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Garcia AM, Freeman JB, Himle MB, Berman NC, Ogata AK, Ng J, Choate-Summers ML, Leonard H. Phenomenology of Early Childhood Onset Obsessive Compulsive Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2009; 31:104-111. [PMID: 20198131 PMCID: PMC2830071 DOI: 10.1007/s10862-008-9094-0] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This paper describes the phenomenological features of early childhood onset obsessive compulsive disorder (OCD; defined as children meeting DSM-IV criteria for OCD with age of onset <8 years). Fifty-eight children (ages 4-8) were included in the sample. OCD and comorbid diagnoses were determined by structured interview, and OCD severity was measured using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Mean age of OCD onset was almost five, and mean age of presentation was between 6 and 7. Mean symptom severity was in the moderately severe range. Comorbidity and family history of OCD were common. Contamination and aggressive/catastrophic obsessions and washing and checking compulsions were endorsed most frequently. Results indicate that early childhood onset OCD may have a lower boy to girl ratio and lower rates of depressive disorders, but may be similar to later childhood onset OCD in terms of OCD symptom presentation and severity.
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Affiliation(s)
- Abbe M. Garcia
- Bradley/Hasbro Children’s Research Center, Providence, USA
| | | | | | - Noah C. Berman
- Bradley/Hasbro Children’s Research Center, Providence, USA
| | | | - Janet Ng
- University of Oregon, Eugene, USA
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102
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Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by disturbing thoughts, impulses, or images (obsessions); repetitive or ritualistic behaviors (compulsions); or the presence of both. Although some may believe this disorder is isolated to the adult population, it affects anywhere from 1% to 4% of children in the United States. However, symptom presentation of this psychiatric condition may be different in the pediatric population. School-age children who are affected by the condition or their parents may attempt to hide these behaviors due to embarrassment or fear of peer victimization. If left untreated, OCD can interfere with the ability to play, socialize, attend school, and function as a part of a family, ultimately affecting success not only in school but in life. It is imperative school nurses are aware of this condition, its symptoms, and treatments and techniques to help students with OCD cope effectively.
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Affiliation(s)
- Mary-Lee C Helbing
- Cardiac Intensive Care Unit, Geisinger Medical Center, Danville, PA, USA
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103
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Abstract
Anxiety disorders are one of the most common categories of psychopathology in children and adolescents. This article provides an overview of several anxiety disorders that are diagnosed often during childhood and adolescence, including separation anxiety disorder, generalized anxiety disorder, social phobia, obsessive-compulsive disorder, and posttraumatic stress disorder. Although anxiety disorders commonly show similar clinical characteristics during childhood and adulthood, this article highlights some of the differences that may present across the life span.
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Affiliation(s)
- Andrea M Victor
- Division of Child & Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA.
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104
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Keeley ML, Storch EA. Anxiety disorders in youth. J Pediatr Nurs 2009; 24:26-40. [PMID: 19159833 DOI: 10.1016/j.pedn.2007.08.021] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Revised: 08/27/2007] [Accepted: 08/30/2007] [Indexed: 10/22/2022]
Abstract
Anxiety disorders are one of the most prevalent categories of childhood and adolescent psychopathology. Due to their distressing, time-consuming, and/or debilitating nature, impairments in academic, social, and family functioning are often substantial. This article reviews the nature, etiology, assessment, and treatment of anxiety disorders in youth. We conclude by reviewing implications for nurses involved in the care of youth with anxiety disorders.
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Affiliation(s)
- Mary L Keeley
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL 32610, USA
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105
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Flaisher-Grinberg S, Albelda N, Gitter L, Weltman K, Arad M, Joel D. Ovarian hormones modulate 'compulsive' lever-pressing in female rats. Horm Behav 2009; 55:356-65. [PMID: 18996389 DOI: 10.1016/j.yhbeh.2008.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2008] [Revised: 10/05/2008] [Accepted: 10/06/2008] [Indexed: 10/21/2022]
Abstract
Life events related to the female hormonal cycle may trigger the onset of obsessive-compulsive disorder (OCD) or exacerbate symptoms in women already suffering from it. These observations suggest a possible role for ovarian hormones in the course of this disorder. Yet, the mechanisms that may subserve the modulatory effect of ovarian hormones are currently unknown. The aim of the present study was therefore to test the role of ovarian hormones in the signal attenuation rat model of OCD. Experiment 1 compared the behavior of pre-pubertal and adult male and female rats in the model, and found no age and sex differences in compulsive responding. Experiment 2 found that compulsive responding fluctuates along the estrous cycle, being highest during late diestrous and lowest during estrous. Acute administration of estradiol to pre-pubertal female rats was found to attenuate compulsive behavior (Experiment 3), and withdrawal from chronic administration of estradiol was shown to increase this behavior (Experiment 4). These findings extend the use of the signal attenuation model of OCD to female rats, and by demonstrating that the model is sensitive to the levels of ovarian hormones, provide the basis for using the model to study the role of ovarian hormones in OCD. In addition, the present findings support the hypothesis that the increased risk of onset and exacerbation of OCD in women post-partum may be a result of the decrease in the level of estradiol, which was elevated during pregnancy.
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106
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Huyser C, Veltman DJ, de Haan E, Boer F. Paediatric obsessive-compulsive disorder, a neurodevelopmental disorder? Evidence from neuroimaging. Neurosci Biobehav Rev 2009; 33:818-30. [PMID: 19428494 DOI: 10.1016/j.neubiorev.2009.01.003] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 01/12/2009] [Accepted: 01/12/2009] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To present an overview of neuroimaging data on paediatric obsessive-compulsive disorder (OCD) and discuss implications for further research. METHOD Medline PsycINFO databases and reference lists were searched for relevant articles. All neuroimaging studies up to October 1, 2008 involving children and adolescents with obsessive-compulsive disorder were included. RESULTS Twenty-eight neuroimaging studies using various neuroimaging techniques (CT (2) MRI (15) MRS (8) and SPECT (2) fMRI (2) but no PET or DTI) including a total of 462 paediatric patients were identified. A number of findings indicate a dysfunction of the prefrontal-striatal-thalamic circuit with the involvement of other basal ganglia structures (putamen globus pallidus) and the thalamus in contrast to adult studies which report mainly involvement of the caudate nucleus and orbitofrontal cortex. Several findings point at an aberrant development of the brain in paediatric OCD, patients when compared with healthy controls. CONCLUSION Neuroimaging studies have contributed to our understanding of the neurobiological basis of paediatric OCD. This review provides an agenda for further theory driven research in particular aimed at identifying a critical window of abnormal maturation of prefrontal-striatal-thalamic and limbic circuitry in paediatric OCD patients.
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Affiliation(s)
- Chaim Huyser
- De Bascule Academic Centre for Child and Adolescent Psychiatry, Duivendrecht, The Netherlands.
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107
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Venkatasubramanian G, Rao NP, Behere RV. Neuroanatomical, neurochemical, and neurodevelopmental basis of obsessive-compulsive symptoms in schizophrenia. Indian J Psychol Med 2009; 31:3-10. [PMID: 21938084 PMCID: PMC3168076 DOI: 10.4103/0253-7176.53308] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The prevalence of the obsessive-compulsive symptoms in schizophrenia (OCSS) appears to be higher than that expected on the basis of comorbidity rates. Review of brain abnormalities in schizophrenia and obsessive-compulsive disorder (OCD) reveals involvement of similar regions namely the frontal lobe, the basal ganglia, the thalamus, and the cerebellum, in both the disorders. Neurodevelopmental etiopathogenesis has been proposed to explain schizophrenia as well as OCD. Significant overlap in neurotransmitter dysfunction (serotonin, glutamate, and dopamine) has been documented between schizophrenia and OCD. The New-onset obsessive-compulsive (OC) symptoms have been reported with the use of atypical antipsychotics in the schizophrenia patients In this background, OCSS is an emerging area of recent interests. This article attempts to review the literature on the neurobiology of OCSS. Neuroimaging, neuropsychological, and neuromotor abnormalities in OCSS discussed in the context of neurodevelopmental etiopathogenesis suggest glutamate abnormalities in OCSS. Atypical antipsychotic induced OCSS points towards the possible roles of glutamate and serotonin. Dopamine may be responsible for the beneficial role of antipsychotics in the treatment of OCD. In summary, we propose that glutamate, serotonin, and dopamine abnormalities may be the probable basis for OCSS.
