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Reid M, Lin A, Farhat LC, Fernandez TV, Olfson E. The genetics of trichotillomania and excoriation disorder: A systematic review. Compr Psychiatry 2024; 133:152506. [PMID: 38833896 DOI: 10.1016/j.comppsych.2024.152506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 05/09/2024] [Accepted: 05/30/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Trichotillomania (TTM) and excoriation disorder (ED) are impairing obsessive-compulsive related disorders that are common in the general population and for which there are no clear first-line medications, highlighting the need to better understand the underlying biology of these disorders to inform treatments. Given the importance of genetics in obsessive-compulsive disorder (OCD), evaluating genetic factors underlying TTM and ED may advance knowledge about the pathophysiology of these body-focused repetitive behaviors. AIM In this systematic review, we summarize the available evidence on the genetics of TTM and ED and highlight gaps in the field warranting further research. METHOD We systematically searched Embase, PsycInfo, PubMed, Medline, Scopus, and Web of Science for original studies in genetic epidemiology (family or twin studies) and molecular genetics (candidate gene and genome-wide) published up to June 2023. RESULTS Of the 3536 records identified, 109 studies were included in this review. These studies indicated that genetic factors play an important role in the development of TTM and ED, some of which may be shared across the OCD spectrum, but there are no known high-confidence specific genetic risk factors for either TTM or ED. CONCLUSIONS Our review underscores the need for additional genome-wide research conducted on the genetics of TTM and ED, for instance, genome-wide association and whole-genome/whole-exome DNA sequencing studies. Recent advances in genomics have led to the discovery of risk genes in several psychiatric disorders, including related conditions such as OCD, but to date, TTM and ED have remained understudied.
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Affiliation(s)
- Madison Reid
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; The University of the South, USA
| | - Ashley Lin
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Luis C Farhat
- Department of Psychiatry, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - Emily Olfson
- Child Study Center, Yale University School of Medicine, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA.
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Kang JI, Kim SJ. Psychometric Analysis of the Obsessive-Compulsive Spectrum Self-Report and Social Anxiety Spectrum Self-Report in the Korean Population. Psychiatry Investig 2024; 21:265-274. [PMID: 38569584 PMCID: PMC10990623 DOI: 10.30773/pi.2023.0338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 11/16/2023] [Accepted: 12/18/2023] [Indexed: 04/05/2024] Open
Abstract
OBJECTIVE The present study aimed to assess the psychometric properties of the Korean versions of the Obsessive-Compulsive Spectrum Self Report (OBS-SR) and the Social Anxiety Spectrum Self Report (SHY-SR) questionnaires, along with determining their optimal cut-off points in a Korean population. METHODS The study included outpatients with obsessive-compulsive disorder (OCD) (n=86), or social anxiety disorder (SAD) (n=52), those with major depressive disorder (MDD) (n=27), and 33 healthy controls. Participants were administered the Korean versions of the OBS-SR and SHY-SR questionnaires. Clinical symptoms were also assessed with several self-rating scales. RESULTS The Korean versions of the OBS-SR and SHY-SR demonstrated good internal consistency, test-retest reliability, and convergent validity. Both questionnaires effectively differentiated between individuals with OCD or SAD and normal controls or those with MDD. Receiver-operating characteristic analyses of the OBS-SR and SHY-SR yielded area under the curve values of 0.89 and 0.96 for Diagnostic and Statistical Manual of Mental Disorders, Forth Edition diagnosis, respectively, and showed optimal threshold values of 50 and 44. CONCLUSION The Korean versions of OBS-SR and SHY-SR demonstrate good reliability and validity in assessing manifestations of obsessive-compulsive and social anxiety psychopathology in Korean populations.
