Introducing Max Sannemalm and the Bergen 4-Day Treatment for OCD

Sunny midsummer was great, but we are even happier that Max Sannemalm just joined our group!

Max is a licensed psychologist and will be joining us as the project coordinator for the randomized controlled non-inferiority trial study comparing the Bergen 4-Day Treatment (B4DT) to gold-standard CBT for OCD.

The Bergen 4-Day Treatment (B4DT) is a new concentrated treatment for OCD developed by Gerd Kvale and Bjarne Hansen from Bergen. In B4DT, patients receive ERP at a clinic during 4 consecutive days. The B4DT has shown to achieve remission in around 70% of patients when delivered in regular care in several uncontrolled treatment trials, and one randomized controlled trial (RCT) including a self-help group and a waitlist group. However, it has yet to be directly compared to gold-standard CBT.

The study will test the non-inferiority, speed of recovery, and cost-effectiveness of B4DT, compared to gold-standard.

To summarize: Exciting things ahead, and welcome to the group, Max!

Oskar Flygare dissertation

Big day today! Oskar Flygare received his PhD after successfully defending his thesis. Congratulations!

Oskar defended his dissertation “Improving access and outcomes in the treatment of Obsessive-Compulsive Disorder”, today June 10th 9am at the Erna Möller hall at Karolinska Institutet, Huddinge.

The opponent was the excellent associate prof. Carolyn Rodriguez from Stanford University who participated via video link. Oskar was accompanied by supervisor prof. Christian Rück and co-supervisor associate prof. Erik Andersson. Co-supervisor prof. David Mataix-Cols participated via video link. The examination board consisted of associate prof. Monica Buhrman, prof. Bo Melin and associate prof. Armita Golkar.

The Rüch lab is certain that there is yet much to come from the brilliant mind of doctor Oskar Flygare!

Genetics in patients with severe treatment refractory OCD – Grant to Long Chen

Research group member Long Chen recently received a grant from the Bror Gadelius memorial fund for his project about genetics in patients with severe treatment refractory obsessive-compulsive disorder (OCD).

The purpose of the study is to accurately map unusual genetic variations in patients with severe treatment refractory OCD. This will be executed by using whole exome sequencing, a method where the protein-coding parts of the gene (the exome) is sequenced. The aim is also to study wether unusual genetic variations have any predictive value for treatment outcomes after deep brain stimulation (DBS), a method that has been shown to benefit patients that are not helped by the current evidence-based medical and psychotherapeutic treatment methods.

Congratulations!

Internet CBT vs face-to-face CBT for OCD

New publication by research group members Lina Lundström and Oskar Flygare!

Cognitive-behavior therapy (CBT) for obsessive-compulsive disorder (OCD) is a highly specialized treatment that is in short supply worldwide. This study aimed to investigate whether therapist-guided internet-delivered CBT (ICBT) is non-inferior to face-to-face CBT for adults with OCD. Secondary objectives were to investigate if ICBT could be equally effective without therapist support (i.e. unguided), to conduct a health-economic evaluation, and to determine whether treatment effects were moderated by source of participant referral.

A consecutive sample of 120 adults with a primary diagnosis of OCD, either self-referred or referred by a clinician, were randomized to receive guided ICBT (n=42), unguided ICBT (n=40) or face-to-face CBT (n= 38) delivered over 14 weeks. The main outcome measure was change in OCD symptom severity according to the clinician rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS) from baseline to 3-month follow-up (primary endpoint). The non-inferiority margin was set to 3 points on the Y-BOCS. 

Results: Of the 120 randomized participants, 80 (67%) were women with a mean age of 32 (SD = 9.64) years.The mean difference between therapist-guided ICBT and face-to-face CBT at the primary endpoint was 2.10 points on the Y-BOCS (90% CI -0.41 to 4.61), P = .17, favoring face-to-face CBT, meaning that the primary non-inferiority results were inconclusive. The difference between unguided ICBT and face-to-face CBT was 5.35 points (90% CI 2.76 to 7.94), P < .001), favoring face-to-face CBT. The health economic analysis showed that both guided and unguided ICBT were cost-effective compared to face-to-face CBT. Source of referral did not moderate treatment outcome. The most common adverse events were anxiety (25%), depressive symptoms (17%) and stress (9%).  

Conclusions and Relevance: In this randomized controlled trial of internet-based versus face-to-face cognitive behavioral therapy for adults with obsessive-compulsive disorder we could not conclusively demonstrate non-inferiority. Therapist-guided ICBT could be a cost-effective alternative to in-clinic CBT for adults with OCD in scenarios where traditional CBT is not readily available. Unguided ICBT is probably less efficacious but could be an alternative when providing remote clinician support is not feasible.

Read the article here.

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.