Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis
Comparison of the Association Between Goal-Directed Planning and Self-reported Compulsivity vs Obsessive-Compulsive Disorder Diagnosis
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DOI：
10.1001/jamapsychiatry.2019.2998
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发表时间：
2020-01-01
期刊：
影响因子：
25.8
通讯作者：
Simpson, H. B.
中科院分区：
文献类型：
--
作者：
Gillan, Claire M.;Kalanthroff, Eyal;Simpson, H. B.
问题：自我报告的强迫症或强迫症的诊断能更好地识别目标导向计划的缺陷吗？在这项对285名被诊断为强迫症、广泛性焦虑症或两者兼有的患者的横断面研究中，与广泛性焦虑症相比，自我报告的强迫症与目标导向缺陷的相关性更强。这项研究表明，跨诊断强迫症症状可能比强迫症的诊断具有更大的生物学有效性。跨诊断心理健康问题的重要维度定义已被建议作为范畴诊断的替代方案，其优势是捕捉诊断类别内的异质性和它们之间的相似性，并更自然地连接心理和神经基础。目的探讨与强迫症(OCD)的诊断相比，自我报告的强迫症维度是否与目标导向及相关的高阶认知缺陷有更强的相关性。设计、设置和参与者在这项横断面研究中，来自美国各地的强迫症和/或广泛性焦虑症(GAD)患者在2015年10月8日至2017年10月1日期间完成了由训练有素的评分员进行的电话诊断访谈、基于互联网的认知测试和自我报告的临床评估。收集跟踪数据以测试可重复性。主要结果和测量结果通过目标导向计划和认知灵活性测试(威斯康星卡片分类测试[WCST])和抽象推理测试来衡量。临床变量包括强迫症和广泛性痴呆症的DSM-5诊断，以及由因子分析得出的3个精神症状维度(一般痛苦、强迫和强迫)。结果285例受试者(平均年龄32[12]岁；年龄18-77岁；女性219例，占76.8%)中，强迫症111例，广泛性痴呆82例，强迫症合并广泛性痴呆92例。与基线时的GAD相比，强迫症的诊断与目标导向型表现无关(β[SE]，-0.02[0.02]；P=.18)。相反，强迫维度与目标导向绩效呈负相关(Beta[SE]，-0.05[0.02]；P=0.003)。抽象推理任务和WCST的结果反映了这一模式；强制性维度与抽象推理相关(Beta[SE]，2.99[0.63]；P<；.001)和WCST的多个指标(如，已完成的类别：Beta[SE]，-0.57[0.09]；P<；.001)，而强迫症诊断不存在(抽象推理：Beta[SE]，0.39[0.66]；P=.56；已完成的类别：Beta[SE]，-0.09[0.10]；P=.38)。与强迫症、强迫症和一般痛苦相关的其他症状维度与目标导向型绩效、WCST或抽象推理没有可靠的联系。强迫症与需要更多的试验才能在基线时达到WCST的第一类呈正相关(Beta[SE]，2.92[1.39]；P=.04)，一般痛苦与基线时目标导向绩效受损有关(Beta[SE]，-0.04[0.02]；P=.01)。然而，与这项研究的关键结果不同的是，两项研究都没有在多次比较中幸存下来，也没有在后续测试中得到复制。结论与强迫症诊断相比，强迫症患者目标导向计划中的结论和相关性缺陷与强迫症维度的相关性可能更强。这一结果可能对评估大脑机制和临床表现之间的联系以及理解精神疾病的结构具有指导意义。这项横断面研究评估了目标导向计划的缺陷是通过自我报告的强迫症还是通过强迫症的诊断更好地识别出来的。
Question Are deficits in goal-directed planning better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder? Findings In this cross-sectional study of 285 patients diagnosed with obsessive-compulsive disorder, generalized anxiety disorder, or both, self-reported compulsivity was more strongly associated with goal-directed deficits than a diagnosis of obsessive-compulsive disorder compared with generalized anxiety disorder. Meaning This study suggests that transdiagnostic compulsivity symptoms may have greater biological validity than a diagnosis of obsessive-compulsive disorder.Importance Dimensional definitions of transdiagnostic mental health problems have been suggested as an alternative to categorical diagnoses, having the advantage of capturing heterogeneity within diagnostic categories and similarity across them and bridging more naturally psychological and neural substrates. Objective To examine whether a self-reported compulsivity dimension has a stronger association with goal-directed and related higher-order cognitive deficits compared with a diagnosis of obsessive-compulsive disorder (OCD). Design, Setting, and Participants In this cross-sectional study, patients with OCD and/or generalized anxiety disorder (GAD) from across the United States completed a telephone-based diagnostic interview by a trained rater, internet-based cognitive testing, and self-reported clinical assessments from October 8, 2015, to October 1, 2017. Follow-up data were collected to test for replicability. Main Outcomes and Measures Performance was measured on a test of goal-directed planning and cognitive flexibility (Wisconsin Card Sorting Test [WCST]) and a test of abstract reasoning. Clinical variables included DSM-5 diagnosis of OCD and GAD and 3 psychiatric symptom dimensions (general distress, compulsivity, and obsessionality) derived from a factor analysis. Results Of 285 individuals in the analysis (mean [SD] age, 32 [12] years; age range, 18-77 years; 219 [76.8%] female), 111 had OCD; 82, GAD; and 92, OCD and GAD. A diagnosis of OCD was not associated with goal-directed performance compared with GAD at baseline (beta [SE], -0.02 [0.02]; P = .18). In contrast, a compulsivity dimension was negatively associated with goal-directed performance (beta [SE], -0.05 [0.02]; P = .003). Results for abstract reasoning task and WCST mirrored this pattern; the compulsivity dimension was associated with abstract reasoning (beta [SE], 2.99 [0.63]; P < .001) and several indicators of WCST performance (eg, categories completed: beta [SE], -0.57 [0.09]; P < .001), whereas OCD diagnosis was not (abstract reasoning: beta [SE], 0.39 [0.66]; P = .56; categories completed: beta [SE], -0.09 [0.10]; P = .38). Other symptom dimensions relevant to OCD, obsessionality, and general distress had no reliable association with goal-directed performance, WCST, or abstract reasoning. Obsessionality had a positive association with requiring more trials to reach the first category on the WCST at baseline (beta [SE], 2.92 [1.39]; P = .04), and general distress was associated with impaired goal-directed performance at baseline (beta [SE],-0.04 [0.02]; P = .01). However, unlike the key results of this study, neither survived correction for multiple comparisons or was replicated at follow-up testing. Conclusions and Relevance Deficits in goal-directed planning in OCD may be more strongly associated with a compulsivity dimension than with OCD diagnosis. This result may have implications for research assessing the association between brain mechanisms and clinical manifestations and for understanding the structure of mental illness.This cross-sectional study assesses whether deficits in goal-directed planning are better identified by self-reported compulsivity or a diagnosis of obsessive-compulsive disorder.