Genetics of OCD

Julia Boberg – psychologist, PhD student and research group member – recently published a review article on the genetic epidemiology and molecular genetics studies of obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms.

Results

OCD is a heritable, polygenic disorder with contributions from both common and rare variants, including de novo deleterious variations. Multiple studies have provided reliable support for a large additive genetic contribution to liability to OCD, with discrete OCD symptom dimensions having both shared and unique genetic risks. Genome-wide association studies have not produced significant results yet, likely because of small sample sizes, but larger meta-analyses are forthcoming. Both twin and genome-wide studies show that OCD shares genetic risk with its comorbid conditions (e.g. Tourette syndrome and anorexia nervosa).

Conclusions

Despite significant efforts to uncover the genetic basis of OCD, the mechanistic understanding of how genetic and environmental risk factors interact and converge at the molecular level to result in OCD’s heterogeneous phenotype is still mostly unknown. Future investigations should increase ancestral genetic diversity, explore age and/or sex differ- ences in genetic risk for OCD and expand the study of pharmacogenetics, gene expression, gene × environment interactions and epigenetic mechanisms for OCD.

Read the full article here.

Mia Asplund i OCD-podden

Mia Asplund är med i senaste avsnittet av OCD-podden och talar om trichotillomani och dermatillomani. Lyssna här!

Mia är leg. psykolog och doktorand i forskargruppen. Hennes forskning handlar om psykologisk behandling av trichotillomani och dermatillomani, även kallat skin-picking disorder. Tricho- och dermatillomani är två psykiatriska tillstånd som innebär ett tvångsmässigt plockande av hår- respektive hud.

English translation: Mia Asplund, psychologist and and PhD student, talks about trichotillomania and skin-picking disorder in the Swedish podcast OCD-podden.

Recruitment completed

We have now completed the recruitment for the MiO study about intestinal flora and OCD!

The study investigates if the intestinal flora is different for people with obsessive compulsive disorder. In total 62 participants were included, 30 with OCD and 32 age and gender-matched controls.

We hope to get the results in the beginning of 2022.

http://www.inasakvareller.se/

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.

ybocs-compare
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.

http://www.sydsvenskan.se/lund/experterna-det-ror-sig-inte-om-tvangstankar/

http://www.aftonbladet.se/debatt/debattamnen/medier/article21944620.ab

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: http://ki.se/nyheter/tuberkulosmedicin-kan-forbattra-effekt-av-kbt

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