Neurocognitive Dimensional Constructs and Noninvasive Neuromodulation Therapy in Pediatric and Adult Obsessive Compulsive Disorder- A Review

Saffron Homayoun, MBChB

Massachusetts General Hospital
Neurocognitive Dimensional Constructs and Noninvasive Neuromodulation Therapy in Pediatric and Adult Obsessive Compulsive Disorder- A Review

Scientific Abstract

Background: Current evidence-based treatments for obsessive compulsive disorder (OCD) do not always lead to adequate symptom response; therefore, the search continues for more effective and better-tolerated treatments. One such promising avenue is the expanding field of noninvasive neuromodulation, e.g., Transcranial Magnetic Stimulation (TMS) and transcranial Direct Current Stimulation (tDCS). While TMS was recently cleared by the U.S. Federal Drug Administration as safe and effective for the treatment of adult OCD, much progress is needed to further improve outcomes, increase access, and in particular, tailor and expand indications for youth afflicted by OCD.

Rational treatment development in neuropsychiatry has found success from dissecting clinical syndromes into core dimensions to define pathophysiological mechanisms and identify biomarkers. Specific to OCD, maladaptive processes have been described in three critical neurocognitive dimensions: a) fear extinction, b) response inhibition, and c) cognitive flexibility (particularly in the context of balancing goal-orientated verses habit-based behaviors).

Methods: To assess the current extent of translational research in the area of noninvasive neuromodulation of neurocognitive dimensional constructs of pathological relevance in OCD, a systematic PubMed search was conducted in February 2021. Search criteria included: 1) noninvasive neuromodulation; 2) neurocognitive tasks assessing fear extinction, response inhibition or goal-orientated verses habit-based behavior; and 3) conducted in either adult or child populations of patients with OCD.

Results: Here we show that no published study data was found on the effect of noninvasive neuromodulation in these three neurocognitive domains in children with OCD, and also very few studies returned for adults with the condition.

Conclusions: In a field that has so far been unable to reach consensus on optimal parameters for noninvasive neuromodulation in the treatment of OCD, we recommend that further research employing this mechanistically-informed approach for this condition is needed, especially in pediatric populations.

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research Areas

Authors

Saffron Homayoun, MBChB Daniel A. Geller, MD Joan A. Camprodon, MD MPH PhD