Research Topic

Advances in Biological Approaches to Treating Resistant/Refractory Obsessive-Compulsive and Related Disorders

About this Research Topic

Obsessive-compulsive and related disorders, such as obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, olfactory reference syndrome, trichotillomania and dermatillomania, have received increased scientific interest since their new diagnostic grouping was introduced to DSM5 in 2013. Of the obsessive-compulsive related disorders, OCD is the more well researched with the literature indicating that it is one of the most disabling mental health disorders and that it affects 2.5–3.0% of the general population. Unfortunately, around 40% of patients with OCD do not achieve remission of their symptoms with pharmacotherapy. Even when switching to another selective serotonin re-uptake inhibitor or clomipramine, or when an atypical antipsychotic is added, the portion of refractory patients still remains around 30%. These figure highlight the need for advances to be made in treatments for OCD. Although obsessive-compulsive related disorders are treated in rather similar ways in clinical practice, research regarding their biological treatment is limited and new studies are desperately needed. There have been some recent advances that require further investigation. For example, serotonin may not be the key neurotransmitter involved in all patients with obsessive-compulsive and related disorders. Evidence suggests that the excitatory neurotransmitter glutamate is dysregulated in OCD and that this dysregulation may contribute to the pathophysiology of the disorder. Currently, studies examining cerebrospinal fluid, imaging studies using magnetic resonance spectroscopy and recent genetic studies suggests a role of glutamate dysregulation in OCD.

This background has motivated interest in studying glutamate modulators in patients who are unresponsive to standard pharmacotherapeutic approaches. In particular, some studies using memantine and riluzole have been reported promising suggestions of benefit. Other studies have explored the role of stimulants and nutritional supplements such as inositol and N-acetylcysteine. Neurostimulation therapies in the form of deep brain stimulation (DBS), repetitive transcranial stimulation (rTMS), deep transcranial magnetic stimulation (dTMS) and transcranial direct current stimulation (tDCS) are also being investigated as treatments for obsessive-compulsive and related disorders. New perspectives on the pathophysiology of obsessive-compulsive and related disorders represent a promising area of research and provide the basis for ongoing development of new biological approaches to treat these often disabling, distressing and resistant disorders.

In this Research Topic, which is an Open Access peer-reviewed article collection, we host original research, clinical trials, review, case report.


Topic editor Stefano Pallanti is the founder of "Istituto di Neuroscienze" and "Clinical Neurosciences ONLUS". All other topic editors declare no competing interests with regards to the Research Topic subject.


Keywords: Obsessive-Compulsive Disorder, pathophysiology of obsessive-compulsive, treatment refractory OCD


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

Obsessive-compulsive and related disorders, such as obsessive-compulsive disorder (OCD), hoarding disorder, body dysmorphic disorder, olfactory reference syndrome, trichotillomania and dermatillomania, have received increased scientific interest since their new diagnostic grouping was introduced to DSM5 in 2013. Of the obsessive-compulsive related disorders, OCD is the more well researched with the literature indicating that it is one of the most disabling mental health disorders and that it affects 2.5–3.0% of the general population. Unfortunately, around 40% of patients with OCD do not achieve remission of their symptoms with pharmacotherapy. Even when switching to another selective serotonin re-uptake inhibitor or clomipramine, or when an atypical antipsychotic is added, the portion of refractory patients still remains around 30%. These figure highlight the need for advances to be made in treatments for OCD. Although obsessive-compulsive related disorders are treated in rather similar ways in clinical practice, research regarding their biological treatment is limited and new studies are desperately needed. There have been some recent advances that require further investigation. For example, serotonin may not be the key neurotransmitter involved in all patients with obsessive-compulsive and related disorders. Evidence suggests that the excitatory neurotransmitter glutamate is dysregulated in OCD and that this dysregulation may contribute to the pathophysiology of the disorder. Currently, studies examining cerebrospinal fluid, imaging studies using magnetic resonance spectroscopy and recent genetic studies suggests a role of glutamate dysregulation in OCD.

This background has motivated interest in studying glutamate modulators in patients who are unresponsive to standard pharmacotherapeutic approaches. In particular, some studies using memantine and riluzole have been reported promising suggestions of benefit. Other studies have explored the role of stimulants and nutritional supplements such as inositol and N-acetylcysteine. Neurostimulation therapies in the form of deep brain stimulation (DBS), repetitive transcranial stimulation (rTMS), deep transcranial magnetic stimulation (dTMS) and transcranial direct current stimulation (tDCS) are also being investigated as treatments for obsessive-compulsive and related disorders. New perspectives on the pathophysiology of obsessive-compulsive and related disorders represent a promising area of research and provide the basis for ongoing development of new biological approaches to treat these often disabling, distressing and resistant disorders.

In this Research Topic, which is an Open Access peer-reviewed article collection, we host original research, clinical trials, review, case report.


Topic editor Stefano Pallanti is the founder of "Istituto di Neuroscienze" and "Clinical Neurosciences ONLUS". All other topic editors declare no competing interests with regards to the Research Topic subject.


Keywords: Obsessive-Compulsive Disorder, pathophysiology of obsessive-compulsive, treatment refractory OCD


Important Note: All contributions to this Research Topic must be within the scope of the section and journal to which they are submitted, as defined in their mission statements. Frontiers reserves the right to guide an out-of-scope manuscript to a more suitable section or journal at any stage of peer review.

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Submission Deadlines

28 February 2019 Manuscript
15 May 2019 Manuscript Extension

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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Topic Editors

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Submission Deadlines

28 February 2019 Manuscript
15 May 2019 Manuscript Extension

Participating Journals

Manuscripts can be submitted to this Research Topic via the following journals:

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