Fresh off the press! On executive functions, gut microbiome and genetics in obsessive-compulsive disorder, by Long-Long Chen✌️.
Today, Max Sannemalm – now a PhD student 🎉 – held his individual study plan (ISP) seminar. The ISP seminar is an opportunity to get input and feedback before starting the projects. Marianne Kristiansson and Joar Guterstam participated from the advisory board and Nitya Jayaram-Lindström participated as an adjunct member.
At the seminar, Max presented the four studies which forms his doctoral studies:
He will be conducting the B4DT study, a non-inferiority study comparing the Bergen 4-day treatment for OCD to conventional CBT for OCD. Along with the RCT, he will do a cost-effectiveness analysis and a qualitative analysis about B4DT and its implementation. In addition, the plan is to do a pilot trial of an ultra-intensive treatment for patients with body dysmorphic disorder (BDD).
Looking forward to seeing Max working wonders!
Vi har just öppnat anmälan till en studie som jämför två olika behandlingsformer för personer med tvångssyndrom.
Läs mer och anmäl dig här: www.ocdprojektet.se
Kognitiv beteendeterapi (KBT) har visat sig vara effektivt för att lindra både tvångstankar och tvångshandlingar när den genomförs under 14 veckor. Karolinska Institutet och Region Stockholm genomför nu en studie som jämför denna typ av KBT med en intensivbehandling som pågår i 4 heldagar.
- Du behöver vara minst 18 år och ha tvångssyndrom (OCD)
- Behandlingen genomförs på Karolinska sjukhuset i Huddinge eller Solna
- Deltagandet är gratis
English translation: We have opened the registration for an RCT comparing a new concentrated treatment for OCD to golden standard CBT.
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!
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!
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.
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.
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.
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).
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.
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.