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BackgroundObsessive–compulsive disorder (OCD) is a debilitating mental health disorder with current psychotherapeutic treatments, while somewhat effective, yielding low accessibility and scalability. A lack of knowledge regarding the neural pathology of OCD may be hindering the development of innovative treatments. Previous research has observed baseline brain activation patterns in OCD patients, elucidating some understanding of the implications. However, by using neuroimaging to observe the effects of treatment on brain activation, a more complete picture of OCD can be drawn. Currently, the gold standard treatment is cognitive behavioral therapy (CBT). However, CBT is often inaccessible, time-consuming, and costly. Fortunately, it can be effectively delivered electronically (e-CBT).ObjectivesThis pilot study implemented an e-CBT program for OCD and observed its effects on cortical activation levels during a symptom provocation task. It was hypothesized that abnormal activations could be attenuated following treatment.MethodsOCD patients completed a 16-week e-CBT program administered through an online platform, mirroring in-person content. Treatment efficacy was evaluated using behavioral questionnaires and neuroimaging. Activation levels were assessed at the resting state and during the symptom provocation task.ResultsIn this pilot, seven participants completed the program, with significant improvements (p

BackgroundObsessive-compulsive disorder (OCD) is a debilitating and prevalent anxiety disorder. Although the basal ganglia and frontal cortex are the brain regions that are most commonly hypothesized to be involved in OCD, the exact pathophysiology is unknown. By observing the effects of proven treatments on brain activation levels, the cause of OCD can be better understood. Currently, the gold standard treatment for OCD is cognitive behavioral therapy (CBT) with exposure and response prevention. However, this is often temporally and geographically inaccessible, time consuming, and costly. Fortunately, CBT can be effectively delivered using the internet (electronically delivered CBT [e-CBT]) because of its structured nature, thus addressing these barriers. ObjectiveThe aims of this study are to implement an e-CBT program for OCD and to observe its effects on brain activation levels using functional magnetic resonance imaging (MRI). It is hypothesized that brain activation levels in the basal ganglia and frontal cortex will decrease after treatment. MethodsIndividuals with OCD will be offered a 16-week e-CBT program with exposure and response prevention mirroring in-person CBT content and administered through a secure web-based platform. The efficacy of the treatment will be evaluated using clinically validated symptomology questionnaires at baseline, at week 8, and after treatment (week 16). Using functional MRI at baseline and after treatment, brain activation levels will be assessed in the resting state and while exposed to anxiety-inducing images (eg, dirty dishes if cleanliness is an obsession). The effects of treatment on brain activation levels and the correlation between symptom changes and activation levels will be analyzed. ResultsThe study received initial ethics approval in December 2020, and participant recruitment began in January 2021. Participant recruitment has been conducted through social media advertisements, physical advertisements, and physician referrals. To date, 5 participants have been recruited. Data collection is expected to conclude by January 2022, and data analysis is expected to be completed by February 2022. ConclusionsThe findings from this study can further our understanding of the causation of OCD and help develop more effective treatments for this disorder. Trial RegistrationClinicalTrials.gov NCT04630197; https://clinicaltrials.gov/ct2/show/NCT04630197. International Registered Report Identifier (IRRID)PRR1-10.2196/30726

Abstract. Most patients with chronic pain do not find adequate pain relief with a single treatment, and accumulating evidence points to the added benefits of rational combinations of different treatments. Given that psychological therapies, such as mindfulness-based interventions (MBIs), are often delivered in conjunction with concomitant analgesic drug therapies (CADTs), this systematic scoping review examines the evidence for any interactions between MBIs and CADTs. The protocol for this review has been published and registered. MEDLINE, Cochrane Central Register of Controlled Trials, EMBASE, and PsycINFO databases were searched until July 2019. We included randomized controlled trials that evaluated the efficacy of MBIs for the treatment of chronic pain. A total of 40 randomized controlled trials (2978 participants) were included. Thirty-nine of 40 (97.5%) included mindfulness-based clinical trials allowed the use of CADTs. However, only 6 of these 39 (15.4%) trials provided adequate details of what these CADTs were, and only 4 (10.3%) trials controlled for CADTs. Of great relevance to this review, none of the included trials analyzed the interactions between MBIs and the CADTs to determine whether they have an additive, synergistic, or antagonistic effect on chronic pain. Adverse events were inconsistently reported, and no judgment could be made about safety. Future trials assessing the interactions between MBIs and CADTs, with better harms reporting, are needed to better define the role of MBIs in the management of chronic pain.

Abstract. Introduction:. Most current chronic pain treatment strategies have limitations in effectiveness and tolerability, and accumulating evidence points to the added benefits of rational combinations of different therapies. However, most published clinical trials of treatment combinations have involved combinations of 2 drugs, whereas very little research has been performed to characterize interactions between drug and nondrug interventions. Mindfulness-based interventions (MBIs) have been emerging as a safe and potentially effective treatment option in the management of chronic pain, but it is unclear how MBIs can and should be integrated with various other pain treatment interventions. Thus, we seek to review available clinical trials of MBIs for chronic pain to evaluate available evidence on the interactions between MBIs and various pharmacological treatments. Methods:. A detailed search of trials of MBIs for the treatment of chronic pain in adults will be conducted on the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and PsycINFO from their inception until the date the searches are run to identify relevant randomized controlled trials. Primary outcomes will include the following: (1) what concomitant analgesic drug therapies (CADTs) were allowed; (2) if and how trials controlled for CADTs and analyzed their interaction; and (3) results of available analyses of interactions between the MBI and CADT. Perspective:. This review is expected to synthesize available evidence describing the interactions between MBIs and various studied drug therapies for chronic pain. Available evidence may help inform the rational integration of MBIs with drug therapy for chronic pain.

ObjectivesEarly diagnostic separation between glioblastoma (GBM) and solitary metastases (MET) is important for patient management but remains challenging when based on imaging only. The objective of this study was to assess whether amide proton transfer weighted (APTw) MRI alone or combined with dynamic susceptibility contrast (DSC) MRI parameters, including cerebral blood volume (CBV), cerebral blood flow (CBF), and leakage parameter (K2) measurements, can differentiate GBM from MET.MethodsAPTw MRI and DSC-MRI were performed on 18 patients diagnosed with GBM (N = 10) or MET (N = 8). Quantitative parameter maps were calculated, and regions-of-interest (ROIs) were placed in whole tumor, contrast-enhanced tumor (ET), edema, necrosis and normal-appearing white matter (NAWM). The mean and max of the APTw signal, CBF, leakage-corrected CBV and K2 were obtained from each ROI. Except for K2, all were normalized to NAWM (nAPTwmean/max, nCBFmean/max, ncCBVmean/max,). Receiver Operating Characteristic (ROC) curves and area-under-the-curve (AUC) were assessed for different parameter combinations. Statistical analyses were performed using Mann–Whitney U test.ResultsWhen comparing GBM to MET, nAPTmax, nCBFmax, ncCBVmax and ncCBVmean were significantly increased (p

High disease activity, cognitive dysfunction (CD), fatigue and pain negatively affect the quality of life in patients with systemic lupus erythematosus (SLE). However, the impact on brain perfusion and blood-brain barrier (BBB) permeability remains incompletely understood. Therefore, we utilized 3 T dynamic susceptibility contrast magnetic resonance imaging to investigate these factors in a cohort of 66 female SLE patients. Normalized leakage corrected cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), and the BBB leakage parameter K2, were compared within the cohort by splitting the group into patients with and without each symptom respectively. Fourteen regions of interest were chosen, and the results were adjusted for age, disease duration, smoking and glucocorticoids. We found regional significant alterations in the different SLE subgroups compared to patients without each corresponding symptom, with patterns as follows: moderate to high disease activity (n = 17, decreased MTT, increased K2), CD in ≥1 domain (n = 36, decreased MTT, increased K2), CD in ≥2 domains (n = 20, increased CBF, CBV and K2), fatigue (n = 44, increased CBV and MTT), pain (n = 9, increased CBF and CBV, decreased MTT). Additionally, inverse correlations were found between cognitive scores and K2 in multiple areas, indicating increased BBB permeability with worse cognitive performance. To elucidate the underlying mechanisms, longitudinal studies should be conducted in a larger variation of patients, using different measurements of BBB disruption.