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Affiliation(s)
- Ganesan Venkatasubramanian
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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108
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Grant JE, Kim SW, Odlaug BL, Buchanan SN, Potenza MN. Late-onset pathological gambling: clinical correlates and gender differences. J Psychiatr Res 2009; 43:380-7. [PMID: 18499125 PMCID: PMC2655127 DOI: 10.1016/j.jpsychires.2008.04.005] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 04/09/2008] [Accepted: 04/10/2008] [Indexed: 10/22/2022]
Abstract
Age at illness onset has significant clinical implications for psychiatric disorders. Prior research has not systematically examined age at illness onset and its relationship to the clinical characteristics of pathological gambling (PG). Among a sample of 322 consecutive subjects with current DSM-IV PG, those with late-onset (at or after age 55 years) PG were compared to those with earlier onsets (at or prior to age 25, 26-54 years old) on measures of PG severity, co-occurring disorders, social and legal problems, and family history. Forty-two (13.4%) subjects reported onset of PG at or after age 55 years, 63 (19.6%) reported onset prior to age 25 years, and the majority (n=217; 67.4%) reported onset between the ages of 26 and 54 years. The late-onset group were less likely to declare bankruptcy (p=.029) or have credit card debt attributable to gambling (p=.006). Late-onset PG subjects were significantly more likely to have an anxiety disorder (p<.001) and significantly less likely to have a father (p=.025) or a mother (p=.048) with a gambling problem. Exploratory analyses identified an age-by-gender interaction with respect to treatment-seeking, with more pronounced age-related shortening in the duration between problem onset and treatment seeking observed in men. Age at onset of PG is associated with multiple important clinical features. Long durations of PG prior to treatment-seeking indicate the need for improved prevention efforts among individuals with early PG onset. Late-onset PG is relatively common and has distinct clinical characteristics suggesting that this population might benefit from unique prevention and treatment strategies.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota Medical School, Minneapolis, MN 55454, USA.
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109
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Sex differences in Indian patients with obsessive-compulsive disorder. Compr Psychiatry 2009; 50:70-5. [PMID: 19059517 DOI: 10.1016/j.comppsych.2008.05.003] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2008] [Revised: 05/11/2008] [Accepted: 05/29/2008] [Indexed: 11/24/2022] Open
Abstract
Sex has been postulated as one of the factors mediating heterogeneity in obsessive-compulsive disorder (OCD). This study investigated the sex differences in OCD with respect to sociodemographics, symptom profile, and comorbidity including spectrum disorders. Two hundred thirty-one subjects diagnosed with OCD by Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria were included in the study. The subjects were evaluated by extensive clinical and semistructured interviews by expert clinical psychiatrists, and diagnosis was made by consensus. Male (n = 166) and female (n = 65) subjects with OCD were compared with respect to the data obtained. Males with OCD tended to have an earlier onset and had more symmetry/religious obsessions and miscellaneous compulsions. Males also showed a tendency to have attention deficit hyperactivity disorder. Female subjects were more likely to be married, have cleaning compulsions and be associated with trichotillomania. The findings support the hypothesis that there are sex differences in OCD, but the results are only partly comparable with other studies, suggesting that the phenotypic expression of OCD is possibly dependent on a complex interaction among biologic, personal, and cultural factors.
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110
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Torresan RC, Ramos-Cerqueira ATDA, de Mathis MA, Diniz JB, Ferrão YA, Miguel EC, Torres AR. Sex differences in the phenotypic expression of obsessive-compulsive disorder: an exploratory study from Brazil. Compr Psychiatry 2009; 50:63-9. [PMID: 19059516 DOI: 10.1016/j.comppsych.2008.05.005] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2008] [Revised: 05/15/2008] [Accepted: 05/29/2008] [Indexed: 10/21/2022] Open
Abstract
Previous studies have shown differences in clinical features of obsessive-compulsive disorder (OCD) between men and women, including mean age at onset of obsessive-compulsive symptoms (OCS), types of OCS, comorbid disorders, course, and prognosis. The aim of this study was to compare male and female Brazilian patients with OCD on several demographic and clinical characteristics. Three hundred thirty outpatients with OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition [DSM-IV], criteria) who sought treatment at 3 Brazilian public universities and at 2 private practice clinics in the city of São Paulo were evaluated. The assessment instruments used were the Yale-Brown Obsessive-Compulsive Scale to evaluate OCD severity and symptoms, the Beck Depression and Anxiety Inventories, the Yale Global Tic Severity Scale, and the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Axis I Disorders to assess psychiatric comorbidity. Fifty-five percent of the patients (n = 182) were men who were significantly more likely than women to be single and to present sexual, religious, and symmetry obsessions and mental rituals. They also presented earlier onset of OCS and earlier symptom interference in functioning, and significantly more comorbid tic disorders and posttraumatic stress disorder. Women, besides showing significantly higher mean scores in the Beck Depression and Anxiety Inventories, were more likely to present comorbid simple phobias, eating disorders in general and anorexia in particular, impulse control disorders in general, and compulsive buying and skin picking in particular. No significant differences were observed between sexes concerning family history of OCS or OCD, and global symptoms severity, either in obsession or compulsive subscale. The present study confirms the presence of sex-related differences described in other countries and cultures. The fact that the OCS start earlier and probably have a worse impact in men can eventually lead to more specific and efficacious treatment approaches for these patients.
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Affiliation(s)
- Ricardo Cezar Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Botucatu, SP, Brazil.
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111
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Abstract
With a prevalence of about 2% obsessive-compulsive disorder is ranking among the most frequent psychiatric disorders in childhood and adolescence. The symptoms often lead to severe impairments in academic and social life, as well as to family conflicts. Despite the high efficacy of cognitive-behavioural and psychopharmacological interventions, the long-term course of the disorder is less favourable in a significant number of patients. A profound knowledge of the disorder is crucial to implement effective treatment strategies shortly after the onset of symptoms. This paper gives a review on juvenile obsessive-compulsive disorder and addresses issues of classification, epidemiology, symptoms, co-morbidity, diagnostics, aetiology, treatment strategies and the course of the disorder.
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112
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Abstract
INTRODUCTION Evidence from phenomenological, family, genetic, and treatment studies from Western centers have suggested that tic-related obsessive-compulsive disorder (OCD) could be different from non-tic-related OCD. This study from India investigated the differences in OCD with and without tics, with respect to sociodemographics, symptom profile, and comorbidity, including obsessive-compulsive spectrum disorders, to examine whether the clinical profile of tic-related OCD is similar to that reported previously. METHODS Fifty subjects with OCD and tics (chronic motor tics and Tourette syndrome) were compared with 141 OCD subjects without tics. RESULTS Subjects having OCD with tics tended to be males, and had an earlier onset of illness. They had more of symmetry/aggressive and religious obsessions, and cleaning, ordering/arranging, hoarding, and repeating compulsions and were associated with trichotillomania and hypochondraisis. Stepwise backward (Wald) regression analysis showed that an early age of onset, male gender, aggressive obsessions, cleaning compulsions, and trichotillomania were significantly associated with tic-related OCD. CONCLUSION The findings of this study from India are broadly similar to those reported previously from the West indicating the universality of differences in tic- and non-tic-related OCD. Our findings also support the existing evidence that tics contribute to the heterogeneity of OCD.
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113
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Rodowski MF, Cagande CC, Riddle MA. Childhood obsessive-compulsive disorder presenting as schizophrenia spectrum disorders. J Child Adolesc Psychopharmacol 2008; 18:395-401. [PMID: 18759651 DOI: 10.1089/cap.2007.0027] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Obsessive compulsive disorder (OCD) is a highly heterogeneous disorder, presenting with a wide array of symptoms. Sometimes, OCD can appear to be psychotic in nature, with periods of loss of insight or the emergence of paranoid ideas. Likewise, individuals with schizophrenia spectrum disorders (SSDs), including schizophrenia or schizo-affective disorder, can have obsessive-compulsive or "obsessive-compulsive like" symptoms. The complexities of differentiating obsessive-compulsive symptoms from true psychotic symptoms have been recognized in adults. However, in the child and adolescent OCD literature, this has just begun to be explored. In children, limited insight regarding their obsessions and compulsions often makes it more difficult to differentiate OCD from psychotic disorders, including schizophrenia. This report describes 2 adolescents who were initially diagnosed with "difficult-to-treat" SSDs, leading to the use of third-line antipsychotic treatments such as clozapine. Once the core symptoms were recognized as obsessions and compulsions, and appropriately treated, the apparent "psychosis" resolved and did not return over extended follow up. Awareness of the possibility of OCD presenting as if it were a schizophrenia spectrum disorder can facilitate proper diagnosis and treatment.
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Affiliation(s)
- Maria F Rodowski
- Division of Child and Adolescent Psychiatry, Johns Hopkins University College of Medicine, Baltimore, Maryland 21287-3325, USA.
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114
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Mancebo MC, Garcia AM, Pinto A, Freeman JB, Przeworski A, Stout R, Kane JS, Eisen JL, Rasmussen SA. Juvenile-onset OCD: clinical features in children, adolescents and adults. Acta Psychiatr Scand 2008; 118:149-59. [PMID: 18699949 PMCID: PMC2705172 DOI: 10.1111/j.1600-0447.2008.01224.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To examine clinical correlates of juvenile-onset OCD across the lifespan. METHOD Data collected at the intake interview from 257 consecutive participants with juvenile-onset OCD (20 children, 44 adolescents and 193 adults) in a naturalistic study of the clinical course of OCD were examined. Participants and parents of juvenile participants completed a structured diagnostic interview, rater-administered severity measures and self-report questionnaires. RESULTS Children and adolescents (i.e. juveniles) shared similar features with the exception of age at onset and OCD symptom expression. Clinically meaningful differences between juvenile and adult participants were also found. Compared with adults, juveniles were more likely to be male, recall an earlier age at OCD onset and have different lifetime comorbidity patterns. CONCLUSION Juvenile-onset OCD symptom expression is remarkably similar across the lifespan. However, findings also suggest clinically meaningful differences between juveniles and adults. Future work using a prospective design will improve our understanding of course patterns of juvenile-onset OCD.
