Biological Models and Treatments for Obsessive‐Compulsive and Related Disorders for Children and Adolescents

Arnold, Paul; Kronenberg, Sefi

doi:10.1002/9781118890233.ch60

Cited by 3 publications

(4 citation statements)

References 204 publications

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“…All 8 of 11 who completed the treatment were classified as responders and remission was achieved in 6 of 8 subjects with variable follow-up (1 to 4 months). These findings are comparable to overall results of CBT in OCD in children (60 to 80% response) (26)(27)(28).…”

Section: Psychiatric Interventionssupporting

confidence: 80%

PANDAS/PANS in childhood: Controversies and evidence

Wilbur

Bitnun

Kronenberg

et al. 2018

Paediatrics &Amp; Child Health

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Since first defined in 1998, paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and its later, broader iteration, paediatric acute-onset neuropsychiatric syndrome (PANS), have garnered significant attention and controversy. The role of streptococcal infection in children with explosive onset obsessive-compulsive disorder and new onset tics, the natural history of this entity, and the role of symptomatic and disease-modifying therapies, including antibiotics, immunotherapy, and psychoactive drugs, are all issues that have yet to be definitively addressed. While definitive proof of the autoimmune hypothesis of PANDAS is lacking, given the heightened attention to this entity and apparent rise in use of this diagnostic category, addressing questions around diagnosis, treatment, and etiology is imperative. In this paper, we review current working definitions of PANDAS/PANS, discuss published evidence for interventions related to this entity, and propose a clinical approach to children presenting with acute symptoms satisfying criteria for PANDAS/PANS.

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Section: Psychiatric Interventionssupporting

confidence: 80%

PANDAS/PANS in childhood: Controversies and evidence

Wilbur

Bitnun

Kronenberg

et al. 2018

Paediatrics &Amp; Child Health

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“…As discussed previously, it is widely recognized that initial changes to organs affected by inflammation involve swelling or edema (e.g., nephritis secondary to systemic lupus erythematosus), while chronic disease is associated with atrophy. In fact, diminished basal ganglia volume has been reported in adults and children with chronic OCD [84][85][86], possibly reflecting changes to these structures secondary to past or chronic inflammation. To date, no longitudinal neuroimaging studies have been conducted in PANS/PANDAS to directly address this hypothesis.…”

Section: Animal Studiesmentioning

confidence: 99%

Postinfectious Inflammation, Autoimmunity, and Obsessive-Compulsive Disorder: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection, and Pediatric Acute-Onset Neuropsychiatric Disorder

Vreeland,

Calaprice,

Or-Geva

et al. 2023

Dev Neurosci

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Post-infectious neuroinflammation has been implicated in multiple models of acute onset obsessive-compulsive disorder (OCD) including Sydenham’s chorea (SC), pediatric acute-onset neuropsychiatric syndrome (PANS), and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). These conditions are associated with a range of autoantibodies which are thought to be triggered by an infections, most notably group A streptococci (GAS). Based on animal models using huma sera, these autoantibodies are thought to cross-react with neural antigens in the basal ganglia and modulate neuronal activity and behavior. As is true for many childhood neuroinflammatory diseases and rheumatological diseases, SC, PANS, and PANDAS lack clinically available, rigorous diagnostic biomarkers and randomized clinical trials. In this review article, we outline the accumulating evidence supporting the role neuroinflammation plays in these disorders. We describe work with animal models including patient-derived anti-neuronal autoantibodies, and we outline imaging studies that show alterations in the basal ganglia. In addition, we present research on metabolites, which are helpful in deciphering functional phenotypes, and on the implication of sleep in these disorders. Finally, we encourage future researchers to collaborate across medical specialties (e.g., pediatrics, psychiatry, rheumatology, immunology, and infectious disease) in order to further research on clinical syndromes presenting with neuropsychiatric manifestations.

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“…Although previous meta-analytic data have found evidence of response inhibition impairments in adults with OCD ( 13 ), a recent meta-analysis indicated that the effect size for differences in response inhibition performance between children and youth with OCD vs. controls is approaching zero ( 12 ), suggesting that impaired laboratory-based task performance in this domain may not be a feature of pediatric OCD, or may develop over time when illness symptoms persist. Nonetheless, the study of response inhibition task performance in pediatric OCD may provide key insights into the presence of alterations in inhibitory response circuitry which is thought to drive illness symptoms in everyday settings ( 6 , 11 , 14 , 15 ).…”

Section: Introductionmentioning

confidence: 99%

“…The cortico-striato-thalamo-cortical (CSTC) circuit, comprised of the supplementary motor area (SMA), inferior frontal gyrus (IFG), orbitofrontal cortex (OFC), projections from the anterior cingulate cortex (ACC), white matter tracts including the anterior corpus callosum, cingulum bundle, and anterior limb of the internal capsule and subcortical regions, such as the striatum, subthalamic nucleus, and thalamus are implicated in habitual control and response inhibition ( 16 ). Excessive CSTC activity has been postulated to disrupt attention shifting processes and contribute to increased directed attention to threat and to neutralizing threat, expressed as obsessions and compulsions, respectively, in OCD ( 6 ). Among CSTC circuit regions, fronto-cortical regions, such as the ACC, OFC and IFG, may be particularly relevant in OCD based on the role of the ACC in supporting cognitive control and error-monitoring, the role of the OFC in emotional control, such as selective judgement or weighing of consequences ( 17 , 18 ), and the IFG in action inhibition ( 19 ).…”

Section: Introductionmentioning

confidence: 99%

Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography Study

et al. 2021

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Background: Response inhibition engages the cortico-striato-thalamo-cortical (CSTC) circuit, which has been implicated in children, and youth with obsessive compulsive disorder (OCD). This study explored whether CSTC engagement during response inhibition, measured using magnetoencephalography (MEG), differed in a sample of medication-naïve youth with OCD, compared to typically developing controls (TDC).Methods: Data was analyzed in 17 medication-naïve children and youth with OCD (11.7 ± 2.2 SD years) and 13 TDC (12.6 ± 2.2 SD years). MEG was used to localize and characterize neural activity during a Go/No-Go task. Task performance on Go/No-Go conditions and regional differences in amplitude of activity during Go and No-Go condition between OCD vs. TDC were examined using two-sample t-tests. Post-hoc analysis with Bayesian t-tests was used to estimate the certainty of outcomes.Results: No differences in Go/No-Go performance were found between OCD and TDC groups. In response to the visual cue presented during the Go condition, participants with OCD showed significantly increased amplitude of activity in the primary motor (MI) cortex compared to TDC. In addition, significantly reduced amplitude of PCu was found following successful stopping to No-Go cues in OCD vs. TDC during No-Go task performance. Bayesian t-tests indicated high probability and large effect sizes for the differences in MI and PCu amplitude found between groups.Conclusion: Our preliminary study in a small medication-naïve sample extends previous work indicating intact response inhibition in pediatric OCD. While altered neural response in the current study was found during response inhibition performance in OCD, differences localized to regions outside of the CSTC. Our findings suggest that additional imaging research in medication-naïve samples is needed to clarify regional differences associated with OCD vs. influenced by medication effects, and suggest that MEG may be sensitive to detecting such differences.

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Biological Models and Treatments for Obsessive‐Compulsive and Related Disorders for Children and Adolescents

Cited by 3 publications

References 204 publications

PANDAS/PANS in childhood: Controversies and evidence

PANDAS/PANS in childhood: Controversies and evidence

Postinfectious Inflammation, Autoimmunity, and Obsessive-Compulsive Disorder: Sydenham Chorea, Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection, and Pediatric Acute-Onset Neuropsychiatric Disorder

Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography Study

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