Improve the diagnosis and selection of treatment for people suffering from obsessive-compulsive disorder, and test a new drug to create new treatment pathways for a disease where 50% of patients have resistance to first-line treatments (antidepressants and psychotherapy). These are the goals of FLAD’s Science Award Mental Health 2021 winning project proposed by Pedro Morgado.

It was an ambitious and innovative project that led the jury to select the researcher from the School of Medicine at Minho University, Pedro Morgado, as the first winner of FLAD’s Science Award Mental Health, the largest award in the area of Mental Health in Portugal.

The psychiatrist at Braga Hospital will develop a project with two components. The first focuses on the use of brain imaging to determine the affected areas in the brain of patients with obsessive-compulsive disorder, in order to better diagnose and select the most effective treatment for these individuals.

“We want to better understand whether we can predict the responses to treatments that are available for the obsessive-compulsive disorder through a functional MRI that is done to the person before starting treatment, and that will help us to select the best possible treatment for that person.” – Pedro Morgado

Currently, physicians have at their disposal a set of antidepressants to treat these patients and the choice of the right medication depends largely on their perception of the therapeutic outcome. However, there are no studies indicating which medication is best for each patient. The use of brain imaging will serve to understand whether it is possible to select a more personalized treatment for these individuals.

“We will recruit people with the disease who are starting their treatment. They will do a medical and psychological evaluation and then an MRI where they do a disease-related task, for example, looking at something, choosing between different options while they are in the MRI. What we’re recording is how the brain activates to each of these stimuli that are being shown while the person is doing the MRI. Then we will repeat the MRI after twelve weeks, when the treatment we will select is already having some effect, to try to understand how the situation has evolved, not only from the point of view of symptoms, of the patient, but also from the point of view of brain images, what changes the treatment has provided.” – Pedro Morgado

A very rare clinical trial in Portugal

Conducting a clinical trial to test a new indication for a drug in Portugal is very rare. Doing so for obsessive-compulsive disorder is even rarer, because this is not a widely studied disease by pharmaceutical laboratories when participating in the development of new medication.

In the second part of the project, Pedro Morgado will use the funding from FLAD’s Science Award Mental Health for that precisely: to test the effectiveness of a drug currently used in Portugal to treat Parkinson’s disease in patients with obsessive-compulsive disorder

Finding new therapies is critical, especially when it is estimated that about 50% of patients suffering from this condition do not respond to first-line treatments – antidepressants and psychotherapy.

“This is a drug that acts on dopamine, not serotonin like the antidepressants we use. In preclinical studies, it seems to have promising results in reducing obsessive-compulsive symptoms. We have a study that was done here at the School of Medicine from Minho University in which rodents had characteristics similar to those of the disease. These characteristics have been mitigated or eliminated through the use of a drug of this type.” – Pedro Morgado

What remains to be done is to test the drug in this disease to see if, in fact, it results in the improvement of the symptoms associated with this disorder. If the results are positive, this scientific knowledge can be used by the producers of the drug, in an application request for authorization to the responsible entities – in Portugal, Infarmed –, so that doctors can use it in the treatment of these patients.

“This is the first step in allowing this use to be expanded and massified. It has an impact not only in Portugal, but also internationally.” – Pedro Morgado

Why the obsessive-compulsive disorder?

Globally, up to 4% of people suffer from this disease, says the psychiatrist of Braga’s Hospital. In Portugal, the only study conducted dates back to 2013 and points to 4.4% of the population suffering from obsessive-compulsive disorder, a high number, even more so considering that it is estimated that this is an underdiagnosed disease.

“We are talking about a significant number of people suffering from this disease. The disease has different levels of severity. There are softer forms in which, although there is suffering, people manage their symptoms without a very significant impact on their lives. But there are other forms in which the levels of suffering and disability are very significant and can be as decisive as, for example, preventing a person from being able to leave their home or having a completely normal life, because they are permanently invaded by obsessive thoughts and the need to fulfill their compulsions.” – Pedro Morgado

Despite being a disease that affects a significant part of the population and is very disabling, it does not get much attention. Neither from the general population nor from services, explains the researcher, and this is due to the lack of knowdlege and stigma, but also to the lack of skills for the diagnosis and treatment of the disease.

“There is still a lot of unfamiliarity about the disease. Moreover, people themselves are often ashamed to ask for help because, contrary to what happens in other psychiatric diseases, the rule in obsessive-compulsive disorder is that one recognizes the absurdity of their thoughts and compulsions, and that they recognize that they make no sense. It is necessary to improve knowledge not only at the society level, but also at the level of health professionals.” – Pedro Morgado

The award will allow the researcher to reach more people and produce scientific knowledge in all these areas, from a more accurate diagnosis, to a more personalized and effective decision regarding the treatment plan of patients and, eventually, open the possibility to a new drug to treat this disease.