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Affiliation(s)
- M C Mancebo
- Butler Hospital, 345 Blackstone Blvd, Providence, RI 02906, USA.
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115
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Chang SW, McCracken JT, Piacentini JC. Neurocognitive correlates of child obsessive compulsive disorder and Tourette syndrome. J Clin Exp Neuropsychol 2008; 29:724-33. [PMID: 17896198 DOI: 10.1080/13825580600966383] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
This study investigated the neurocognitive correlates of childhood OCD and TS, which are purported to share frontal-striatal dysfunction. Neurocognitive measures tapping frontal-striatal functions such as executive, attention/memory, and visuomotor abilities were administered to three groups of participants, OCD without comorbid TS (OCD), TS without comorbid OCD (TS), and normal controls. Results suggested that OCD group demonstrated deficits in the area of spatial attention relative to healthy controls. The OCD participants demonstrated no cognitive deficits compared to the TS group. TS participants showed trends towards impairments in the areas of response inhibition, divided attention, and cognitive flexibility relative to the OCD and normal control groups. Spatial attention deficits for the OCD group are partially consistent with adult OCD studies indicating deficits in spatial memory. TS findings were less robust and may be construed tentatively as suggestive of executive function deficits. Future research is needed to delineate the influence of development on neurocognitive deficits associated with OCD and TS.
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Affiliation(s)
- Susanna W Chang
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA 90095, USA.
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116
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Abstract
Obsessive-compulsive disorder (OCD) in children is strikingly similar in clinical presentation and treatment responsiveness to OCD in adults. While treatment is commonly effective for OCD not all subtypes of OCD are similarly responsive to treatment. Numerous studies describe the differential responsiveness of OCD subtypes to pharmacological treatment in adults, yet few such studies exist in pediatric OCD. This manuscript reviews the extant literature that addresses differential response of OCD subtypes to medication intervention. Specific OCD subtypes can be derived utilizing the following strategies: symptom factor analysis, comorbidity latent class analysis, concurrent internalizing disorders, concurrent externalizing disorders, tic-related subtype and early-onset subtype are reviewed in relation to data on differential pharmacotherapy response. Only externalizing disorders moderate treatment response in pediatric OCD. Specifically, attention-deficit hyperactivity disorder, oppositional defiant disorder and conduct disorder are associated with poorer response to medication treatment. Hoarding appears to be associated with a poor response to medication in adults, but data are sparse in children. The presence of tic disorders may also predict poorer response to pharmacotherapy in pediatric OCD. Strategies for treatment of the tic-related subtype of OCD, while strongly supporting the use of antipsychotic-augmentation for enhanced response in adults, are lacking controlled data in pediatric OCD.
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Affiliation(s)
- Marco Grados
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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117
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Maina G, Albert U, Salvi V, Pessina E, Bogetto F. Early-onset obsessive-compulsive disorder and personality disorders in adulthood. Psychiatry Res 2008; 158:217-25. [PMID: 18237785 DOI: 10.1016/j.psychres.2006.08.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2005] [Revised: 05/21/2006] [Accepted: 08/08/2006] [Indexed: 11/28/2022]
Abstract
Obsessive-compulsive disorder (OCD) often emerges in childhood or adolescence. The aim of the present study was to evaluate whether adult patients with prepuberal onset differ from subjects with later onset in terms of personality disorder comorbidity. The Structured Clinical Interview for DSM-IV Axis II Disorders was used to assess 148 patients with a principal diagnosis of OCD according to the Structured Clinical Interview for DSM-IV Axis I Disorders. The following two subgroups of subjects were selected according to the age at onset of symptomatology: patients with an early-onset (< or =10 years), and patients with a later onset (> or =17 years). Of the 148 patients screened for the present study, 33 (22.3%) had an early onset and 1369 (46.6%) had a later onset. With regard to personality disorders, early-onset patients showed more OC personality disorders (OCPD) than later onset patients. Our finding suggests that OCD in childhood increases the risk for developing OCPD in adulthood, or that early-onset OCD and OCPD share a common pathogenesis.
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Affiliation(s)
- Giuseppe Maina
- Department of Neurosciences, Mood and Anxiety Disorders Unit, University of Turin, Via Cherasco 11-10126 Torino, Italy.
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118
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de Mathis MA, do Rosario MC, Diniz JB, Torres AR, Shavitt RG, Ferrão YA, Fossaluza V, de Bragança Pereira CA, Miguel EC. Obsessive–Compulsive Disorder: Influence of Age at Onset on Comorbidity Patterns. Eur Psychiatry 2008; 23:187-94. [DOI: 10.1016/j.eurpsy.2008.01.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Revised: 01/10/2008] [Accepted: 01/11/2008] [Indexed: 11/29/2022] Open
Abstract
AbstractPurpose.This study investigates the influence of age at onset of OCS on psychiatric comorbidities, and tries to establish a cut-off point for age at onset.Methods.Three hundred and thirty OCD patients were consecutively recruited and interviewed using the following structured interviews: Yale-Brown Obsessive Compulsive Scale; Yale Global Tic Severity Scale and the Structured Clinical Interview for DSM-IV. Data were analyzed with regression and cluster analysis.Results.Lower age at onset was associated with a higher probability of having comorbidity with tic, anxiety, somatoform, eating and impulse–control disorders. Longer illness duration was associated with lower chance of having tics. Female gender was associated with anxiety, eating and impulse–control disorders. Tic disorders were associated with anxiety disorders and attention-deficit/hyperactivity disorder. No cut-off age at onset was found to clearly divide the sample in homogeneous subgroups. However, cluster analyses revealed that differences started to emerge at the age of 10 and were more pronounced at the age of 17, suggesting that these were the best cut-off points on this sample.Conclusions.Age at onset is associated with specific comorbidity patterns in OCD patients. More prominent differences are obtained when analyzing age at onset as an absolute value.
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119
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Abstract
Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with obsessive-compulsive disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico-basal ganglia-thalamo-cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico-basal ganglia-thalamo-cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.
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Affiliation(s)
- Tiago V Maia
- Columbia University and New York State Psychiatric Institute, NY 10032, USA
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120
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Sloman GM, Gallant J, Storch EA. A school-based treatment model for pediatric obsessive-compulsive disorder. Child Psychiatry Hum Dev 2007; 38:303-19. [PMID: 17570056 DOI: 10.1007/s10578-007-0064-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
School psychologists have expertise in the realm of school-based assessment and intervention for behavioral, educational, and psychological difficulties. Recent evidence indicates that many school psychologists lack evidenced based knowledge about assessment and treatment of pediatric Obsessive-Compulsive Disorder (OCD). Pediatric OCD is a relatively common disorder that contributes to substantial impairment in educational and psychosocial domains. Evidence based treatment of pediatric OCD, particularly cognitive-behavioral therapy, has shown to be efficacious. Therefore, the aims of this paper are to provide a review of empirically established treatments for pediatric OCD, and present a school-based problem-solving model that school psychologists can utilize to conceptualize, assess, and treat OCD.
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Affiliation(s)
- Glenn M Sloman
- Department of Educational Psychology, University of Florida, Gainesville, FL, USA
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121
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Abstract
Systematic research and practice guidelines addressing preschool psychopharmacological treatment in very young children are limited, despite evidence of increasing clinical use of medications in this population. The Preschool Psychopharmacology Working Group (PPWG) was developed to review existing literature relevant to preschool psychopharmacology treatment and to develop treatment recommendations to guide clinicians considering psychopharmacological treatment in very young children. This article reviews the developmental considerations related to preschool psychopharmacological treatment, presents current evidence bases for specific disorders in early childhood, and describes the recommended algorithms for medication use. The purpose of this effort is to promote responsible treatment of young children, recognizing that this will sometimes involve the use of medications.
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122
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Grant JE, Mancebo MC, Pinto A, Williams KA, Eisen JL, Rasmussen SA. Late-onset obsessive compulsive disorder: clinical characteristics and psychiatric comorbidity. Psychiatry Res 2007; 152:21-7. [PMID: 17363071 DOI: 10.1016/j.psychres.2006.09.015] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Revised: 08/12/2006] [Accepted: 09/20/2006] [Indexed: 10/23/2022]
Abstract
There has been little research examining clinical correlates of late-onset OCD in a large sample of individuals with a primary diagnosis of OCD. Using a sample of 293 consecutive subjects with lifetime DSM-IV OCD, we compared subjects with late-onset (after age 30 years) OCD to those with earlier onset on a variety of clinical measures. Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Thirty-three (11.3%) of the 293 subjects with OCD reported onset of OCD on or after age 30 years (mean age of OCD onset of 38.8+/-9.7 years). Subjects with late-onset had significantly shorter durations of illness prior to receiving treatment, less severe obsessinality, and a trend demonstrating a greater likelihood of responding to cognitive behavioral therapy (CBT). Late-onset OCD subjects were also significantly less likely to report contamination, religious, or somatic obsessions. Comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differ between groups. These preliminary results suggest that although onset on or after age 30 years is fairly uncommon among people with OCD, individuals developing OCD later in life have similar clinical characteristics as those with earlier onset and may respond better to CBT.
