Cycloserine as Adjunct to CBT in OCD

Our study of d-cycloserine in OCD is out now in JAMA Psychiatry (click for link). This randomized clinical trial examines whether d-cycloserine augments cognitive behavioral therapy in the treatment of obsessive-compulsive disorder (OCD) and whether concomitant use of antidepressants moderates the effects of d-cycloserine.

Sammanfattning på svenska:

Andersson E, Hedman E, Enander J,  Radu Djurfeldt D, Ljótsson B, Cervenka S, Isung J, Svanborg C, Mataix-Cols D, Kaldo V, Andersson G, Lindefors N, Rück C. D-cycloserine vs Placebo as Adjunct to Cogntive Behavioral Therapy for Obsessive-Compulsive Disorder and Interaction With Antidepressants: A randomized clinical trial. JAMA Psychiatry. Published online May 13, 2015. doi:10.1001/jamapsychiatry.2015.0546.

New study: How is OCD related to schizophrenia and bipolar disorder?

In a new publication in Schizophrenia Bulletin Swedish registers were used in the so far largest study set out to understand the relationship between OCD and psychosis and bipolar disorders.  Clinically it is clear that psychotic delusions can sometimes  be hard to tell apart from obsessions, especially when there is low insight.

In this population-based longitudinal and multigenerational family study, we examined the patterns of comorbidity, longitudinal risks, and shared familial risks between these disorders. Participants were individuals with a diagnosis of OCD (n = 19814), schizophrenia (n = 58336), bipolar disorder (n = 48180), and schizoaffective disorder (n = 14904) included in the Swedish Patient Register; their first-, second-, and third-degree relatives; and population-matched unaffected controls and their relatives. Individuals with OCD had a 12-fold increased risk of having a comorbid diagnosis of schizophrenia and a 13-fold increased risk of bipolar disorder and schizoaffective disorder. This still means that those disorders disorders will not affect most OCD patients. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for later diagnosis of all other disorders, and vice versa. OCD-unaffected first-, second-, and third-degree relatives of probands with OCD had a significantly increased risk for all 3 disorders; the magnitude of this risk decreased as the genetic distance increased. We conclude that OCD is etiologically related to both schizophrenia spectrum and bipolar disorders.

Cederlöf M, Lichtenstein P, Larsson H, Boman M, Rück C, Landén M, Mataix-Cols D. Obsessive-Compulsive Disorder, Psychosis, and Bipolarity: A Longitudinal Cohort and Multigenerational Family Study. Schizophr Bull (2014) doi: 10.1093/schbul/sbu169

Vi söker en psykolog för banbrytande forskning och klinik

Vår forskningsgrupp söker i samarbete med Mottagningen för Tvångssyndrom, Psykiatri Sydväst en psykolog för att driva vidare forskningen kring internetbaserad KBT för OCD. Behandlingen har redan testats med god effekt i flera studier men vi vill nu göra en studie där iKBT jämförs med individuell KBT i klinik. Tjänsten är en kombinerad forsknings/kliniktjänst där kliniktjänstgöringen är på Mottagningen för Tvångssyndrom, en mottagning som just nu är inne i en expansiv fas. I forskningsdelen handleds du av Dr. Erik Andersson, Docent Christian Rück och Professor David Mataix-Cols. Detta är, för att uttrycka det ödmjukt, en chans att delta i den absoluta framkanten och om allt går bra så är en doktorandtjänst en senare möjlighet.

Läs mer:

Erik Andersson now a PhD, first to come out of our lab.

Erik Andersson today defended his thesis in the best of ways and is now a PhD from the Karolinska Institutet. Opponent was Prof Sabine Wilhelm, Harvard and she said “this is the best dissertation I have come across, by far”. The dissertation committee consisted of Prof Bo Runeson, Prof Christina Hultman and Professor Mats Fredriksson. Main supervisor was Christian Rück and Viktor Kaldo, Nils Lindefors and Gerhard Andersson were co-supervisors. Let’s celebrate!

Erik Andersson, new PhD, adimired by Sabine Wilhelm and Christian Rück.

Erik Andersson nails his thesis

Boom. He nailed it.
Boom. He nailed it.

Erik Andersson nailed his thesis “Enhancing cognitive behavior therapy in the treatment of obsessive-compulsive disorder” to the KI library as the traditional publication. He will defend his work on September 19. 

The thesis defense is open to the public. Details here: