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Obsessive-Compulsive Disorder

Obsessive-Compulsive Disorder

Obsessive-compulsive disorder (OCD) is a mental health condition characterized by recurrent obsessions, compulsions, or both, which consume significant time and interfere with daily functioning. Obsessions involve persistent, intrusive, and unwanted thoughts, images, or urges that evoke anxiety. Common examples include irrational fears of contamination or harm. Compulsions are repetitive behaviors or mental acts performed to reduce the anxiety caused by obsessions. For instance, individuals...

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Protocol for Repetitive Transcranial Magnetic Stimulation with Symptom Provocation to Treat Obsessive-compulsive Disorder

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Deep brain stimulation for obsessive-compulsive disorder is associated with cortisol changes.

Pelle P de Koning¹, Martijn Figee, Erik Endert

¹Department of Psychiatry, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. p.p.dekoning@amc.uva.nl

Psychoneuroendocrinology

|January 22, 2013

Summary

Deep brain stimulation (DBS) for obsessive-compulsive disorder (OCD) impacts the hypothalamic-pituitary-adrenal (HPA) axis. Symptom severity in OCD patients correlated with changes in urinary free cortisol levels when DBS was turned off.

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Area of Science:

Neuroscience
Endocrinology
Psychiatry

Background:

Deep brain stimulation (DBS) is an established treatment for therapy-refractory obsessive-compulsive disorder (OCD).
The precise mechanism of action for DBS in OCD remains largely undetermined.
The hypothalamic-pituitary-adrenal (HPA) axis is implicated in the pathophysiology of OCD.

Purpose of the Study:

To investigate the effect of DBS on HPA axis activity in patients with OCD.
To explore the relationship between DBS-induced symptom changes and HPA axis markers.

Main Methods:

A within-subject design comparing stimulation ON and OFF conditions over a one-week interval in 16 OCD patients.
Measurement of 24-hour urinary free cortisol (UFC), adrenaline, and noradrenaline levels.
Assessment of obsessive-compulsive (Y-BOCS), depressive (HAM-D), and anxiety (HAM-A) symptom scores.

Main Results:

A 53% median increase in UFC levels was observed when DBS was turned OFF (p=0.12).
No significant changes in urinary adrenaline or noradrenaline excretion were detected.
Increased Y-BOCS and HAM-D scores in the OFF condition strongly correlated with elevated UFC levels.

Conclusions:

DBS treatment for OCD is associated with modulation of the HPA axis, specifically affecting cortisol levels.
Changes in symptom severity during DBS withdrawal correlate with alterations in UFC excretion.
These findings suggest a link between HPA axis function and the therapeutic effects of DBS in OCD.