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Affiliation(s)
- Jon E Grant
- Department of Psychiatry, University of Minnesota, 2450 Riverside Avenue, Minneapolis, MN 55454, USA.
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123
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Abstract
AIMS Obsessive-compulsive disorder (OCD) preferentially responds to a class of antidepressants called serotonin reuptake inhibitors (SRI). This review discusses certain issues unique to pharmacological treatment of OCD: choice of SRI, dose and duration of treatment, options after first failed SRI trial and treatment of SRI non-responders. METHODS We performed a MEDLINE search for pharmacotherapy studies published until December 2006. In addition, the reference sections of major articles, and reviews were also screened. We also considered clinical guidelines and narrative reviews in writing this review. RESULTS The SRIs are equally effective in treating OCD. Meta-analyses suggest that clomipramine may be superior to other SRIs. OCD tends to respond to higher doses of SRIs than that used to treat depression. Response to treatment is usually delayed and may take up to 8-12 weeks. Atypical antipsychotics are the only proven augmenting agents in SRI non-responders. Cognitive behaviour therapy (CBT) is an effective treatment strategy in treating OCD and possibly has a role in treating SRI non-responders. DISCUSSION Side effect profile and drug-drug interactions largely determine the choice of SRI. Those who fail to respond to one SRI trial may well respond to another SRI trial. Clomipramine is recommended if 2-3 trials of SRIs fail to produce response. Atypical antipsychotics are the first-line augmenting agents in SRI non-responders. CBT should be considered in all patients with OCD and is a potential option in SRI non-responders. CONCLUSION OCD is a chronic and debilitating disorder. In responders, SRIs have to be continued in the same doses (if possible) for a minimum of 1-2 years and may be lifelong in those with persistent symptoms and in those with multiple relapses. CBT has to be offered in combination with SRIs wherever facilities for CBT exist.
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Affiliation(s)
- S B Math
- OCD clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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124
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Keeley ML, Storch EA, Dhungana P, Geffken GR. Pediatric obsessive-compulsive disorder: a guide to assessment and treatment. Issues Ment Health Nurs 2007; 28:555-74. [PMID: 17613156 DOI: 10.1080/01612840701354570] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive or distressing (obsessions), and repetitive behaviors or mental acts (compulsions) often performed in response to an obsession. Recent epidemiological studies have found lifetime prevalence of pediatric OCD to be approximately 1-4% in the USA. OCD begins before the age of 18 years for as many as 80% of cases and follows a chronic, unremitting course. Due to the distressing, time-consuming, and debilitating nature of OCD, impairments in academic, social, and family functioning are often substantial. Despite the relatively high prevalence rate of OCD, dissemination about effective assessment and treatment has lagged. Increasing the awareness of OCD symptoms and its treatment among nurses and other health professionals will enhance identification of children presenting with unrecognized or untreated symptoms of OCD and will stimulate appropriate referrals for treatment to improve children's psychological functioning and overall quality of life. This paper reviews the nature, etiology, assessment, and treatment of OCD, highlighting clinical implications for nurses involved in mental health care.
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Affiliation(s)
- Mary L Keeley
- University of Florida, Gainesville, Florida 32610, USA
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125
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Keeley ML, Storch EA, Merlo LJ, Geffken GR. Clinical predictors of response to cognitive-behavioral therapy for obsessive-compulsive disorder. Clin Psychol Rev 2007; 28:118-130. [PMID: 17531365 DOI: 10.1016/j.cpr.2007.04.003] [Citation(s) in RCA: 161] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 04/19/2007] [Accepted: 04/20/2007] [Indexed: 11/19/2022]
Abstract
This paper reviews predictors of treatment response in open and controlled trials of cognitive-behavioral therapy for obsessive-compulsive disorder (OCD). We focus on demographic characteristics, aspects of OCD symptoms, comorbidity, family factors, cognitive influences, and treatment-specific characteristics as predictor variables. Although inconsistent findings characterize much of the literature, several relatively consistent and salient predictors have emerged, including symptom severity, symptom subtype, severe depression, the presence of comorbid personality disorders, family dysfunction, and the therapeutic alliance. Implications of findings and recommendations for future research are discussed.
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Affiliation(s)
- Mary L Keeley
- Department of Clinical & Health Psychology, University of Florida, Gainesville, Florida, United States; Department of Psychiatry, University of Florida, Gainesville, Florida, United States
| | - Eric A Storch
- Department of Psychiatry, University of Florida, Gainesville, Florida, United States; Department of Pediatrics, University of Florida, Gainesville, FL, United States.
| | - Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, Florida, United States
| | - Gary R Geffken
- Department of Psychiatry, University of Florida, Gainesville, Florida, United States; Department of Pediatrics, University of Florida, Gainesville, FL, United States
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126
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Diniz JB, Issler CK, Lafer B, Miguel EC. Comment on Tükel et al., "The clinical impact of mood disorder comorbidity on obsessive-compulsive disorder" (Eur Arch Psychiatry Clin Neurosci, 256(4):240-245). Eur Arch Psychiatry Clin Neurosci 2007; 257:183-4. [PMID: 17149541 DOI: 10.1007/s00406-006-0691-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2006] [Accepted: 08/24/2006] [Indexed: 11/28/2022]
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127
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Stewart SE, Rosario MC, Brown TA, Carter AS, Leckman JF, Sukhodolsky D, Katsovitch L, King R, Geller D, Pauls DL. Principal components analysis of obsessive-compulsive disorder symptoms in children and adolescents. Biol Psychiatry 2007; 61:285-91. [PMID: 17161383 DOI: 10.1016/j.biopsych.2006.08.040] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2006] [Revised: 08/24/2006] [Accepted: 08/25/2006] [Indexed: 11/25/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) has a broadly diverse clinical expression that may reflect etiologic heterogeneity. Several adult studies have identified consistent symptom dimensions of OCD. The purpose of this study was to conduct an exploratory principal components analysis of obsessive-compulsive (OC) symptoms in children and adolescents with OCD to identify improved phenotypes for future studies. METHODS This study examined lifetime occurrence of OC symptoms included in the 13 symptom categories of the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Principal components analysis with promax rotation was performed on 231 children and adolescents with OCD and compared with results of similar adult studies. RESULTS A four-factor solution emerged explaining 59.8% of symptom variance characterized by 1) symmetry/ordering/repeating/checking; 2) contamination/cleaning/aggressive/somatic; 3) hoarding; and 4) sexual/religious symptoms. All factors included core symptoms that have been consistently observed in adult studies of OCD. CONCLUSIONS In children and adolescents, OCD is a multidimensional disorder. Symptom dimensions are predominantly congruent with those described in similar studies of adults with OCD, suggesting fairly consistent covariation of OCD symptoms through the developmental course. Future work is required to understand changes in specific symptom dimensions observed across the life span.
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Affiliation(s)
- S Evelyn Stewart
- Psychiatric and Neurodevelopmental Genetics Unit, Massachusetts General Hospital, Department of Psychiatry, Harvard Medical School, Boston, Massachusetts 02114, USA
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128
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Vasconcelos MS, Sampaio AS, Hounie AG, Akkerman F, Curi M, Lopes AC, Miguel EC. Prenatal, perinatal, and postnatal risk factors in obsessive-compulsive disorder. Biol Psychiatry 2007; 61:301-7. [PMID: 17123475 DOI: 10.1016/j.biopsych.2006.07.014] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2006] [Revised: 06/29/2006] [Accepted: 07/06/2006] [Indexed: 11/17/2022]
Abstract
BACKGROUND The etiology of obsessive-compulsive disorder (OCD) remains unknown, although it is thought to involve an interaction of genetic and environmental factors. This study aimed to identify prenatal, perinatal, and postnatal risk factors in OCD. METHODS We compared retrospectively 68 OCD patients to 70 control subjects based on responses given on a standardized questionnaire. The questionnaire was designed to evaluate environmental factors, with a special focus on gestation, labor, birth, and early infancy aspects. RESULTS The group of OCD patients had risk factors with greater frequency than the control group. Notable among the significant findings (p < or = 0.001) were edema of the hands, feet, or face and excessive weight gain during gestation; hyperemesis gravidarum; prolonged labor; preterm birth; and jaundice. When socioeconomic class was used as a covariable in the logistic regression analysis, prolonged labor and edema during pregnancy remained statistically significant. CONCLUSIONS Some early risk factors may be associated with the expression of OCD later in life such as edema during pregnancy and prolonged labor. If our findings are confirmed in future studies, greater attention should be given to such factors in predisposed individuals, especially in prenatal care and delivery.
