Predictors of treatment outcome for youth receiving intensive residential treatment for obsessive–compulsive disorder (OCD)

ABSTRACT

Little is known about the predictors of outcome from intensive residential treatment of OCD. This study aimed to examine age, gender, and baseline OCD severity, as well as measures of comorbid anxiety and depressive, internalizing/externalizing, and inattention symptoms, as predictors of treatment outcome in adolescents receiving intensive residential treatment for OCD.

The sample comprised 314 adolescents aged 13–17 years with treatment-resistant OCD and a Children’s Yale–Brown Obsessive–Compulsive Scale Self-Report (CY-BOCS-SR) total score ≥16. Bivariate and multiple regression models were used to evaluate the predictors of continuous OCD severity outcome and treatment response.

Results of the bivariate regression analyses of predictors demonstrated that length of treatment, pre-treatment OCD severity, and symptoms of anxiety and depression significantly predicted post-treatment OCD severity, while only symptoms of depression and anxiety predicted treatment response. When including all predictors in the same model, only baseline OCD severity remained a significant predictor of post-treatment OCD severity, and none of the assessed variables significantly predicted treatment response.

Results indicate that low pre-treatment OCD severity predicts lower OCD severity following treatment, although it did not predict treatment response.     

Patient Suicide: A Survey of Therapists' Reactions

A substantial proportion of therapists will at some point in their professional life experience the loss of a patient to suicide. Our aims were to assess how therapists react to patient's suicide over time and which factors contribute to the reaction. One third of the therapists, mostly women, suffer from severe distress. The impact is not different for therapists in institutional settings and therapists in private practice. The item “overall distress” immediately after the suicide predicts emotional reactions and changes in behavior. Our data suggest that identifying the severely distressed subgroup could be done using a visual analogue scale for overall distress. As a consequence, more specific and intensified help could be provided to these individuals.     

Experiences of surgery readiness assessments in British Columbia

Abstract

Background: A surgical readiness assessment is a major step in the medical journey of trans people seeking gender-affirming surgery. Much of the peer-reviewed literature surrounding surgical readiness assessments emphasizes the perspectives of academics and clinicians, leaving the voices of trans and gender diverse patients largely unheard.

Aims: This paper foregrounds patient experiences with surgery readiness assessments to discuss the tensions, challenges and opportunities they generate.

Methods: We conducted a thematic analysis of 35 in-depth interviews with trans people who accessed or were seeking to access gender-affirming surgery in British Columbia.

Results: We developed three main themes to capture participants’ narratives of their surgical assessment experiences. The first, assessments as gatekeeping, explores the stories of people who described their assessments as outdated and even discriminatory processes. The second, assessments as a barrier to care, discusses the informational missteps, bureaucratic regulations, economic issues, and geographic concerns that made assessments difficult to access. The third, assessments as useful, includes positive stories about assessments that often involved feeling supported by an assessor and feeling prepared for the next steps.

Discussion: These narratives demonstrate how much variation exists among people’s experiences of readiness assessments for gender-affirming surgery. No matter how their actual assessment turned out, many participants approached their appointments with a great deal of anxiety and trepidation. We attributed this stress was to challenges ranging from lengthy wait times, arbitrary medical gatekeeping, a lack of access to knowledgeable and supportive providers, unclear or changing administrative processes, and insufficient communication. To address these challenges, it is crucial for the medical system to create more accessible pathways with centralized, up-to-date information for people trying to access assessments. Patients are best served by multi-disciplinary gender-affirming teams that provide individualized care.     

The use of electrophysiology in the study of early development

Electrophysiology is a timely and important tool in the study of early cognitive development. This commentary polishes the definition of event‐related potential (ERP) components; often interpreted as expressions of mental processes. Further, attention is drawn to time‐frequency analysis of the electroencephalogram (EEG) which conveys much more information than the exclusive use of traditional ERP methodology. Several studies have shown that frequency bands of the EEG undergo systematic development in early childhood. EEG frequency analysis has a potential in early risk assessment. 40 Hz gamma range oscillation bursts accompany stimulus feature binding both in infants and in adults, probably indexing grouping and selection of distributed neuronal populations. Methodological concerns are noted and the need for long‐term normative studies is stressed. Copyright © 2005 John Wiley & Sons, Ltd.     

The effects of a ‘pretend play-based training’ designed to promote the development of emotion comprehension,emotion regulation,and prosocial behaviour in 5- to 6-year-old Swiss children

The objective of this study was to evaluate the effects of a pretend play-based training designed to promote the development of socio-emotional competences. 79 children aged 5 to 6 years were evaluated before and after a pretend play-based training. The experimental group (39 children) received this programme on emotion comprehension, negative emotion regulation, and prosocial behaviour one hour a week for eleven weeks during class hours, while the control group (40 children) received no specific intervention. The programme was implemented by 5 teachers. The results show improvements in the ability to understand emotions in children who benefited from the training. These findings are discussed in the broader context of using this form of play as a privileged pedagogical tool to allow children to develop these competences.     

Newborns modulate their crawling in response to their native language but not another language

Human newborns can propel themselves to their mother's breast when positioned skin to skin on her abdomen just after birth. For decades, researchers have considered this primitive crawling behavior a spinal reflex, immune to supra spinal control. However, recent research suggests that neonatal crawling is already responsive to visual and olfactory stimuli processed at a supra spinal level. Here we report that a few hours post birth, French newborns can also modulate their crawling in response to their native language – a source of information that is processed supra-spinally. The crawling patterns of 23 French-born newborns were recorded on video and via an infrared motion capture system during two randomly ordered 2-min trials. The newborns were secured on a mini skateboard to facilitate arm and leg movements during their crawling propulsion. They heard a repetitive sequence of the same sentences either in French, their native language, or in English, a rhythmically different and hence discriminable unfamiliar language, on each trial. In French, compared to English, crawling was enhanced, with significantly more arm and leg steps and significantly more and larger trunk rotations in the cephalo-caudal axis. Moreover, newborns rotated their heads and trunk toward the appropriate loud speaker when hearing French but not English. These preliminary findings suggest that newborn crawling is not a simple stereotyped reflex under spinal control, but a complex pattern that can be modulated in response to higher-order, supra-spinally processed stimuli. The findings open fascinating questions about the range of stimuli to which newborn crawling is responsive.