Dr. Ron’s Research Review – July 9, 2014

© 2014

This week’s research review focuses on OCD.

Metabolic Syndrome

a naturalistic Italian study examined metabolic syndrome in obsessive-compulsive disorder. In 104 patients with OCD, metabolic syndrome was present in 21.2% (95% confidence interval: 13.7%-30.3%) of the sample. Abdominal obesity was present in 36.5%, hypertension in 42.3%, high triglycerides in 23.1%, low high-density lipoprotein cholesterol levels in 22.1% and fasting hyperglycemia in 4.8% of the sample. Metabolic syndrome was associated with cigarette smoking (duration of cigarette smoking), absence of physical activity, a higher body mass index and a greater proportion of obesity. Among pharmacological treatments, metabolic syndrome was associated with the duration of the exposure (lifetime) to antipsychotics. (Albert et al., 2013)

Zinc

A randomized placebo-controlled clinical trial evaluated the effect of oral zinc sulfate on obsessive-compulsive disorder. Twelve patients were given fluoxetine (20 mg/d) plus zinc (440 mg/d) and 11 patients were given fluoxetine plus placebo for 8 wk. RESULTS: Both groups showed a decrease in the mean Yale-Brown Obsessive-Compulsive Scale score. Based on t tests, in weeks 2 and 8, patients treated with fluoxetine plus zinc had significantly lower scores than those treated with fluoxetine plus placebo. (Sayyah et al., 2012)

Berberine

Berberine has an anti-compulsive effect in a murine model of obsessive-compulsive disorder. (Dixit et al., 2012)

Dr. Ron


 

Abstracts

Metabolic syndrome and obsessive-compulsive disorder: a naturalistic Italian study.
            (Albert et al., 2013) Download
OBJECTIVE: The increased risk for metabolic syndrome (MetS) in individuals with schizophrenia and bipolar disorder has been documented. No study examined MetS in patients with obsessive-compulsive disorder (OCD), despite the fact that a great proportion of them are treated with antipsychotic addition. The aim of our study was to investigate the prevalence and the sociodemographic and clinical correlates of MetS in an Italian sample of patients with OCD. METHOD: Subjects with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, OCD and a Yale-Brown Obsessive-Compulsive Scale score >/= 16 were included. Sociodemographic and clinical characteristics, current and lifetime pharmacological treatments, lifestyle information, and comorbidity for cardiovascular diseases and diabetes were collected. MetS was diagnosed according to the National Cholesterol Education Program Adult Treatment Panel III modified criteria. RESULTS: We enrolled 104 patients with OCD. MetS was present in 21.2% (95% confidence interval: 13.7%-30.3%) of the sample. Abdominal obesity was present in 36.5%, hypertension in 42.3%, high triglycerides in 23.1%, low high-density lipoprotein cholesterol levels in 22.1% and fasting hyperglycemia in 4.8% of the sample. MetS was associated with cigarette smoking (duration of cigarette smoking), absence of physical activity, a higher body mass index and a greater proportion of obesity. Among pharmacological treatments, MetS was associated with the duration of the exposure (lifetime) to antipsychotics. CONCLUSIONS: This is the first study that examined the prevalence and correlates of MetS in a sample of patients with OCD. Our cross-sectional evaluation found a prevalence of MetS higher than those reported in the Italian general population, although the confidence interval encompasses the general population estimate reported. Patients with OCD on antipsychotic treatment are particularly at risk for MetS and should be carefully monitored for metabolic abnormalities and cardiovascular complications.

Increased serotonergic neurotransmission is not responsible for the anticompulsive effect of berberine in a murine model of obsessive-compulsive disorder.
(Dixit et al., 2012) Download
Berberine, an isoquinoline alkaloid, is being extensively explored in several clinical trials for the treatment of metabolic disorder and cancer. It is also reported to be a potent inhibitor of prolyl oligopeptidase, which makes it a potential candidate for the treatment of neuropsychiatric disorders. We have previously shown the potential of berberine in the control of seizures in various murine models of epilepsy, diabetes-induced memory dysfunction, and ethanol-induced hyperexcitability. We have now examined the effects of acute and subchronic (7 days) administration of berberine on a murine model of obsessive-compulsive disorder - the marble-burying behavior of male mice, because berberine administration is reported to increase brain monoamine levels - a desirable endpoint in the treatment of obsessive-compulsive disorder. The studies showed that an acute administration of berberine [1-25 mg/kg, intraperitoneally (i.p.)] dose-dependently inhibited marble burying in male mice without altering locomotor activity. This effect was retained after its subchronic administration. Furthermore, coadministration of a subeffective dose of berberine (1 mg/kg) and fluoxetine (5 mg/kg, i.p.) significantly reduced marble burying in mice. Pretreatment with p-chlorophenylamine (300 mg/kg, i.p. x3 days), a tryptophan hydroxylase inhibitor and serotonin-depleting agent, completely blocked the effect of fluoxetine on marble burying, whereas it failed to alter the effect of berberine. In conclusion, the findings of the present investigation indicate that the anticompulsive and/or anxiolytic effect of berberine observed in the present investigation may be attributed to its effect on other neurotransmitter systems, such as the nitrergic or the dopaminergic system rather than to increased serotonin turnover in the brain.

Evaluation of oral zinc sulfate effect on obsessive-compulsive disorder: a randomized placebo-controlled clinical trial.
            (Sayyah et al., 2012) Download
OBJECTIVE: Obsessive-compulsive disorder is a common neuropsychiatric condition. Although various pharmaceutical agents are available for the treatment of obsessive-compulsive disorder, psychiatrists often find that many patients cannot tolerate the side effects of these medications, the patients do not respond properly to the treatment, or the medications lose their effectiveness after a period of treatment. The augmentation with safe supplementation of medication, such as with trace elements, may be a solution to some of these problems. METHODS: This study was a prospective, double-blinded, 8-wk trial. Twelve patients were given fluoxetine (20 mg/d) plus zinc (440 mg/d) and 11 patients were given fluoxetine plus placebo for 8 wk. RESULTS: Both groups showed a decrease in the mean Yale-Brown Obsessive-Compulsive Scale score. Based on t tests, in weeks 2 and 8, patients treated with fluoxetine plus zinc had significantly lower scores than those treated with fluoxetine plus placebo. CONCLUSION: The results show that zinc, as adjuvant agent for obsessive-compulsive disorder, produces improved outcomes.


 

References

Albert, U, et al. (2013), ‘Metabolic syndrome and obsessive-compulsive disorder: a naturalistic Italian study.’, Gen Hosp Psychiatry, 35 (2), 154-59. PubMedID: 23158675
Dixit, PV, et al. (2012), ‘Increased serotonergic neurotransmission is not responsible for the anticompulsive effect of berberine in a murine model of obsessive-compulsive disorder.’, Behav Pharmacol, 23 (7), 716-21. PubMedID: 22890212
Sayyah, M, et al. (2012), ‘Evaluation of oral zinc sulfate effect on obsessive-compulsive disorder: a randomized placebo-controlled clinical trial.’, Nutrition, 28 (9), 892-95. PubMedID: 22465904