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Affiliation(s)
- Marcos Salem Vasconcelos
- Department of Psychiatry, University of São Paulo Medical School, OCD Spectrum Disorders Program(PROTOC), São Paulo, Brazil
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129
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March JS, Franklin ME, Leonard H, Garcia A, Moore P, Freeman J, Foa E. Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biol Psychiatry 2007; 61:344-7. [PMID: 17241830 DOI: 10.1016/j.biopsych.2006.09.035] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Revised: 09/08/2006] [Accepted: 09/11/2006] [Indexed: 01/14/2023]
Abstract
BACKGROUND The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). METHODS Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-behavior therapy (CBT), medical management with sertraline (SER), and the combination of CBT and SER (COMB), to pill placebo (PBO) in children and adolescents with OCD, we asked whether the presence of a comorbid tic disorder influenced symptom reduction on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) after 12 weeks of treatment. RESULTS Fifteen percent (17 of 112) of patients exhibited a comorbid tic disorder. In patients without tics, results replicated previously published intent-to-treat outcomes: COMB > CBT > SER > PBO. In patients with a comorbid tic disorder, SER did not differ from PBO, while COMB remained superior to CBT and CBT remained superior to PBO. CONCLUSIONS In contrast to CBT outcomes, which are not differentially impacted, tic disorders appear to adversely impact the outcome of medication management of pediatric OCD. Children and adolescents with obsessive-compulsive disorder and a comorbid tic disorder should begin treatment with cognitive-behavior therapy alone or the combination of cognitive-behavior therapy plus a serotonin reuptake inhibitor.
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Affiliation(s)
- John S March
- Department of Psychiatry, Duke University Medical Center, Durham, North Carolina 27710, USA.
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130
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Jans T, Wewetzer C, Klampfl K, Schulz E, Herpertz-Dahlmann B, Remschmidt H, Warnke A. Phänomenologie und Komorbidität der Zwangsstörung bei Kindern und Jugendlichen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:41-50. [PMID: 17230428 DOI: 10.1024/1422-4917.35.1.41] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Gegenstand der Studie waren die Symptomatologie und die Komorbidität der Zwangsstörung mit Beginn im Kindes- und Jugendalter. Methodik: Untersucht wurde eine Inanspruchnahmestichprobe von 55 kinder- und jugendpsychiatrischen Patienten (29 männlich, 26 weiblich), die überwiegend stationär behandelt wurden (95%). Strukturierte diagnostische Interviews zur Erfassung von Zwangsstörung und weiteren psychischen Störungen wurden zu Befragungen von Eltern und Kind eingesetzt. Ergebnis: Das mittlere Alter bei Beginn der Zwangsstörung betrug 11,3 Jahre. Jungen waren bei Störungsbeginn etwas, aber nicht statistisch signifikant jünger als Mädchen. Zwangshandlungen bezogen sich vorwiegend auf Waschen und Sauberkeit, Kontrollieren sowie Wiederholungen, Ordnen und Zählen. Zwangsgedanken beinhalteten vor allem Verunreinigung, die Erwartung schlimmer Ereignisse, Sexualität oder Aggression. In der klinischen Behandlungsroutine wurden seltener eine gemischte Zwangsstörung mit Gedanken und Handlungen diagnostiziert als bei Anwendung strukturierter Interviews. Die Komorbiditätsrate war Elternangaben zufolge hoch (Lebenszeit-Diagnosen: 69%; aktuelle Diagnosen: 53%). Angststörungen, affektive Störungen, hyperkinetische Störungen, Störungen des Sozialverhaltens und Ess-Störungen standen im Vordergrund. Die Zwangssymptomatik war bei Patienten mit einer höheren Anzahl an komorbiden Lebenszeitdiagnosen signifikant stärker ausgeprägt. Schlussfolgerungen: Die Studienergebnisse stehen in Einklang mit denjenigen internationaler Studien. Deutlich wurde eine Methodenabhängigkeit gestellter Diagnosen. In der Subtypisierung von Patientengruppen durch Symptomdimensionen wird ein fruchtbarer Ansatz für weitere Studien gesehen.
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Affiliation(s)
- Thomas Jans
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie der Julius-Maximilians-Universität Würzburg, Germany
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131
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Martin JL, Thienemann M. Group cognitive-behavior therapy with family involvement for middle-school-age children with obsessive-compulsive disorder: a pilot study. Child Psychiatry Hum Dev 2006; 36:113-27. [PMID: 16049647 DOI: 10.1007/s10578-005-3496-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Middle-school-aged children with obsessive-compulsive disorder (OCD) are poised in development between the dependency of elementary-school-aged children and growing independence of adolescence. OCD patients of this age group may differ from older ones in the quality of symptoms and level of insight. We report the results of a naturalistic, pilot study of group Cognitive-behavior Therapy (CBT) for school-aged children with OCD with parents involved. The authors predicted symptom improvement and format acceptability. METHOD Over a 1.5 year period, 14 children with OCD aged 8-14 years and their parents received 14-week group CBT based on March and Mulle's OCD in Children and Adolescents: A Cognitive-Behavioral Treatment Manual in three consecutive sessions of four to six families. Age of onset averaged 8.7 years, 36% had undergone at least one medication trial, and 36% had previous CBT experience. RESULTS OCD symptoms measured by the Children's Yale-Brown Obsessive Compulsive Scale improved significantly, both statistically and clinically (25%) from moderate-severe to mild-moderate. Mean Clinical Global Impression of Impairment (NIMH-CGI) Impairment ratings fell from clinical to sub-clinical and CGI Improvement ratings were "much improved". Children's self-reported depression decreased significantly from pre- to post-group. Parent ratings of the negative impact of OCD symptoms on the Children's OCD Impact Scale and of behavior problems on the Child Behavior Checklist each improved significantly. CONCLUSIONS This pilot study, which included a non-selected clinical sample, demonstrates that a manual-based treatment protocol may be effectively adapted for group treatment of different developmental levels and be exported for clinical use. Clinical improvement justifies further investigation in a controlled study.
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Affiliation(s)
- Jacqueline L Martin
- Division of Child and Adolescent Psychiatry and Child Development, Stanford University School of Medicine, Stanford, CA, USA.
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132
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Grisham JR, Frost RO, Steketee G, Kim HJ, Hood S. Age of onset of compulsive hoarding. J Anxiety Disord 2006; 20:675-86. [PMID: 16112837 DOI: 10.1016/j.janxdis.2005.07.004] [Citation(s) in RCA: 128] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Revised: 06/27/2005] [Accepted: 07/21/2005] [Indexed: 11/22/2022]
Abstract
Although compulsive hoarding appears to be a chronic, progressive disorder, little is known about its onset and course. The current study employed retrospective assessment of 51 individuals with compulsive hoarding difficulties to determine onset of various hoarding symptoms (clutter, acquisition, difficulty discarding), as well as the individual's degree of recognition of the problem at various times throughout his or her life. Participants were asked to describe life events from each decade that occurred at the time hoarding symptoms were developing. Symptoms of clutter and difficulty discarding appeared to begin at approximately the same age, whereas acquiring problems began slightly later. Recognition of the problem developed significantly later than any of the symptoms themselves. A portion of participants reported that their hoarding symptoms were reduced at some point in their lives, but few reported full remission of hoarding at any point. Survival analysis of age of onset of hoarding symptoms indicated that individuals who reported a stressful event when saving behavior started had a significantly later age of onset than those who reported no events at the age of onset. Perhaps for some individuals compulsive hoarding is a lifelong characterological phenomenon, whereas for others hoarding behavior develops later as a reaction to stress or loss.
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133
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de Mathis MA, Diniz JB, do Rosário MC, Torres AR, Hoexter M, Hasler G, Miguel EC. What is the optimal way to subdivide obsessive-compulsive disorder? CNS Spectr 2006; 11:762-8, 771-4, 776-9. [PMID: 17008820 DOI: 10.1017/s1092852900014899] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The clinical presentation of obsessive-compulsive disorder (OCD) varies not only across patients but over the course of the disorder. This diversity indicates that OCD is a heterogeneous disorder, which may have an important impact on psychopathological, longitudinal, genetic, and treatment research. To better understand OCD heterogeneity, more homogeneous phenotypic descriptions are necessary to delimiting clinically meaningful subgroups of patients. Besides phenotypic descriptions, another method of delimiting OCD patient subgroups includes the search for endophenotypes (extended phenotypes) based on neurophysiological, immunological, genetic, neuropsychological, or neuroanatomic (neuroimaging) paradigms. This article will describe some strategies that deal with OCD heterogeneity, including the identification of more homogeneous phenotypical categories, an improved understanding of obsessive-compulsive symptom dimensions and how to use them as quantitative traits, and broadening the diagnostic boundaries of OCD to include other related conditions. The relevance and limitations of each approach are also discussed. Since the etiological mechanisms associated with the expressions of OCD are unknown, there is probably not one but several heuristic strategies to search for more homogeneous OCD subgroup, that combined may provide the most fruitful results.
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134
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Abstract
Several lines of evidence suggest a meaningful association between obsessive-compulsive disorder and Tourette syndrome, including comorbidity, phenomenologic overlap, evidence from family and genetic studies, and the possible role of basal ganglia circuitry in both conditions. Obsessive-compulsive behaviors occur frequently in patients who have Tourette syndrome and tend to have a later onset than tics. Despite commonalities, the approaches to treating tics and obsessive-compulsive symptoms are actually quite distinct. A specialized form of cognitive behavior therapy and pharmacotherapy with a potent serotonin reuptake inhibitor are the two established first-line therapies for obsessive-compulsive disorder. An adequate trial of a serotonin reuptake inhibitor is 10 to 12 weeks in duration at doses near the upper end of the recommended range for age and weight. Cases of obsessive-compulsive disorder that do not sufficiently improve with serotonin reuptake inhibitors might benefit from adjunctive low-dose antipsychotic (eg, risperidone) medication whether or not tics are present. Warnings about an increased risk of suicidality among children and adolescents taking antidepressants for pediatric depression extend to those taking the medications for obsessive-compulsive disorder, but the risk-to-benefit ratio is more favorable in this latter population because several serotonin reuptake inhibitors have been shown to be efficacious in obsessive-compulsive disorder.
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Affiliation(s)
- Wayne K Goodman
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA.
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135
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Shavitt RG, Belotto C, Curi M, Hounie AG, Rosário-Campos MC, Diniz JB, Ferrão YA, Pato MT, Miguel EC. Clinical features associated with treatment response in obsessive-compulsive disorder. Compr Psychiatry 2006; 47:276-81. [PMID: 16769302 DOI: 10.1016/j.comppsych.2005.09.001] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 06/09/2005] [Accepted: 09/12/2005] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aims to investigate the effect of sociodemographic and clinical features on the short-term response to pharmacological treatment in obsessive-compulsive disorder (OCD). We focused especially on investigating factors previously associated with poorer prognosis, such as comorbidity with tic disorders, early onset of symptoms, and sensory phenomena preceding compulsions, which have been described as common in both tic-related and early-onset OCD. METHOD The study involved 41 consecutive adult patients with OCD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and was conducted at the OCD Spectrum Disorders Clinic of the University of Sao Paulo School of Medicine in São Paulo, Brazil, between January of 2000 and December of 2001. All patients were treated exclusively with oral clomipramine for 14 weeks. Treatment response, measured for Yale-Brown Obsessive-Compulsive Scale score decrease from baseline, was assessed by an investigator blinded as to the variables of interest present. RESULTS Linear regression analysis showed that having a partner and sensory phenomena preceding compulsions were associated with better response to clomipramine treatment (P = .04 and P = .002, respectively). Tic comorbidity and early onset of symptoms were not associated with poorer response. CONCLUSIONS In OCD, having a partner and sensory phenomena preceding compulsions seem to be associated with a favorable response to pharmacological treatment.
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Affiliation(s)
- Roseli G Shavitt
- Department of Psychiatry, University of São Paulo School of Medicine, Caixa Postal 8091, São Paulo, Brazil.
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136
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Abstract
The available literature indicates that OCD affecting children and adolescents is highly prevalent. Pediatric-onset OCD seems to share important similarities with the adult disorder but also shows important differences. For example, the clinical phenotype of OCD is remarkably consistent at all ages with some allowances for developmental expression. Pediatric patients frequently demonstrate poor insight into the nature of their obsessions, which in association with their limited verbal expression may make the diagnosis more difficult. Obsessions involving fear of harm and separation, compulsions without obsessions, and rituals involving family members are more common in younger patients. Treatment response,including serotonergic specificity and the need for robust dosing, is another feature shared by early- and adult-onset OCD. Imporfant differences across the life span can also be identified. Perhaps the clearest difference pertains to age of onset. Age-at-onset data have shown a bimodal distribution of age of onset of OCD, with one peak in preadolescent childhood and another peak in adulthood. Another distinction between child and adult OCD is gender representation. Whereas adult studies report equal gender representation or a slight female preponderance, pediatric clinical samples are clearly male predominant. Patterns of psychiatric comorbidity in pediatric OCD show high rates of tic and mood and anxiety disorders, similar to the patterns in adults, but also show a distinct association with disruptive behavior disorders (ADHD and oppositional defiant disorder) and other specific and pervasive developmental disorders. Family studies indicate that the disorder is highly familial and that a childhood onset of the disorder seems to be associated with a markedly increased risk for familial transmission of OCD, tic disorders, and ADHD. Both scientifically and clinically, the recognition of developmentally specific OCD phenotypes may be valuable. For example, research efforts aimed at identifying OCD-associated genes are likely to be more successful if developmentally homogeneous samples are studied instead of combining data from children, adolescents, and adults, as has been common in OCD studies. Clinical management is also informed by an appreciation of the unique cor-relates of OCD affecting youth, especially comorbidity with chronic tic dis-orders and ADHD and their impact on treatment. The so-called "spectrum disorders" related to OCD are less prominent in children and adolescents than in adults. Although sharing some features with typical OCD, these symptoms are less clearly ego-dystonic and less anxiety producing, frequently provide a measure of gratification, and are less responsive in general to SSRIs. Often cognitive antecedents to these behaviors are less well developed than in more typical OCD, and behavioral interventions are the mainstay of treatment but with more variable success.
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Affiliation(s)
- Daniel A Geller
- Pediatric Obsessive Compulsive Disorder Program, Division of Pediatric Psychopharmacology, Massachusetts General Hospital, YAW 6A, Fruit Street, Boston, MA 02114, USA.
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Roessner V, Becker A, Banaschewski T, Rothenberger A. Tic disorders and obsessive compulsive disorder: where is the link? JOURNAL OF NEURAL TRANSMISSION. SUPPLEMENTUM 2006:69-99. [PMID: 16355604 DOI: 10.1007/3-211-31222-6_5] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Over the last years evidence on the overlap between tic-disorders (TD) and obsessive compulsive behavior/disorder (OCB/OCD) has increased. The main focus of research have been the phenomenological and epidemiological similarities and differences in samples of different age, primary diagnosis (TD vs. OCD) including the co-occurrence of both. Unfortunately, only a minority of studies included all three groups (TD, TD + OCD, OCD). Nevertheless, new insight concerning possible subtypes for both TD and OCD has been gained. While some authors concentrated on OCD with/without tics we will summarize the field of TD and OCB/OCD from the viewpoint of tics, since OCB plays an important role in patients with TD. Thereby we will not only sharpen the clinicans' awareness of known differences in phenomenology, epidemiology, genetics and neurobiology, aimed to improve their diagnoses and treatment but also highlight the gaps of knowledge and discuss possibilities for further research in this field.
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Affiliation(s)
- V Roessner
- Department of Child and Adolescent Psychiatry, University of Göttingen, Germany.
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Lochner C, Stein DJ. Does work on obsessive-compulsive spectrum disorders contribute to understanding the heterogeneity of obsessive-compulsive disorder? Prog Neuropsychopharmacol Biol Psychiatry 2006; 30:353-61. [PMID: 16458405 DOI: 10.1016/j.pnpbp.2005.11.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/02/2005] [Indexed: 11/28/2022]
Abstract
BACKGROUND There is a growing literature on the concept of an obsessive-compulsive spectrum of disorders. Here, we consider the different dimensions on which obsessive-compulsive spectrum (OCSDs) lie, and focus on how the concepts from this literature may help understand the heterogeneity of obsessive-compulsive disorder (OCD). METHODS A computerized literature search (MEDLINE: 1964-2005) was used to collect studies addressing different dimensions on which the OCSDs lie. Against this backdrop, we report on a cluster analysis of OCSDs within OCD. RESULTS OCSDs may lie on several different dimensions. Our cluster analysis found that in OCD there were 3 clusters of OCD spectrum symptoms: (1) "Reward deficiency" (including trichotillomania, pathological gambling, hypersexual disorder and Tourette's disorder), (2) "Impulsivity" (including compulsive shopping, kleptomania, eating disorders, self-injury and intermittent explosive disorder), and (3) "Somatic" (including body dysmorphic disorder and hypochondriasis). CONCLUSIONS It is unlikely that OC symptoms and disorders fall on any single phenomenological dimension; instead, multiple different constructs may be required to map this nosological space. Although there is evidence for the validity of some of the relevant dimensions, additional work is required to delineate more fully the endophenotypes that underlie OC symptoms and disorders.
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Affiliation(s)
- Christine Lochner
- MRC Unit on Anxiety Disorders, Department of Psychiatry, University of Stellenbosch, South Africa.
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139
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Geller DA, Doyle R, Shaw D, Mullin B, Coffey B, Petty C, Vivas F, Biederman J. A quick and reliable screening measure for OCD in youth: reliability and validity of the obsessive compulsive scale of the Child Behavior Checklist. Compr Psychiatry 2006; 47:234-40. [PMID: 16635654 DOI: 10.1016/j.comppsych.2005.08.005] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2005] [Revised: 05/20/2005] [Accepted: 08/24/2005] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The high prevalence and morbidity of obsessive compulsive disorder (OCD) in youth, the secretive nature of the disorder leading to under-recognition, and the lack of specialized child psychiatry services in many areas suggest that a simple, quick, and reliable screening tool to identify cases could be very useful to clinicians who work with children. METHOD We used 8 items from the Child Behavior Checklist (CBCL), an empirically derived instrument free of clinician bias, to investigate the usefulness of a previously reported CBCL-based obsessive compulsive scale (OCS) by Nelson et al [Nelson EC, Hanna GL, Hudziak JJ, Botteron KN, Heath AC, Todd RD. Obsessive-compulsive scale of the Child Behavior Checklist: Specificity, sensitivity, and predictive power. Pediatrics 2001;108(1):E14] in a separate cohort of youth with OCD. We computed the psychometric properties of the OCS in our sample of youth with OCD and in psychiatric and normal controls, and compared these to the published values. RESULTS Using the recommended cutoff between the 60th and 70th percentiles of the OCS to best predict the presence of OCD, we found very high sensitivity (92%-78%), specificity (86%-94%), negative predictive value (96%-90%), and positive predictive value (77%-86%). CONCLUSIONS The OC scale of the CBCL shows good reliability and validity and acceptable psychometric properties to help discriminate youth with OCD.
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Affiliation(s)
- Daniel A Geller
- Pediatric Psychopharmacology Clinic, Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA.
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140
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Turner CM. Cognitive-behavioural theory and therapy for obsessive-compulsive disorder in children and adolescents: current status and future directions. Clin Psychol Rev 2006; 26:912-38. [PMID: 16624461 DOI: 10.1016/j.cpr.2005.10.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2005] [Revised: 10/09/2005] [Accepted: 10/11/2005] [Indexed: 10/24/2022]
Abstract
Obsessive-compulsive disorder is recognised to be much more common than once thought, and increased awareness of prevalence has been associated with an increase in clinical and research attention. However, while the cognitive behavioural model of OCD has received considerable empirical support from adult studies, there has been relatively little investigation of this model in childhood populations. Although this literature is beginning to emerge, initial evaluations suggest there may be important differences between childhood and adult OCD with regard to the cognitive, behavioural, and family factors implicated in the etiology and maintenance of the disorder. Despite this, cognitive-behavioural interventions have been largely modelled on their adult counterparts, and there has been little evaluation of the effectiveness of various treatment components. This paper therefore seeks to critically review the current status of CBT for children and adolescents with OCD, addressing both cognitive behavioural theory and therapy. Current issues in clinical practice will be identified, gaps in the knowledge base will be highlighted, and the paper will conclude by making specific recommendations regarding the integration of research and practice.
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Affiliation(s)
- Cynthia M Turner
- Obsessive-Compulsive and Related Disorders Clinic for Young People, Maudsley Hospital Children's Department, London, UK
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141
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Morer A, Viñas O, Lázaro L, Calvo R, Andrés S, Bosch J, Gastó C, Massana J, Castro J. Subtyping obsessive-compulsive disorder: clinical and immunological findings in child and adult onset. J Psychiatr Res 2006; 40:207-13. [PMID: 16019031 DOI: 10.1016/j.jpsychires.2005.04.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2004] [Revised: 02/14/2005] [Accepted: 04/07/2005] [Indexed: 11/16/2022]
Abstract
It has been suggested that certain kinds of childhood OCD with specific clinical, biological and immunological characteristics may form a subgroup of OCD. We study the presence of these characteristics in child onset OCD and propose that the disorder be considered as a subtype of adult OCD. Forty adult patients with OCD were divided in two groups according to time of disease onset: 18 early onset and 21 late. Both sets were compared with a control group of 14 psychiatric patients. Child onset OCD was associated with higher mean ASLO titers, higher frequencies of history of tic disorders and tonsillitis in childhood and compulsive symptoms. No differences were found in D8/17 antibody titers or in other autoimmune parameters. The findings suggest that child onset OCD can be considered as a subgroup of adult OCD, although more specific biological markers are needed to identify it.
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Affiliation(s)
- A Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Hospital Clínic Universitari, Sabino Arana no. 1, 08028 Barcelona, Spain.
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142
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Besiroglu L, Agargun MY, Ozbebit O, Aydin A. A discrimination based on autogenous versus reactive obsessions in obsessive-compulsive disorder and related clinical manifestations. CNS Spectr 2006; 11:179-86. [PMID: 16575374 DOI: 10.1017/s1092852900014292] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Although putative subtypes of obsessive-compulsive disorder (OCD) have been gradually more recognized, there is no generally accepted subtype discrimination. It has been suggested that autogenous and reactive obsessions stem from different cognitive process. This study aimed to assess existence of gender, age at onset of illness, and comorbidity differences in OCD patients suffering from autogenous and reactive obsessions. METHODS The medical records of 177 OCD patients were evaluated retrospectively for gender, age at onset, comorbid diagnoses, and predisposing life events. Obsessions and compulsions were coded according to the Yale-Brown Obsessive-Compulsive Scale. All patients were grouped as the patients with autogenous (autogenous group [AG] n=32), reactive (reactive group [RG] n=77) and mixed obsessions (mixed group [MG] n=68). RESULTS AG patients were significantly more likely to be male, compared with the RG and MG patients. They also had significantly later onset of illness. Dissociative disorders were less common among AG patients compared with the other groups. CONCLUSION Results suggest that the discrimination between autogenous and reactive obsessions are not only based on their development and maintenance mechanism through different cognitive process but that there also clinical manifestations of this discrimination.
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Affiliation(s)
- Lutfullah Besiroglu
- Department of Psychiatry, Yüzüncü Yil University School of Medicine, Van, Turkey.
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143
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Tükel R, Ertekin E, Batmaz S, Alyanak F, Sözen A, Aslantaş B, Atli H, Ozyildirim I. Influence of age of onset on clinical features in obsessive-compulsive disorder. Depress Anxiety 2005; 21:112-7. [PMID: 15965994 DOI: 10.1002/da.20065] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We compared early-onset and late-onset obsessive-compulsive disorder (OCD) patients in terms of demographic and clinical features. One hundred sixteen outpatients whose primary diagnosis was OCD according to DSM-IV diagnostic criteria were recruited. Early-onset (n=50) and late-onset (n=66) OCD groups were compared with respect to demographic variables and scores obtained on various scales. A male gender predominance was found in early-onset OCD group. Symmetry/exactness obsessions, religious obsessions, hoarding/saving obsessions, and hoarding/collecting compulsions also were significantly more frequent in the early-onset group than in the late-onset group. The results may suggest a phenotypic difference between the two groups. Further studies are needed to investigate the differences between early-onset and late-onset OCD groups to examine the hypothesis that early-onset OCD is a distinct subtype of the disorder.
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Affiliation(s)
- Raşit Tükel
- Istanbul University, Istanbul Faculty of Medicine, Department of Psychiatry, Istanbul, Turkey.
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144
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Abstract
Compulsions are meant to relieve anxiety or to prevent a dreaded event. An adolescent or adult may recognize that the ritual is unreasonable or excessive, but that is not necessarily true for the young child. Children and adolescents will attempt to hide their rituals, although with more severe symptoms, this is not usually possible. To meet the diagnostic criteria for the disorder, the person must experience distress, spend more than 1 hour a day in either obsessions or compulsions, or experience significant interference in his/her life. This article reviews the phenomenology, causes, treatment, and outcome of children and adolescents with obsessive-compulsive disorder.
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Affiliation(s)
- Henrietta L Leonard
- The Pediatric Anxiety Research Clinic (PARC) at the Bradley Hasbro Research Center, Rhode Island Hospital, Coro West 2, Providence, RI 02906, USA.
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145
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Lewin AB, Storch EA, Adkins JW, Merlo LJ, Murphy TK, Goodman WK, Geffken GR. Update and Review of Pediatric Obsessive-compulsive Disorder. Psychiatr Ann 2005. [DOI: 10.3928/00485713-20050901-07] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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146
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Sourander A, Multimäki P, Nikolakaros G, Haavisto A, Ristkari T, Helenius H, Parkkola K, Piha J, Tamminen T, Moilanen I, Kumpulainen K, Almqvist F. Childhood predictors of psychiatric disorders among boys: a prospective community-based follow-up study from age 8 years to early adulthood. J Am Acad Child Adolesc Psychiatry 2005; 44:756-67. [PMID: 16034277 DOI: 10.1097/01.chi.0000164878.79986.2f] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To study early childhood predictors for early adulthood psychiatric disorders. METHOD The sample included 2,712 Finnish boys born in 1981. Information about the 8-year-old boys' problem behavior was obtained from parents, teachers, and children. The 10-15-year follow-up information about psychiatric disorders in early adulthood was based on the national military register between the years 1999 and 2004. RESULTS According to the military register, 10.4% of men had a psychiatric disorder. All informant sources, parents, teachers, and the children themselves predicted early adulthood psychiatric disorders. Conduct symptoms at age 8 independently predicted substance abuse, antisocial personality, and psychotic disorders in early adulthood. Self-reported depressive symptoms, poor school performance, and living in a nonintact family had an independent predictive association with antisocial personality and depressive disorders. Parent-reported emotional symptoms and self-reported psychosomatic symptoms independently predicted anxiety disorders. About one third of those who had used services at age 8 had a psychiatric disorder in early adulthood. Among service users, conduct and hyperkinetic symptoms predicted psychiatric disorders in early adulthood. CONCLUSIONS Efforts to prevent early adult psychiatric disturbance already present in childhood are emphasized. Active screening to detect children in need of early interventions in childhood to prevent negative development in early adulthood is justified.
