(79) Brain and Behavior Based Strategies in the Treatment of OCD

Presenter: Dr. Jeff Borenstein, President and CEO of the Brain and Behavioral Research Foundation.
Organization Focus: Funds innovative neuroscience and psychiatry research to understand and treat brain and behavior disorders.
Disorders Addressed: Includes addiction, ADHD, anxiety, autism, bipolar disorder, borderline personality disorder, depression, eating disorders, OCD, PTSD, schizophrenia.
Funding Legacy: Since 1987, over $408 million awarded across 5,900 grants globally.

Guest Speaker: Dr. Christopher Pittenger, Associate Professor at Yale University.
- Roles: Assistant Chair for Translational Research, Director of the OCD Research Clinic, Co-Director of Neuroscience Research Training Program.
- Previous Grants: Young Investigator grantee in 2007 and 2009, Independent Investigator grantee in 2015.
Webinar Agenda: Overview of OCD, prevalence, biology, psychology, novel research developments.

Prevalence: Affects approximately 1 in 40 people world-wide (8 million in the US, 30 million globally).
DSM Definitions: Obsessions include recurrent, persistent intrusive thoughts, images, or urges causing anxiety/distress. Compulsions are repetitive behaviors to mitigate anxiety.
Obsessions:
- Types: Contamination fears, intrusive thoughts about harm, symmetry/ordering needs.
- Experience: Patients recognize thoughts as excessive yet feel compelled to act upon them.

Common Categories of Obsessions (approx. 70% covered):
- Contamination: Fear of germs or moral impurities, leading to compulsive washing.
- Intrusive Harm Thoughts: Anxiety about potential harm to others or property, linked to checking compulsions.
- Symmetry or Order: Need for arrangement leading to compulsive behaviors to restore order.
Variability: OCD symptoms can vary significantly among individuals, leading to diagnostic challenges.

Misdiagnosis: Often diagnosed as depression or anxiety initially, delaying appropriate treatment.
Treatment Resistance: 25%-30% of OCD cases remain treatment-resistant to standard therapies.

Genetics and Brain Activity: Genetic component exists but specifics are unclear. Functional neuroimaging studies indicated increased activity in:
- Key Regions: Orbitofrontal cortex, anterior cingulate cortex, caudate nucleus (basal ganglia).
PET Imaging Studies: Landmark studies showing heightened region-specific brain activity in OCD patients.

Primary Treatment Modalities:
- Psychotherapy: Cognitive-behavioral therapy (CBT) is the first-line treatment, focusing on exposure and response prevention (ERP).
- Pharmacotherapy: SSRIs, e.g. Prozac, Zoloft, approved as effective treatments for OCD.
Emotional Reinforcement Cycle: The cycle of intrusive thoughts, anxiety, compulsions, and temporary relief reinforces OCD symptoms, which therapy aims to disrupt.

Exploration of Glutamate Modulators: Investigating agents like riluzole that could influence glutamate levels and enhance treatment outcomes.
- Ketamine Studies: Initial research indicating potential anti-obsessional effects through rapid acting antidepressant properties.
Psychedelic Research: Investigating psilocybin and its neurochemical interactions and potential therapeutic effects on OCD.
Neurofeedback: A non-pharmacological approach aiming to regulate orbitofrontal cortex activity as a potential treatment strategy.

Transcranial Magnetic Stimulation (TMS): Evidence for stimulation in specific brain areas, but larger studies needed for validation.
OCD Onset Patterns: Two primary age peaks: childhood (often gender-biased) and mid-life—different paths of symptom development.

Acknowledgments: Gratitude extended to patients, families, staff, and funding organizations like the Brain and Behavioral Research Foundation for their support.
Next Webinar: Will feature Stephen Maron discussing traumatic memories and their erasure on April 14th.