| Research Abstract |
We have investigated the heterogeneity of Obsessive-Compulsive Disorder (OCD) especially focusing on the relationship with Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus (PANADS). Indeed, it has been suggested that a subgroup of children with OCD and tic disorders are proposed to have an infectious trigger. We assessed about 50 patients with OCD about the lifetime history of immunologic conditions, infections, rheumatic fever, chorea, and other movement disorders especially during their childhood. However, few of them or of their parents (N=3) could recall such a lifetime history. All of the subjects also had a lifetime history of tics and one of them showed abnormalities in basal ganglia function by SPECT. Thus even though there might be crucially methodological problems such as recall bias in the study, it could be speculated that ethnic differences might exist regarding the etiological effects of autoimmune function on OCD. To clarify the issues, we ar
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e currently conducting further researches such as a prospective study among children suffering from streptococcal infections.
On the other hand, we had done the important works on OCD using the grant-in-aid for scientific research. There is increasing evidence that OCD is a heterogeneous disorder characterized by several different symptom dimensions. Nevertheless, the majority of this work has taken place within the Western countries. In the study, we factor analyzed data on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) Symptom Checklist from a large Japanese OCD patient group to examine the cross-cultural stability and reliability of the symptom dimensions. As results, four factors that explained 57.7% of variance was identified; (1) contamination/washing, (2) hoarding, (3) symmetry/repeating rituals and ordering compulsions, and (4) aggressive/checking. Both the hoarding and symmetry groups differentially showed more severe clinical features such as lower scores of GAFS compared to the other groups. Thus this study supported trans-cultural consistency and stability in the symptom structure of OCD, suggesting the possibility that OCD may be more robustly mediated by universal psychobiological mechanisms. These findings had been published in American Journal of Psychiatry (Hisato Matsunaga et al. Symptom Structure in Japanese Patients with Obsessive-Compulsive Disorder. American Journal of Psychiatry 165(2); 251-253, 2008). Another study focused on the treatment for SSRI-refractory OCD. Although atypical antipsychotic drugs (AAPDs) have been found effective in the augmentation of serotonin reuptake inhibitors (SRIs) for treatment-resistant obsessive-compulsive disorder (OCD) in short terms trials, there are few data on the effectiveness and safety of these agents in clinical settings over the long term. In the study, subjects (n=46) who responded to selective SRIs (SSRIs) in an initial 12-week trial were continued on SRI-monotherapy plus cognitive-behavioral therapy (CBT) for one year. Subjects (n=44) who failed to respond to SSRIs were randomly assigned to one of 3 AAPDs such as risperidone and were consecutively treated using SSRI+AAPD combined with CBT for a year. As results, augmentation of AAPDs reduced Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) scores in SSRI-refractory OCD patients. However, compared to SSRI responders, total Y-BOCS scores in those who required AAPD augmentation were initially higher, and they remained levels than SRI responders after one year of the treatments. Thus even though it seems rather useful for some types of OCD patients such as those with symmetry/ordering and hoarding symptoms, these data more emphasize the limitations of the current pharmacotherapeutic options in treatment-refractory OCD, which raise a number of safety concerns when used chronically. The study has already been accepted in Journal of Clinical Psychiatry (H Matsunaga et al. A Long-Term Trial on Effectiveness and Safety of Atypical Antipsychotic Agents in Augmenting SSRI-Refractory Obsessive-Compulsive Disorder. Journal of Clinical Psychiatry (in press)). Less
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