A Clinical Staging Model for Obsessive–Compulsive Disorder: Is It Ready for Prime Time?

Fontenelle, Leonardo F.; Yücel, Murat

doi:10.1016/j.eclinm.2019.01.014

Cited by 23 publications

(25 citation statements)

References 91 publications

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“…Indeed, the fact that most OCRDs have a particular course, with early and insidious onset, may compromise an accurate identification of stages of illness and make it difficult to distinguish vulnerability from chronicity in OCRDs. Nonetheless, staging systems for OCD likely represent a step forward to dissect these phases biologically (Fontenelle and Yucel, 2019).…”

Section: Discussionmentioning

confidence: 99%

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study

Fontenelle

Oldenhof

Moreira-de-Oliveira

et al. 2020

Aust N Z J Psychiatry

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Background: The Research Domain Criteria seeks to bridge knowledge from neuroscience with clinical practice by promoting research into valid neurocognitive phenotypes and dimensions, irrespective of symptoms and diagnoses as currently conceptualized. While the Research Domain Criteria offers a vision of future research and practice, its 39 functional constructs need refinement to better target new phenotyping efforts. This study aimed to determine which Research Domain Criteria constructs are most relevant to understanding obsessive-compulsive and related disorders, based on a consensus between experts in the field of obsessive-compulsive and related disorders. Methods: Based on a modified Delphi method, 46 experts were recruited from Australia, Africa, Asia, Europe and the Americas. Over three rounds, experts had the opportunity to review their opinion in light of feedback from the previous round, which included how their response compared to other experts and a summary of comments given. Results: Thirty-four experts completed round one, of whom 28 (82%) completed round two and 24 (71%) completed round three. At the final round, four constructs were endorsed by ⩾75% of experts as ‘primary constructs’ and therefore central to understanding obsessive-compulsive and related disorders. Of these constructs, one came from the Positive Valence System (Habit), two from the Cognitive Control System (Response Selection/Inhibition and Performance Monitoring) and the final construct was an additional item suggested by experts (Compulsivity). Conclusion: This study identified four Research Domain Criteria constructs that, according to experts, cut across different obsessive-compulsive and related disorders. These constructs represent key areas for future investigation, and may have potential implications for clinical practice in terms of diagnostic processes and therapeutic management of obsessive-compulsive and related disorders.

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Section: Discussionmentioning

confidence: 99%

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study

Fontenelle

Oldenhof

Moreira-de-Oliveira

et al. 2020

Aust N Z J Psychiatry

Self Cite

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“…Clinical staging models 53 integrate these epidemiological and neurobiological findings (Figure 2) 47 . The clinical staging model for psychosis is the most established 54,55 , but similar models have also emerged for bipolar [56][57][58][59] , depressive 60,61 and anxiety [62][63][64][65] disorders. The premorbid stage starts during the perinatal period and is often asymptomatic and generally associated with preserved functioning (Figure 2).…”

Section: Neurodevelopmental Prevention Of Mental Disorders In Young Peoplementioning

confidence: 99%

Preventive psychiatry: a blueprint for improving the mental health of young people

et al. 2021

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Preventive approaches have latterly gained traction for improving mental health in young people. In this paper, we first appraise the conceptual foundations of preventive psychiatry, encompassing the public health, Gordon's, US Institute of Medicine, World Health Organization, and good mental health frameworks, and neurodevelopmentally‐sensitive clinical staging models. We then review the evidence supporting primary prevention of psychotic, bipolar and common mental disorders and promotion of good mental health as potential transformative strategies to reduce the incidence of these disorders in young people. Within indicated approaches, the clinical high‐risk for psychosis paradigm has received the most empirical validation, while clinical high‐risk states for bipolar and common mental disorders are increasingly becoming a focus of attention. Selective approaches have mostly targeted familial vulnerability and non‐genetic risk exposures. Selective screening and psychological/psychoeducational interventions in vulnerable subgroups may improve anxiety/depressive symptoms, but their efficacy in reducing the incidence of psychotic/bipolar/common mental disorders is unproven. Selective physical exercise may reduce the incidence of anxiety disorders. Universal psychological/psychoeducational interventions may improve anxiety symptoms but not prevent depressive/anxiety disorders, while universal physical exercise may reduce the incidence of anxiety disorders. Universal public health approaches targeting school climate or social determinants (demographic, economic, neighbourhood, environmental, social/cultural) of mental disorders hold the greatest potential for reducing the risk profile of the population as a whole. The approach to promotion of good mental health is currently fragmented. We leverage the knowledge gained from the review to develop a blueprint for future research and practice of preventive psychiatry in young people: integrating universal and targeted frameworks; advancing multivariable, transdiagnostic, multi‐endpoint epidemiological knowledge; synergically preventing common and infrequent mental disorders; preventing physical and mental health burden together; implementing stratified/personalized prognosis; establishing evidence‐based preventive interventions; developing an ethical framework, improving prevention through education/training; consolidating the cost‐effectiveness of preventive psychiatry; and decreasing inequalities. These goals can only be achieved through an urgent individual, societal, and global level response, which promotes a vigorous collaboration across scientific, health care, societal and governmental sectors for implementing preventive psychiatry, as much is at stake for young people with or at risk for emerging mental disorders.

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“…The field may need to consider using drugs that have been shown to have benefit in OCD. For example, high doses of Selective Serotonin Reuptake Inhibitors (SSRIs), exposure, and response treatment are effective for people in the later stages of OCD [132], which has also been recently conceptualized within a staging framework [133]. In addition, there is interest in pharmacological approaches that are being used for treatment-resistant depression, such as ketamine and psilocybin [134].…”

Section: Treatment-resistant Depression and Other Co-morbidities As Mmentioning

confidence: 99%

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

Treasure

Willmott

Ambwani

et al. 2020

JCM

149

122

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The cognitive interpersonal model was outlined initially in 2006 in a paper describing the valued and visible aspects of anorexia nervosa (Schmidt and Treasure, 2006). In 2013, we summarised many of the cognitive and emotional traits underpinning the model (Treasure and Schmidt, 2013). In this paper, we describe in more detail the perpetuating aspects of the model, which include the inter- and intrapersonal related consequences of isolation, depression, and chronic stress that accumulate in the severe and enduring stage of the illness. Since we developed the model, we have been using it to frame research and development at the Maudsley. We have developed and tested interventions for both patients and close others, refining the model through iterative cycles of model/intervention development in line with the Medical Research Council (MRC) framework for complex interventions. For example, we have defined the consequences of living with the illness on close others (including medical professionals) and characterised the intense emotional reactions and behaviours that follow. For the individual with an eating disorder, these counter-reactions can allow the eating disorder to become entrenched. In addition, the consequent chronic stress from starvation and social pain set in motion processes such as depression, neuroprogression, and neuroadaptation. Thus, anorexia nervosa develops a life of its own that is resistant to treatment. In this paper, we describe the underpinnings of the model and how this can be targeted into treatment.

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A Clinical Staging Model for Obsessive–Compulsive Disorder: Is It Ready for Prime Time?

Cited by 23 publications

References 91 publications

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study

A transdiagnostic perspective of constructs underlying obsessive-compulsive and related disorders: An international Delphi consensus study

Preventive psychiatry: a blueprint for improving the mental health of young people

Cognitive Interpersonal Model for Anorexia Nervosa Revisited: The Perpetuating Factors that Contribute to the Development of the Severe and Enduring Illness

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