Noninvasive brain stimulation in obsessive–compulsive disorder

Shivakumar, Venkataram; Dinakaran, Damodharan; Narayanaswamy, Janardhanan C.; Venkatasubramanian, Ganesan

doi:10.4103/psychiatry.indianjpsychiatry_522_18

Cited by 18 publications

(7 citation statements)

References 65 publications

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“… 5 Despite these treatment options, approximately 40% of patients did not respond to the recommended drugs or CBT. 6 Therefore, there is an urgent need to find more safe and effective treatment for OCD. Different add-on stimulation techniques could be effective for patients with severe OCD who were unresponsive to drugs and/or behavioral therapy.…”

Section: Introductionmentioning

confidence: 99%

“…At present, the commonly used stimulation targets of OCD are dorsolateral prefrontal cortex(DLPFC),orbitofrontal cortex(OFC), and supplementary motor area(SMA). 6 The stimulation parameters used for those targets are usually low-frequency stimulation or cTBS, with suppressive effects on cortical excitability. However, studies involving DLPFC and SMA areas had reported inconsistent results.…”

Section: Introductionmentioning

confidence: 99%

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Continuous Theta-Burst Stimulation Over the Right Orbitofrontal Cortex in Treatment-Resistant Obsessive-Compulsive Disorder Treatment: A Randomized Sham-Controlled Trial

Liu¹,

Shao²,

Liao³

et al. 2021

IJGM

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Purpose Examining whether modulation of right orbitofrontal cortex (OFC) activity by continuous theta-burst stimulation (cTBS) affects obsessive-compulsive disorder (OCD) symptoms. Patients and Methods A total of 28 treatment-resistant OCD participants were treated with either active or sham cTBS of the OFC twice per day, for five days a week, for 2 weeks, in a double-blinded manner. Clinical response to treatment was determined using the Yale–Brown Obsessive-Compulsive Scale (Y-BOCS). Results There were no statistically significant differences between the 2 groups after two weeks of treatment in the Yale–Brown Obsessive-Compulsive Scale score (group*time interaction, F2,20=0.996, p=0.387) and other secondary outcome measures, including anxiety symptoms and responder rates. Depressive symptoms improved significantly in the active group (p=0.027), but the significant difference disappeared at 6 weeks (p=0.089). Conclusion This is the first randomized controlled study using cTBS in the right OFC to observe the improvement of treatment-resistant OCD symptoms. It is safe to use cTBS, but 2 weeks of treatment is not enough to achieve a curative effect. Future studies are needed to explore more advanced stimulation parameters suitable for the treatment of OCD. Clinical Trial Registration www.chictr.org.cn , identifier ChiCTR2000034814.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Continuous Theta-Burst Stimulation Over the Right Orbitofrontal Cortex in Treatment-Resistant Obsessive-Compulsive Disorder Treatment: A Randomized Sham-Controlled Trial

Liu¹,

Shao²,

Liao³

et al. 2021

IJGM

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“…Whereas transcranial direct current stimulation (tDCS) needs more investigation for the treatment of compulsivity given the lack of sham controlled studies, repetitive Transcranial Magnetic Stimulation (rTMS) (Box 2) as non-invasive and relatively site specific, has been the most studied neuromodulation technique in the treatment of compulsive behavior in both AUD and OCD (Campbell et al, 2018; Shivakumar et al, 2019). As the time of writing, there have been 10 studies probing rTMS as a tool to change alcohol consumption and explore the associated neurocircuit changes in AUD (Table 2).…”

Section: Neuromodulatory Strategies To Target Compulsivity In Audmentioning

confidence: 99%

Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation

Burchi

Makris

Lee

et al. 2019

Front. Behav. Neurosci.

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Alcohol use Disorder (AUD) is one of the leading causes of morbidity and mortality worldwide. The progression of the disorder is associated with the development of compulsive alcohol use, which in turn contributes to the high relapse rate and poor longer term functioning reported in most patients, even with treatment. While the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) defines AUD by a cluster of symptoms, parsing its heterogeneous phenotype by domains of behavior such as compulsivity may be a critical step to improve outcomes of this condition. Still, neurobiological underpinnings of compulsivity need to be fully elucidated in AUD in order to better design targeted treatment strategies. In this manuscript, we review and discuss findings supporting common mechanisms between AUD and OCD, dissecting the construct of compulsivity and focusing specifically on characteristic disruptions in habit learning and cognitive control in the two disorders. Finally, neuromodulatory interventions are proposed as a probe to test compulsivity as key pathophysiologic feature of AUD, and as a potential therapy for the subgroup of individuals with compulsive alcohol use, i.e., the more resistant stage of the disorder. This transdiagnostic approach may help to destigmatize the disorder, and suggest potential treatment targets across different conditions.

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“…Two reviews suggest that stimulating the mPFC could enhance the effects of exposure therapy 17,18 . Moreover, noninvasive neurostimulation as a treatment augmentation strategy has demonstrated promising results in treatment-resistant contexts, such as treatment-resistant depression 19 and obsessive-compulsive disorder 20 . However, it has not been tested as a means of enhancing exposure therapy to treat extinction-resistant fears, such as biologically prepared fears, including fear in an intergroup (ie, out-group) context.…”

mentioning

confidence: 99%

Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

McDonald,

Meckes,

Shires

et al. 2023

J ECT

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Objectives Exposure therapy is a cornerstone of social anxiety treatment, yet not all patients respond. Symptoms in certain social situations, including intergroup (ie, out-group) contexts, may be particularly resistant to treatment. Exposure therapy outcomes may be improved by stimulating neural areas associated with safety learning, such as the medial prefrontal cortex (mPFC). The mPFC also plays an important role in identifying others as similar to oneself. We hypothesized that targeting the mPFC during exposure therapy would reduce intergroup anxiety and social anxiety. Methods Participants (N = 31) with the public speaking subtype of social anxiety received active (anodal) or sham transcranial direct current stimulation (tDCS) targeting the mPFC during exposure therapy. Exposure therapy consisted of giving speeches to audiences in virtual reality. To target intergroup anxiety, half of the public speaking exposure trials were conducted with out-group audiences, defined in this study as audiences of a different ethnicity. Results Contrary to hypotheses, tDCS did not facilitate symptom reduction. Some evidence even suggested that tDCS temporarily increased in-group favoritism, although these effects dissipated at 1-month follow-up. In addition, collapsing across all participants, we found reductions across time for public speaking anxiety and intergroup anxiety. Conclusions The data provide evidence that standard exposure therapy techniques for social anxiety can be adapted to target intergroup anxiety. Transcranial direct current stimulation targeting the mPFC may boost safety signaling, but only in contexts previously conditioned to signal safety, such as an in-group context.

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Noninvasive brain stimulation in obsessive–compulsive disorder

Cited by 18 publications

References 65 publications

Continuous Theta-Burst Stimulation Over the Right Orbitofrontal Cortex in Treatment-Resistant Obsessive-Compulsive Disorder Treatment: A Randomized Sham-Controlled Trial

Continuous Theta-Burst Stimulation Over the Right Orbitofrontal Cortex in Treatment-Resistant Obsessive-Compulsive Disorder Treatment: A Randomized Sham-Controlled Trial

Compulsivity in Alcohol Use Disorder and Obsessive Compulsive Disorder: Implications for Neuromodulation

Augmenting Virtual Reality Exposure Therapy for Social and Intergroup Anxiety With Transcranial Direct Current Stimulation

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