Understudied clinical dimensions in pediatric obsessive compulsive disorder

Exploring the structure of the university-students obsessive-compulsive tendency scale in Iranian university students: a network analysis study

INTRODUCTION

A risk factor for developing obsessive-compulsive disorder (OCD) in non-clinical samples is obsessive-compulsive tendencies (OCT). An OCT scale has recently been developed for university students (UOC) and showed promising psychometric properties. However, no validated Persian language scale evaluates OCT in non-clinical samples. Accordingly, this study aimed to validate the Persian version of the UOC in Iranian university students.

METHODS

Three hundred sixty-eight university students (54.6% females, mean ages: 22.4 ± 4.51) entered the study. The Persian version of UOC was evaluated concerning the structure of Exploratory Factor Analysis (EFA), Confirmatory factor analysis (CFA), and Exploratory graph analysis (EGA). Regarding the construct validity, the concurrent validity was assessed between the UOC and The Obsessive-Compulsive Inventory-Revised (OCI-R), Kessler Psychological Distress Scale (K10), and Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). We calculated Cronbach's alpha to evaluate the reliability of the UOC. All statistical calculations were done in R programming language (in R-Studio Desktop version 4.2.1).

RESULTS

The Persian version of UOC showed a convenient internal consistency with Cronbach's alpha coefficient for the total scale 0.88. UOC scores were significantly correlated with OCI-R, K-10, and YBOCS. The EFA and EGA showed four and three-factor solutions with 25 and 28 items, respectively. Also, CFA showed that these two solutions were reliable, and the three-factors solution showed higher fit indexes. Finally, the results showed that item-27 was the most central item in the UOC network structure.

CONCLUSION

The findings from the present study indicated that the Persian version of UOC has acceptable psychometric properties. So, this scale can be used for examining obsessive-compulsive tendencies in Iranian university students.

'Excessive and Unreasonable': The Relation Between Clinical Insight and Clinical Correlates and Treatment Outcomes in Obsessive-Compulsive Disorder Across the Life Course

Individuals with mental disorders possess varying levels of clinical insight-the degree to which one understands that they are afflicted with a mental disorder and that their symptoms are manifestations of this psychopathology. Although clinical insight in OCD is thought to play an especially important role in determining various clinical characteristics and treatment outcomes, insight has not been sufficiently addressed developmentally, the importance of which this review will elucidate. Findings from this review suggest that clinical insight is typically associated with more complex cases and worse treatment outcomes across the life course, and also reveal nuances between pediatric and adult OCD cases with low insight. Implications of these findings, future research directions, and recommendations for the field are discussed.

A comparison of phenomenological, clinical and familial psychiatric features of pediatric OCD and trichotillomania

OBJECTIVES

Although trichotillomania (TTM) is classified in the obsessive-compulsive disorders (OCD) chapter of the DSM-5, several studies showed that it has several differences. The aim of this study was to examine the phenomenology, comorbidity, and family psychiatric characteristisc of childhood TTM and OCD.

METHODS

This study compared youth ages 6-17 years with a primary diagnosis of TTM (n = 63) to those with primary OCD (n = 65) on clinical and familial psychiatric characteristics.

RESULTS

In our study, the findings showed that family history of schizophrenia (42.3%) was higher among patients with TTM than the OCD group, while the history of OCD (55.8%) in the family was significantly higher among the OCD group (p < 0.001). The behaviour of plucking eyebrows was significantly higher among patients with TTM comorbid OCD than patients with only trichotillomania. TTM patients with comorbid OCD had one-dimensional symptom distribution than the presence of the OCD-only group, and the severity of OCD was lower. The incidence of pathological doubting was higher among the TTM group with comorbid OCD, than those with only OCD diagnosis.

CONCLUSIONS

These findings support significant differences between OCD and TTM. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.KEYPOINTSWe aimed to compare the trichotillomania in itself and in the presence of OCD with the OCD group.Even if OCD accompanied trichotillomania, OCD symptom dimensions and severity were found to be lower than in the OCD-only group.Trichotillomania is a heterogeneous disorder with different dimensions besides the OCD spectrum.

Association of insight, avoidance behavior, indecisiveness, and inflated responsibility with other clinical characteristics in children and adolescents with obsessive-compulsive disorder

Objectives:

Although the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) includes ancillary symptom dimensions – insight, avoidance, degree of indecisiveness, inflated sense of responsibility, pervasive slowness/disturbance of inertia, and pathological doubting –, we know little about their clinical/scientific utility. We examined these ancillary dimensions in childhood obsessive-compulsive disorder (OCD), and tested their associations with clinical characteristics.

Methods:

Treatment-seeking children and adolescents (n=173) with a DSM-5 OCD diagnosis were recruited from six centers in India and evaluated with a semi-structured proforma for sociodemographic/clinical details, the Structured Clinical Interview for DSM-5, the CY-BOCS, the Children’s Depression Rating Scale, and the Family Interview for Genetic Studies. Regression analysis was used to study the associations between ancillary dimensions (independent variables) and clinical variables (dependent variables).

Results:

87.9% of the sample reported at least a mild-moderate severity of ancillary dimensions, which were highly intercorrelated. Multiple ancillary dimensions were correlated with illness severity on the CY-BOCS. On regression analysis, only insight and avoidance retained significance. There were few differential associations between OCD symptom and ancillary dimensions.

Conclusion:

Ancillary dimensions are more a feature of illness severity than differentially associated with individual symptom dimensions in childhood OCD. Insight and avoidance should be considered for inclusion in the assessment of illness severity in childhood OCD.

Towards a computational psychiatry of juvenile obsessive-compulsive disorder

Obsessive-Compulsive Disorder (OCD) most often emerges during adolescence, but we know little about the aberrant neural and cognitive developmental mechanisms that underlie its emergence during this critical developmental period. To move towards a computational psychiatry of juvenile OCD, we review studies on the computational, neuropsychological and neural alterations in juvenile OCD and link these findings to the adult OCD and cognitive neuroscience literature. We find consistent difficulties in tasks entailing complex decision making and set shifting, but limited evidence in other areas that are altered in adult OCD, such as habit and confidence formation. Based on these findings, we establish a neurocomputational framework that illustrates how cognition can go awry and lead to symptoms of juvenile OCD. We link these possible aberrant neural processes to neuroimaging findings in juvenile OCD and show that juvenile OCD is mainly characterised by disruptions of complex reasoning systems.

Development and psychometric evaluation of the Mandarin Chinese version of the Yale-Brown Obsessive-Compulsive Scale - Second Edition

Objective:

To examine the psychometric properties of the Chinese version of the Yale-Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II).

Method:

A total of 86 adults with a primary diagnosis of obsessive-compulsive disorder (OCD), ranging in age from 15 to 78 years, participated in the study. Participants were administered the Y-BOCS-II by a trained clinician who also rated overall illness severity on two additional measures. Patients completed the Obsessive Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21.

Results:

Results indicated high internal consistency and fair 1-week test retest reliability. The Y-BOCS-II scales correlated strongly with clinician-rated obsessive-compulsive severity and modestly with self-reported obsessive-compulsive symptom frequency and distress. The relationship between Y-BOCS-II total score and depressive and anxiety symptoms was strong, which may reflect high rates of comorbid conditions in this sample or the linkage between obsessive-compulsive symptom severity and distress. Factor analysis demonstrated a two-factor structure consisting of obsession and compulsion factors, with interference due to obsessions cross-loading.

Conclusions:

Overall, these results support the use of the Y-BOCS-II among individuals from China. Future study by an independent group is necessary to replicate these findings, as well as investigate interrater reliability and treatment sensitivity.

Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India

CONTEXT

Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents.

AIMS

To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD.

SETTING AND DESIGN

This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India.

MATERIALS AND METHODS

Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5^th Edition Research Version, Children's Depression Rating Scale, and Family Interview for Genetic Studies.

RESULTS

The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years. Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms. CYBOCS assessment revealed that >2/3^rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness. Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample.

CONCLUSIONS

This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.

Development and Psychometric Evaluation of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition

OBJECTIVE

To develop and examine the psychometric properties of the Children's Yale-Brown Obsessive-Compulsive Scale Second Edition (CY-BOCS-II) in children and adolescents with obsessive-compulsive disorder (OCD).

METHOD

Youth with OCD (N = 102; age range 7-17 years), who were seeking treatment from 1 of 2 specialty OCD treatment centers, participated in the study. The CY-BOCS-II was administered at an initial assessment, and measures of OCD symptom severity, anxiety and depressive symptoms, behavioral and emotional problems, and global functioning were administered. Inter-rater and test-retest reliabilities were assessed on a subsample of participants (n = 50 and n = 31, respectively) approximately 1 week after intial assessment.

RESULTS

The CY-BOCS-II demonstrated moderate-to-strong internal consistency (α = 0.75-0.88) and excellent inter-rater (intraclass correlation coefficient = 0.86-0.92) and test-retest (intraclass correlation coefficient = 0.95-0.98) reliabilities across all scales. Construct validity was supported by strong correlations with clinician-rated measures of OCD symptom severity and moderate correlations with measures of anxiety symptoms. Exploratory factor analysis showed a 2-factor structure, which was generally inconsistent with its adult counterpart, the Yale-Brown Obsessive-Compulsive Scale Second Edition.

CONCLUSION

Initial findings support the CY-BOCS-II as a reliable and valid measure of obsessive-compulsive symptoms in youth.

Factor Structure and Measurement Invariance of the Obsessive-Compulsive Inventory – Child Version (OCI-CV) in General Population

Abstract. Evidence-based assessment is necessary as a first step for developing psychopathological studies and assessing the effectiveness of empirically validated treatments. There are several measures of obsessive-compulsive disorder (OCD) and/or symptomatology in children and adolescents, but all of them present some limitations. The Obsessive-Compulsive Inventory-Revised (OCI-R) by Foa and her colleagues has showed to be a good self-report measure to capture the dimensionality of OCD in adults and adolescents. The child version of the OCI (OCI-CV) was validated for clinical children and adolescents in 2010, showing excellent psychometric properties. The objective of this study was to examine the factor structure and invariance of the OCI-CV in the general population. Results showed a six-factor structure with one second-order factor, good consistency values, and invariance across region, age, and sex. The OCI-CV is an excellent inventory for assessing the dimensions of OCD symptomatology in general populations of children and adolescents. The invariance across sex and age warrants its utilization for research purposes.

Psychometric Properties of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) in Chilean Children and Adolescents

In recent years, there has been a considerable increase in the development of assessment tools for obsessive-compulsive symptomatology in children and adolescents. The Obsessive Compulsive Inventory-Child Version (OCI-CV) is a well-established assessment self-report, with special interest for the assessment of dimensions of Obsessive Compulsive Disorder (OCD). This instrument has shown to be useful for clinical and non-clinical populations in two languages (English and European Spanish). Thus, the aim of this study was to analyze the psychometric properties of the OCI-CV in a Chilean community sample. The sample consisted of 816 children and adolescents with a mean age of 14.54 years (SD = 2.21; range = 10-18 years). Factor structure, internal consistency, test-retest reliability, convergent/divergent validity, and gender/age differences were examined. Confirmatory factor analysis showed a 6-factor structure (Doubting/Checking, Obsessing, Hoarding, Washing, Ordering, and Neutralizing) with one second-order factor. Good estimates of reliability (including internal consistency and test-retest), evidence supporting the validity, and small age and gender differences (higher levels of OCD symptomatology among older participants and women, respectively) are found. The OCI-CV is also an adequate scale for the assessment of obsessions and compulsions in a general population of Chilean children and adolescents.

Psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale in youth with autism spectrum disorders and obsessive-compulsive symptoms

The psychometric properties of the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) were investigated in 46 treatment-seeking youth, 7-15 years of age, who were diagnosed with an autism spectrum disorder (ASD) and exhibited obsessive-compulsive symptoms. The CY-BOCS Total score exhibited good internal consistency, with differing internal consistencies observed on the Obsession Severity scale (α = 0.86) and Compulsion Severity scale (α = 0.59). Good to excellent inter-rater reliability was observed for the CY-BOCS Total score and both Severity scales. Convergent and divergent validity of the CY-BOCS Total score and both Severity scales were satisfactory. Insight into obsessive-compulsive symptoms was moderately associated with the CY-BOCS Total score. The CY-BOCS demonstrated treatment sensitivity, demonstrating significant changes in obsessive-compulsive symptoms within a subsample of youth receiving cognitive-behavioral treatment. Overall, the CY-BOCS demonstrated adequate psychometric properties and utility in assessing obsessive-compulsive symptoms in youth with ASD and clinically significant obsessive-compulsive symptoms.

Factors Predicting Youth Anxiety Severity: Preliminary Support for a Standardized Behavioral Assessment of Parental and Youth Avoidance Behaviors

Anxiety severity in youth is associated with a host of negative outcomes including poor response to treatment. Thus, a better understanding of factors that contribute to anxiety severity is needed. Such factors may include parental anxiety as well as anxiety-related approach and avoidance behaviors in both children and parents. In this study, we examined automatic behavioral tendencies as a method of quantifying anxiety-related approach and avoidance behaviors in children and their parents. Clinically anxious youth (N = 19) with mixed anxiety diagnoses and their parents completed an approach-avoidance task (AAT) comprising different emotional expressions. Our results suggest that in addition to parent report of youth anxiety, both youth and parent automatic avoidance biases predict clinician-rated youth anxiety severity accounting for 62% of the variance in clinician-rated youth anxiety. These results suggest that the AAT may be a useful measure of automatic behavioral tendencies in clinically anxious youth and their parents and that these factors may be relevant to youth anxiety severity.

Mediators and moderators of functional impairment in adults with obsessive-compulsive disorder

The current study examined correlates, moderators, and mediators of functional impairment in 98 treatment-seeking adults with obsessive-compulsive disorder (OCD). Participants completed or were administered measures assessing obsessive-compulsive symptom severity, functional impairment, resistance against symptoms, interference due to obsessive-compulsive symptoms, depressive symptoms, insight, and anxiety sensitivity. Results indicated that all factors, except insight into symptoms, were significantly correlated with functional impairment. The relationship between obsessive-compulsive symptom severity and functional impairment was not moderated by patient insight, resistance against obsessive-compulsive symptoms, or anxiety sensitivity. Mediational analyses indicated that obsessive-compulsive symptom severity mediated the relationship between anxiety sensitivity and obsessive-compulsive related impairment. Indeed, anxiety sensitivity may play an important contributory role in exacerbating impairment through increases in obsessive-compulsive symptom severity. Depressive symptoms mediated the relationship between obsessive-compulsive symptom severity and obsessive-compulsive related impairment. Implications for assessment and treatment are discussed.

Treatment and outcomes for anxiety disorders among children and adolescents: a review of coping strategies and parental behaviors

This article reviews the current literature on the treatment of anxiety disorders in children and adolescents and describes the factors that are essential to address in treatment. Coping deficits and parental behaviors are highlighted as factors that contribute to anxiety in youth. Interventions for anxious youth are described, with particular emphasis on cognitive-behavioral therapy for anxiety disorders. Finally, a review of the longitudinal course of anxiety and suggestions for future directions in treatment and research are provided.

A review of obsessive-compulsive disorder in children and adolescents

This article is a review of recent literature on obsessive-compulsive disorder in the pediatric population. Areas covered include: a brief historical perspective, clinical presentation in relation to symptoms found in different age groups, epidemiology, psychiatric comorbidity, etiology (with regards to genetics, neuroimaging, and familial factors), clinical course and prognosis, and treatment, with special emphasis on individual and family-based cognitive-behavioral therapy and psychopharmacology.

The role of avoidance in the phenomenology of obsessive-compulsive disorder

BACKGROUND

Pathologic levels of ritualistic avoidance (also known as active avoidance) are common in the clinical presentation of obsessive-compulsive disorder (OCD). Despite its clinical relevance, there has been little examination of active avoidance as a ritualistic compulsion in adults with OCD.

OBJECTIVE

The objective of this study is to determine if adults with OCD who engage in ritualistic avoidance have greater obsessive-compulsive, anxiety, and depressive symptom severity and different comorbidity patterns than adults who do not engage in ritualistic avoidance.

METHOD

Adults with OCD (n = 133) completed an evaluation that included clinician ratings of obsessive-compulsive severity; overall illness severity; and self-reported ratings of anxiety, depression, and obsessive-compulsive severity.

RESULTS

Ritualized avoidance was endorsed by greater than 25% of the sample. Avoidant subjects and, more specifically, contaminant avoidant and reading-writing avoidant subjects presented with elevated levels of obsessive-compulsive symptom severity and greater overall clinical severity than comparison patients who did not engage in each respective avoidance ritual.

CONCLUSIONS

Patients who engage in ritualized avoidance exhibited greater obsessive-compulsive symptom severity than patients who did not. These findings suggest that ritualized avoidance functions as a compulsion for adults with OCD and that avoidance should receive careful consideration in assessment and treatment.