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Affiliation(s)
- Jee In Kang
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Se Joo Kim
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
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Himle JA, Grogan-Kaylor A, Hiller MA, Mannella KA, Norman LJ, Abelson JL, Prout A, Shunnarah AA, Becker HC, Russman Block SR, Taylor SF, Fitzgerald KD. Exposure and response prevention versus stress management training for adults and adolescents with obsessive compulsive disorder: A randomized clinical trial. Behav Res Ther 2024; 172:104458. [PMID: 38103359 DOI: 10.1016/j.brat.2023.104458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 11/24/2023] [Accepted: 12/06/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE Though exposure and response prevention (ERP) is a well-proven treatment for OCD across the lifespan, prior RCTs have not studied adolescent and adult patients with the same ERP protocol relative to an active comparator that controls for non-specific effects of treatment. This approach assesses differences in the effect of OCD-specific exposures in affected adolescents and adults and in response to ERP compared to a stress-management control therapy (SMT). METHODS This assessor-blinded, parallel, 2-arm, randomized, ambulatory clinical superiority trial randomized adolescents (aged 12-18) and adults (24-46) with OCD (N = 126) to 12 weekly sessions of ERP or SMT. OCD severity was measured before, during and after treatment using the child or adult version of the Yale-Brown Obsessive Compulsive Scale (C/Y-BOCS), depending on participant age. We predicted that ERP would produce greater improvement in OCD symptoms than SMT and that there would be no significant post-treatment differences across age groups. RESULTS ERP (n = 63) produced significantly greater improvements on C/Y-BOCS scores at post-treatment than SMT (n = 63) (Effect size = -0.72, CI = -0.52 to -0.91, p < .001). ERP also produced more treatment responders (ERP = 86%, SMT = 32%; χ2 = 46.37, p < .001) and remitters than SMT (ERP = 39%, SMT = 7%; χ2 = 16.14, p < .001). Finally, there were no statistically significant post-treatment differences in C/Y-BOCS scores between adolescents and adults assigned to ERP. CONCLUSION A single ERP protocol is superior to SMT in treating both adolescents and adults with OCD. OCD-specific therapy is necessary across the lifespan for optimal outcomes in this highly disabling disorder, though non-specific treatments like SMT are still all-too-commonly provided.
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Affiliation(s)
- Joseph A Himle
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA; Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA.
| | - Andrew Grogan-Kaylor
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Matthew A Hiller
- School of Social Work, University of Michigan, 1080 South University Ave, Ann Arbor, MI, 48109, USA
| | - Kristin A Mannella
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Luke J Norman
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - James L Abelson
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Aileen Prout
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Angela A Shunnarah
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Hannah C Becker
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stefanie R Russman Block
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Stephan F Taylor
- Department of Psychiatry, Medical School, University of Michigan, 1500 East Medical Center Dr., Ann Arbor, MI, 48109, USA
| | - Kate D Fitzgerald
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, 630 W 168th St, New York, NY, 10032, USA
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Phillips KA, Susser LC. Body Dysmorphic Disorder in Women. Psychiatr Clin North Am 2023; 46:505-525. [PMID: 37500247 DOI: 10.1016/j.psc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Body dysmorphic disorder (BDD) consists of distressing or impairing preoccupation with perceived defects in physical appearance that are actually nonexistent or only slight. This common and often-severe disorder, which affects more women than men, frequently goes unrecognized. BDD is associated with marked impairment in functioning, poor quality of life, and high rates of suicidality. Most patients seek cosmetic treatment, which virtually never improves BDD symptoms. In contrast, serotonin-reuptake inhibitors, often at high doses, and cognitive behavioral therapy that is tailored to BDD's unique clinical features are often effective. This article provides a clinical overview of BDD, including BDD in women.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Weill Cornell Psychiatry Specialty Center, 315 East 62nd Street, New York, NY 10065, USA.
| | - Leah C Susser
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Outpatient Department, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Blanco-Vieira T, Radua J, Marcelino L, Bloch M, Mataix-Cols D, do Rosário MC. The genetic epidemiology of obsessive-compulsive disorder: a systematic review and meta-analysis. Transl Psychiatry 2023; 13:230. [PMID: 37380645 PMCID: PMC10307810 DOI: 10.1038/s41398-023-02433-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 04/04/2023] [Accepted: 04/14/2023] [Indexed: 06/30/2023] Open
Abstract
The first systematic review and meta-analysis of obsessive-compulsive disorder (OCD) genetic epidemiology was published approximately 20 years ago. Considering the relevance of all the studies published since 2001, the current study aimed to update the state-of-art knowledge on the field. All published data concerning the genetic epidemiology of OCD from the CENTRAL, MEDLINE, EMBASE, BVS, and OpenGrey databases were searched by two independent researchers until September 30, 2021. To be included, the articles had to fulfill the following criteria: OCD diagnosis provided by standardized and validated instruments; or medical records; inclusion of a control group for comparison and case-control, cohort or twin study designs. The analysis units were the first-degree relatives (FDRs) of OCD or control probands and the co-twins in twin pairs. The outcomes of interest were the familial recurrence rates of OCD and the correlations of OCS in monozygotic compared with dizygotic twins. Nineteen family, twenty-nine twin, and six population-based studies were included. The main findings were that OCD is a prevalent and highly familial disorder, especially among the relatives of children and adolescent probands, that OCD has a phenotypic heritability of around 50%; and that the higher OCS correlations between MZ twins were mainly due to additive genetic or to non-shared environmental components.
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Affiliation(s)
- Thiago Blanco-Vieira
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
| | - Joaquim Radua
- Institut d'Investigacions Biomediques August Pi i Sunyer, CIBERSAM, Instituto de Salud Carlos III, University of Barcelona, Barcelona, Spain
| | - Lívia Marcelino
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil
| | - Michael Bloch
- Yale Child Study Center, Yale University, School of Medicine, New Heaven, USA
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatric Research, Karolinska Institutet, Stockholm, Sweden
| | - Maria Conceição do Rosário
- Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
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Kendler KS, Abrahamsson L, Ohlsson H, Sundquist J, Sundquist K. Obsessive-Compulsive Disorder and Its Cross-Generational Familial Association With Anxiety Disorders in a National Swedish Extended Adoption Study. JAMA Psychiatry 2023; 80:314-322. [PMID: 36723936 PMCID: PMC10077103 DOI: 10.1001/jamapsychiatry.2022.4777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 11/23/2022] [Indexed: 02/02/2023]
Abstract
Importance We know little about the transmission of obsessive-compulsive disorder (OCD) across generations. Objective To evaluate the sources of parent-offspring transmission of OCD and familial cross-generational association with more typical anxiety disorders. Design, Setting, and Participants This Swedish population register-based study analyzed data for offspring born in Sweden from 1960 to 1995 from the following 4 family types: intact, not-lived-with biological father, lived-with stepfather, and adoptive. Follow-up occurred on December 31, 2018, and data were analyzed from April 6, 2022, to September 26, 2022. Exposures Three sources of parent-offspring resemblance: genes plus rearing, genes only, and rearing only. Main Outcomes and Measures Diagnoses of OCD, all anxiety disorders, generalized anxiety disorder (GAD), social phobia, and panic disorder were obtained from national inpatient, outpatient, and primary care medical registers. Parent-child resemblance was assessed by tetrachoric correlation (r). Results The offspring population consisted of 2 413 128 individuals; mean (SD) age at follow-up was 40.2 (10.7) years, 1 258 670 individuals (52.2%) were male, and 1 154 458 individuals (47.8%) were female. For each type of parent-child relationship, the best-estimate correlation for OCD for genes plus rearing was 0.19 (95% CI, 0.17 to 0.20); genes only, 0.18 (95% CI, 0.11 to 0.24); and rearing only, 0.04 (95% CI, -0.10 to 0.19). From bivariate adoption analyses, the cross-generational genetic correlations between OCD with anxiety disorder diagnostic categories were estimated as follows: for all anxiety disorders, 0.62 (95% CI, 0.46 to 0.77); GAD, 0.87 (95% CI, 0.53 to 1.00); social phobia, 0.70 (95% CI, 0.31 to 1.00); and panic disorder, 0.47 (95% CI, 0.20 to 0.73). Conclusions and Relevance This Swedish population register-based study found that OCD was transmitted from parents to children largely through a genetic relationship, with rearing playing a minor role. Viewed cross-generationally, OCD and anxiety disorders were moderately genetically correlated, with the genetic correlations strongest between OCD and GAD, intermediate for OCD and social phobia, and weakest between OCD and panic disorder. These genetic correlations were modestly attenuated when diagnostic hierarchies were imposed before analysis.