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Affiliation(s)
- Andre Sourander
- Department of Child Psychiatry, Turku University Hospital, Finland.
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147
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Chabane N, Delorme R, Millet B, Mouren MC, Leboyer M, Pauls D. Early-onset obsessive-compulsive disorder: a subgroup with a specific clinical and familial pattern? J Child Psychol Psychiatry 2005; 46:881-7. [PMID: 16033636 DOI: 10.1111/j.1469-7610.2004.00382.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The familial nature of obsessive-compulsive disorder (OCD) has been previously demonstrated. The identification of candidate symptoms such as age at onset may help to disentangle the clinical and genetic heterogeneity of the disorder. In this study, the specificity of early-onset OCD was investigated, focusing on the effect of gender, comorbid conditions and familial risk of tics and OCD by studying a population consisting exclusively of patients with early-onset OCD. METHODS One hundred and forty-four patients having OCD were recruited in the study (108 early-onset probands and 36 late-onset probands). The early-onset probands and 199 of their first-degree relatives were investigated using structured interviews and questionnaires. This sample of early onset was mainly composed of children and adolescents (74 children and adolescents and 34 adults). RESULTS The average age of onset of OCD is 9.98+/-3.2 years. Forty-four per cent of the probands have a comorbid tic disorder. The age-corrected morbid risk among the first-degree relatives is 17% for OCD and 12% for tics. Morbid risk for OCD and tics was independent of the presence of tics in probands. Only 32.6% of the probands have a positive family history of OCD. CONCLUSIONS These findings are consistent with other reports in the literature that the morbid risk of OCD is elevated in relatives of probands with early-onset OCD. However, the majority of cases do not have a positive family history of OCD. This result suggests that early onset is not the only specific clinical marker for familial risk in OCD. Thus more work is needed to clearly elucidate other factors related to increased genetic vulnerability for OCD.
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Affiliation(s)
- Nadia Chabane
- Service de psychopathologie de l'enfant et de l'adolescent, Assistance Publique-Hôpitaux de Paris, Hôpital Robert Debré, Paris, France.
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148
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Hanna GL, Fingerlin TE, Himle JA, Boehnke M. Complex segregation analysis of obsessive-compulsive disorder in families with pediatric probands. Hum Hered 2005; 60:1-9. [PMID: 16088199 DOI: 10.1159/000087135] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2004] [Accepted: 05/12/2005] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The purpose of this study was to assess the mode of inheritance for obsessive-compulsive disorder (OCD) in families ascertained through pediatric probands. METHODS We ascertained 52 families (35 case and 17 control families) through probands between the ages of 10 and 17 years. Direct interviews were completed with 215 individuals. Family informant data were collected on another 450 individuals without direct interviews, forming two data sets with one contained within the other. Complex segregation analyses were performed using regressive models as programmed in REGTL in the S.A.G.E. package. All models used in the analyses included sex-specific age and type parameters. RESULTS All models that excluded a residual effect of an affected parent were rejected. With that parameter included, the environmental and sporadic models were rejected in comparisons with the most general model in both data sets (all p < 0.005). With the direct interview data, the general codominant Mendelian model was not rejected when compared with the most general model (p = 0.140). We could not distinguish between any of the simple Mendelian models using either data set. However, the dominant Mendelian model provided a somewhat better fit than the other Mendelian models to the direct interview data. CONCLUSIONS The results provide evidence for a major susceptibility locus in families with OCD when age at onset is incorporated into the model. Mendelian factors at most partially explained the familial aggregation of the phenotype, and residual familial effects were necessary to fit the data adequately. The results support the importance of linkage efforts by suggesting that a major locus is segregating within a proportion of families with OCD ascertained through pediatric probands.
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Affiliation(s)
- Gregory L Hanna
- Department of Psychiatry, University of Michigan Medical School, Ann Arbor, 48109, USA.
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149
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do Rosario-Campos MC, Leckman JF, Curi M, Quatrano S, Katsovitch L, Miguel EC, Pauls DL. A family study of early-onset obsessive-compulsive disorder. Am J Med Genet B Neuropsychiatr Genet 2005; 136B:92-7. [PMID: 15892140 DOI: 10.1002/ajmg.b.30149] [Citation(s) in RCA: 168] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Results from family studies have suggested that obsessive-compulsive disorder (OCD) is a genetically heterogeneous disorder and have emphasized the importance of identifying valid subgroups of patients. The current study focused on early-onset OCD probands and examined the recurrence risks of OCD and tics among first-degree family members. One hundred six children and adolescents with OCD were recruited from a specialty clinic for OCD and 44 control individuals without OCD were identified by random-digit dialing. These 150 probands and their 465 first-degree relatives were assessed by trained interviewers, using standardized semi-structured interviews. Diagnoses were assigned according to DSM-IV criteria by two experts blind to the proband's diagnosis, through the best-estimate process. These data were analyzed using chi(2) tests, t-tests, logistic regression, and generalized estimating equations (GEE). Case probands had a mean age of onset of OC symptoms of 6.7 years (SD = 2.8), and high comorbid rates with Tourette syndrome (33%) and chronic tics (13.2%). Compared to control relatives, case relatives had higher age-corrected recurrence risks of OCD (22.7% vs. 0.9%, odds ratio (OR) = 32.5, 95% confidence interval (CI) = 4.5-230.8, P = 0.0005), and chronic tics (11.6% vs. 1.7%, OR = 7.9, 95% CI = 1.9-33.1, P = 0.005). A comorbid diagnosis of tics in the relatives was the best predictor of their diagnosis of OCD (OR = 7.35, 95% CI = 3.79-14.25, P < 0.0001). There was a significant correlation between the ages of onset of OCD in probands and their affected relatives. Childhood onset OCD is a highly familial disorder. Some early-onset cases may represent a valid subgroup, with higher genetic loading and shared vulnerability with chronic tic disorders.
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150
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Issler CK, Amaral JADMS, Tamada RS, Schwartzmann AM, Shavitt RG, Miguel EC, Lafer B. Clinical expression of obsessive-compulsive disorder in women with bipolar disorder. BRAZILIAN JOURNAL OF PSYCHIATRY 2005; 27:139-42. [PMID: 15962140 DOI: 10.1590/s1516-44462005000200013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE: To study clinical and psychopathological features of obsessive-compulsive disorder (OCD) in women with bipolar disorder (BD). METHODS: Fifteen outpatients with concurrent bipolar disorder I (80.0%) or II (20.0%) and obsessive-compulsive disorder were studied. Most of them (80.0%) sought treatment for bipolar disorder. They were ascertained by means of the Structured Clinical Interview for DSM-IV (SCID/P), semi-structured interviews to investigate obsessions, compulsions and sensory phenomena that may precede compulsions and an additional module for the diagnosis of chronic motor and vocal tics. Severity of symptoms was assessed by the Yale-Brown Obsessive-Compulsive Rating Scale, Hamilton Depression Rating Scale and Young Mania Rating Scale. RESULTS: Obsessive-compulsive disorder presented early onset (before the age of 10) in 9 (60%) cases, preceded bipolar disorder in 10 (66.7%) and displayed chronic waxing and waning course in 13 (86.7%) of them. There was wide overlap between types of obsessive-compulsive symptoms and all patients experienced sensory phenomena preceding the compulsions. There was no clear-cut impact of depressive and manic episodes on the intensity of obsessive-compulsive symptoms, which increased in depression and decreased in mania in 40.0% of the cases, had the opposite pattern in 26.7% of the patients and fluctuated inconsistently in the rest of them. Tics disorders were diagnosed in 5 (33.3%) patients. CONCLUSIONS: Our results suggest that in women with comorbid bipolar disorder and obsessive-compulsive disorder the latter presents features that may be typical of the association of the two disorders, such as early onset and sensory phenomena preceding compulsions. A prospective controlled study is necessary to confirm these observations, due to some limitations of our study: small exclusively female sample, heterogeneity concerning the type of bipolar disorder and the disorder that determined sought of treatment and retrospective non-controlled design.
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Affiliation(s)
- Cilly Klüger Issler
- Psychiatric Institute, Clinical Hospital, Medical School, Universidade de São Paulo, São Paulo, Brazil.
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