No abstract

Brief intensive cognitive-behavioral therapy (CBT) using exposure and response prevention significantly improves obsessive-compulsive disorder (OCD) symptoms in as little as 4 weeks. However, it has been thought that much longer treatment was needed to produce the changes in brain function seen in neuroimaging studies of OCD. We sought to elucidate the brain mediation of response to brief intensive CBT for OCD and determine whether this treatment could induce functional brain changes previously seen after longer trials of pharmacotherapy or standard CBT. [ 18 F]-fluorodeoxyglucose positron emission tomography brain scans were obtained on 10 OCD patients before and after 4 weeks of intensive individual CBT. Twelve normal controls were scanned twice, several weeks apart, without treatment. Regional glucose metabolic changes were compared between groups. OCD symptoms, depression, anxiety and overall functioning improved robustly with treatment. Significant changes in normalized regional glucose metabolism were seen after brief intensive CBT (P = 0.04). Compared to controls, OCD patients showed significant bilateral decreases in normalized thalamic metabolism with intensive CBT but had a significant increase in right dorsal anterior cingulate cortex activity that correlated strongly with the degree of improvement in OCD symptoms (P = 0.02). The rapid response of OCD to intensive CBT is mediated by a distinct pattern of changes in regional brain function. Reduction of thalamic activity may be a final common pathway for improvement in OCD, but response to intensive CBT may require activation of dorsal anterior cingulate cortex, a region involved in reappraisal and suppression of negative emotions.

The neurophysiological bases of cognitive-behavioral therapy (CBT) for obsessive–compulsive disorder (OCD) are incompletely understood. Previous studies, though sparse, implicate metabolic changes in pregenual anterior cingulate cortex (pACC) and anterior middle cingulate cortex (aMCC) as neural correlates of response to CBT. The goal of this pilot study was to determine the relationship between levels of the neurochemically interlinked metabolites glutamate + glutamine (Glx) and N-acetyl-aspartate + N-acetyl-aspartyl-glutamate (tNAA) in pACC and aMCC to pretreatment OCD diagnostic status and OCD response to CBT. Proton magnetic resonance spectroscopic imaging (1H MRSI) was acquired from pACC and aMCC in 10 OCD patients at baseline, 8 of whom had a repeat scan after 4 weeks of intensive CBT. pACC was also scanned (baseline only) in 8 age-matched healthy controls. OCD symptoms improved markedly in 8/8 patients after CBT. In right pACC, tNAA was significantly lower in OCD patients than controls at baseline and then increased significantly after CBT. Baseline tNAA also correlated with post-CBT change in OCD symptom severity. In left aMCC, Glx decreased significantly after intensive CBT. These findings add to evidence implicating the pACC and aMCC as loci of the metabolic effects of CBT in OCD, particularly effects on glutamatergic and N-acetyl compounds. Moreover, these metabolic responses occurred after just 4 weeks of intensive CBT, compared to 3 months for standard weekly CBT. Baseline levels of tNAA in the pACC may be associated with response to CBT for OCD. Lateralization of metabolite effects of CBT, previously observed in subcortical nuclei and white matter, may also occur in cingulate cortex. Tentative mechanisms for these effects are discussed. Comorbid depressive symptoms in OCD patients may have contributed to metabolite effects, although baseline and post-CBT change in depression ratings varied with choline-compounds and myo-inositol rather than Glx or tNAA.

No abstract

According to the Diagnostic and Statistical Manual of Mental Disorders, body dysmorphic disorder (BDD), or dysmorphophobia, is the preoccupation with an imagined defect in appearance that leads to significant distress and impairments to daily functioning. Due to their lack of insight, individuals with BDD believe that cosmetic procedures will be the solution to their insecurities, even though they rarely get satisfaction from them. Cosmetic procedures can then become an addiction, as patients never reach full satisfaction. In response to this issue, aesthetic practitioners need to identify those presenting with BDD by administering a questionnaire that asks how many cosmetic surgeries the individual has had previously, before continuing with any aesthetic procedure. Those who show signs of BDD can then be referred to mental health professionals for specialised treatments, such as medications, cognitive behavioural therapy, exposure and response prevention, and family support.

Research on obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), and eating disorders (EDs), including anorexia and bulimia, has shown appreciable two-way comorbidity between these conditions, especially OCD and BDD. There are few, if any, however, assessments of the multidimensional comorbidity of OCD, BDD, and EDs. Here, we review the literature on prevalence and comorbidity of these disorders and estimate their three-way comorbidity. We calculate that multidimensional comorbidity of OCD, BDD, and EDs is present in about 1.5% of cases of primary OCD, 3.7% of cases of primary BDD and 9.8% of cases of primary EDs. We further provide recommendations for treatment of cases in which all three disorders appear together, beginning with the advice to treat that disorder first which poses the highest danger to the patient upon check in. for LVM.

Aesthetic practitioners treat all kinds of people, and each one is motivated to seek treatment for different reasons. In some cases, patients may have underlying issues that encourage them to seek aesthetic procedures. In this comment piece, Eda Gorbis explores the issue of body dysmorphic disorder in aesthetic patients, and provides recommendations on how to identify and treat this psychiatric disorder

Excoriation disorder or skin picking disorder (SPD) is a chronic mental illness. It is defined by recurrent skin picking, scratching, rubbing and digging or urges to do so that goes on for extended periods of time, resulting in skin lesions and behaviour that interferes with functioning in other areas of life. The skin-picked area of the body can be smooth and healthy, and the anomaly invisible to the naked eye. Commonly, individuals with SPD seek aesthetic procedures to address perceived self-defects or to remedy their self-inflicted scarring. It is important for aesthetic practitioners to identify SPD because continuing with aesthetic interventions could worsen the illness for the sufferer. In response to this issue, aesthetic practitioners can identify individuals with SPD by administering a screening questionnaire and appropriately providing referrals to mental health professionals.