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Affiliation(s)
- Kenneth S. Kendler
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond
- Department of Psychiatry, Virginia Commonwealth University, Richmond
| | - Linda Abrahamsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Henrik Ohlsson
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
| | - Jan Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University, Malmö, Sweden
- Department of Family Medicine and Community Health, Icahn School of Medicine at Mount Sinai, New York, New York
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Abd Elgawad A, Elbatrawy A, Shorub E, Ramadan M, Elkhatib H. Autistic traits and obsessive-compulsive personality traits in OCD patients. MIDDLE EAST CURRENT PSYCHIATRY 2022. [PMCID: PMC9188838 DOI: 10.1186/s43045-022-00213-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background Studies have reported a high prevalence of autism spectrum disorder in young people with obsessive-compulsive disorder with a negative effect on psychosocial functioning. However, the extent to which autism spectrum disorder and obsessive-compulsive personality disorder traits overlap and by inference, the extent to which these separately classified Diagnostic and Statistical Manual of Mental Disorders disorders five (obsessive-compulsive personality disorder, personality disorder, autism spectrum disorder, neurodevelopmental disorder) may share a nosological relationship has not so far been systematically investigated in clinical samples. This study is done to detect the frequency of obsessive-compulsive personality traits and autistic traits in a sample of patients with obsessive-compulsive disorder. Results Results revealed that younger patients had significantly more severe and extreme obsessive-compulsive disorder scores. Moreover, Structured Clinical Interview for DSM-IV (SCID-II) and Autism Spectrum Quotient analysis revealed that younger patients had a significantly higher prevalence of personality traits and autistic traits respectively. Statistical significance as many patients with severe and extreme Yale-Brown Obsessive-Compulsive Scale showed criteria of obsessive-compulsive personality disorder. No association of statistical significance was found between obsessive-compulsive disorder severity and autistic trait presence. On the contrary, statistical significance was found between autistic traits and obsessive-compulsive personality disorder. Conclusions There is the presence of comorbidity of obsessive-compulsive personality traits and autism spectrum traits in obsessive-compulsive disorder patients. Obsessive-compulsive personality traits prevalence in obsessive-compulsive disorder patients was higher than in autistic traits. Several factors of genetic predisposition, environmental factors like education and marital status, employment, and intrinsic factors as age of patients all exhibited a pivotal role in obsessive-compulsive disorder prevalence and severity.
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Abstract
BACKGROUND A number of recent investigations have focused on the neurobiology of obsessive-compulsive personality disorder (OCPD). However, there have been few reviews of this literature with no detailed model proposed. We therefore undertook a systematic review of these investigations, aiming to map the available evidence and investigate whether it is possible to formulate a detailed model of the neurobiology of OCPD. METHODS OCPD can be considered from both categorical and dimensional perspectives. An electronic search was therefore conducted using terms that would address not only OCPD as a category, but also related constructs, such as perfectionism, that would capture research on neuropsychology, neuroimaging, neurochemistry, and neurogenetics. RESULTS A total of 1059 articles were retrieved, with 87 ultimately selected for abstract screening, resulting in a final selection of 49 articles focusing on neurobiological investigations relevant to OCPD. Impaired executive function and cognitive inflexibility are common neuropsychological traits in this condition, and suggest that obsessive-compulsive disorder (OCD) and OCPD may lie on a continuum. However, neuroimaging studies in OCPD indicate the involvement of specific neurocircuitry, including the precuneus and amygdala, and so suggest that OCD and OCPD may have important differences. Although OCPD has a heritable component, we found no well-powered genetic studies of OCPD. CONCLUSION Although knowledge in this area has advanced, there are insufficient data on which to base a comprehensive model of the neurobiology of OCPD. Given the clinical importance of OCPD, further work to understand the mechanisms that underpin this condition is warranted.
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Virtanen S, Kuja-Halkola R, Sidorchuk A, Fernández de la Cruz L, Rück C, Lundström S, Suvisaari J, Larsson H, Lichtenstein P, Mataix-Cols D, Latvala A. Association of Obsessive-Compulsive Disorder and Obsessive-Compulsive Symptoms With Substance Misuse in 2 Longitudinal Cohorts in Sweden. JAMA Netw Open 2022; 5:e2214779. [PMID: 35666504 PMCID: PMC9171556 DOI: 10.1001/jamanetworkopen.2022.14779] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Neurobiological models have postulated shared neural mechanisms between obsessive-compulsive disorder (OCD) and substance use disorders, but results from clinical and epidemiological studies are conflicting or even suggest that OCD may be protective against substance misuse. OBJECTIVE To investigate whether OCD and obsessive-compulsive symptoms are associated with substance misuse and the extent to which shared genetic and/or environmental factors account for this association. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, individuals in the general population of Sweden born between January 1, 1932, and December 31, 1997 (population cohort), were followed up through Swedish nationwide registers from January 1, 1997, to December 31, 2013. The second cohort included twin participants in the Child and Adolescent Twin Study in Sweden (CATSS) followed up from ages 18 to 24 years. Data were analyzed from March 1, 2021, to March 31, 2022. EXPOSURES Lifetime International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of OCD in the National Patient Register (population cohort 1), and self-reported obsessive-compulsive symptoms at 18 years of age (CATSS cohort). MAIN OUTCOMES AND MEASURES Substance misuse was defined as registered substance use-related disorder, criminal conviction, or death (population cohort), and self-reported alcohol and drug dependence symptoms at 18 and 24 years of age (CATSS cohort). RESULTS The general population cohort included 6 304 188 individuals (48.9% women and 51.1% men; median baseline age, 30.5 [IQR, 15.0-46.4] years), of whom 27 342 had an OCD diagnosis. Obsessive-compulsive disorder was associated with an elevated risk of substance misuse (hazard ratio, 3.68 [95% CI, 3.52-3.85]). In the 9230 individuals in the CATSS cohort (5551 women [60.1%] and 3679 men [39.9%]), obsessive-compulsive symptoms at 18 years of age were associated with increased symptoms of alcohol dependence (concurrent [n = 9219], β = 0.18 [95% CI, 0.16-0.20]; longitudinal [n = 3381], β = 0.10 [95% CI, 0.06-0.14]) and drug dependence (concurrent [n = 749], β = 0.19 [95% CI, 0.11-0.27]; longitudinal [n = 452], β = 0.15 [95% CI, 0.04-0.25]). Comorbid anxiety and depression did not entirely explain the associations in either cohort. Using data from full siblings and maternal half-siblings (population cohort) and monozygotic and dizygotic twins (CATSS cohort) provided estimates of the relative contribution of genetic and environmental influences to the covariance between OCD and obsessive-compulsive symptoms and substance misuse or dependence. The associations were explained by genetic (56%-68%) and nonshared environmental (32%-44%) factors. CONCLUSIONS AND RELEVANCE The findings of this Swedish population-based cohort study challenge the notion that OCD is protective against developing substance misuse. The association of OCD and obsessive-compulsive symptoms with substance misuse was largely explained by shared genetics but was also compatible with partial environmental mediation.
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Affiliation(s)
- Suvi Virtanen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Phillips KA, Kelly MM. Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:413-419. [PMID: 35747292 PMCID: PMC9063569 DOI: 10.1176/appi.focus.20210012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 06/15/2023]
Abstract
Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly poor quality of life and high rates of suicidality. Onset of BDD is usually in childhood or adolescence and, unless appropriately treated, tends to be chronic. The first-line pharmacologic approach for both delusional and non-delusional BDD is serotonin reuptake inhibitors (SRIs), often at high doses. SRI augmentation and switching strategies can be effective. The first-line psychotherapy is cognitive-behavioral therapy (CBT) tailored to BDD's unique clinical features. Cosmetic treatment (such as surgery or dermatologic treatment), although received by a majority of patients with BDD, is not recommended. BDD has many similarities to obsessive-compulsive disorder (OCD) and appears closely related to OCD but also has some important differences. This article, which updates a 2015 article on BDD that we published in this journal, provides a clinically focused overview of BDD and its relationship to OCD.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
| | - Megan M Kelly
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
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Mahjani B, Bey K, Boberg J, Burton C. Genetics of obsessive-compulsive disorder. Psychol Med 2021; 51:2247-2259. [PMID: 34030745 PMCID: PMC8477226 DOI: 10.1017/s0033291721001744] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 04/11/2021] [Accepted: 04/20/2021] [Indexed: 01/14/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a psychiatric disorder with multiple symptom dimensions (e.g. contamination, symmetry). OCD clusters in families and decades of twin studies clearly demonstrate an important role for genetics in the etiology of the disorder. METHODS In this review, we summarize the genetic epidemiology and molecular genetic studies of OCD and obsessive-compulsive symptoms. RESULTS OCD is a heritable, polygenic disorder with contributions from both common and rare variants, including de novo deleterious variations. Multiple studies have provided reliable support for a large additive genetic contribution to liability to OCD, with discrete OCD symptom dimensions having both shared and unique genetic risks. Genome-wide association studies have not produced significant results yet, likely because of small sample sizes, but larger meta-analyses are forthcoming. Both twin and genome-wide studies show that OCD shares genetic risk with its comorbid conditions (e.g. Tourette syndrome and anorexia nervosa). CONCLUSIONS Despite significant efforts to uncover the genetic basis of OCD, the mechanistic understanding of how genetic and environmental risk factors interact and converge at the molecular level to result in OCD's heterogeneous phenotype is still mostly unknown. Future investigations should increase ancestral genetic diversity, explore age and/or sex differences in genetic risk for OCD and expand the study of pharmacogenetics, gene expression, gene × environment interactions and epigenetic mechanisms for OCD.
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Affiliation(s)
- Behrang Mahjani
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Tics, Obsessive-Compulsive Disorder (OCD) and Related Disorders, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katharina Bey
- Department of Psychiatry and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Julia Boberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Christie Burton
- Neurosciences and Mental Health, Hospital for Sick Children, Toronto, Canada
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12
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Strom NI, Soda T, Mathews CA, Davis LK. A dimensional perspective on the genetics of obsessive-compulsive disorder. Transl Psychiatry 2021; 11:401. [PMID: 34290223 PMCID: PMC8295308 DOI: 10.1038/s41398-021-01519-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/04/2021] [Accepted: 06/16/2021] [Indexed: 12/21/2022] Open
Abstract
This review covers recent findings in the genomics of obsessive-compulsive disorder (OCD), obsessive-compulsive symptoms, and related traits from a dimensional perspective. We focus on discoveries stemming from technical and methodological advances of the past five years and present a synthesis of human genomics research on OCD. On balance, reviewed studies demonstrate that OCD is a dimensional trait with a highly polygenic architecture and genetic correlations to multiple, often comorbid psychiatric phenotypes. We discuss the phenotypic and genetic findings of these studies in the context of the dimensional framework, relying on a continuous phenotype definition, and contrast these observations with discoveries based on a categorical diagnostic framework, relying on a dichotomous case/control definition. Finally, we highlight gaps in knowledge and new directions for OCD genetics research.
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Affiliation(s)
- Nora I Strom
- Institute of Psychiatric Phenomics and Genomics (IPPG), University Hospital, LMU Munich, Munich, Germany
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
- Department of Psychology, Humboldt Universität zu Berlin, