The Set Shifting in Symptomatic and Remitted Obsessive Compulsive Disorder

Description

Trishna G. Chettri¹, Praveen Bhattarai², Lata Poudel³, Binita Dhungel⁴, Adesh N. Tiwary⁵, and Shiba S. Thakuri⁶ (Clinical Psychologist, Mental Hospital Lagankhel, NAMS, Nepal¹, Psychiatrist, Mental Hospital Lagankhel, NAMS, Nepal^2.3, NCD and Mental Health Division⁴,  Clinical Psychologist, Manoshastra Counseling Center, Patan, Nepal⁵, and Social Work Officer, Mental Hospital Lagankhel, Nepal⁶)

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts, repetitive behaviors, and impairments in executive functioning, particularly cognitive flexibility. Set-shifting tasks, such as the Wisconsin Card Sorting Test (WCST), are commonly used to assess this ability, but it remains unclear whether deficits persist following symptom remission. This study examined executive function in patients with predominantly compulsive OCD (ICD-10 F42.1), dividing them into symptomatic (active symptoms) and remitted (>85% symptom reduction) groups. Cognitive flexibility was assessed using the WCST, and clinical symptoms were measured with the Vancouver Obsessional Compulsive Inventory (VOCI). Sociodemographic factors were the same for all groups in the study. This study uses several statistical tests, like the Student’s t-test, Mann-Whitney U test, and Spearman’s rank-order correlation. The results showed no big differences between people who still had symptoms and those who had recovered on any of the WCST tests. This includes total errors, the number of categories completed, perseverative responses or errors, and conceptual level responses. This suggests that even after symptoms go away, people still have trouble switching their thinking, just like those who are still experiencing symptoms. These findings suggest that problems with executive function in OCD might be a lasting and consistent trait, not just something that happens when symptoms are active. Staying rigid in thinking might help explain why the disorder lasts a long time and comes back. This could be connected to problems in the orbitofrontal cortex. It shows that treating cognitive inflexibility along with managing symptoms is important for better long-term outcomes.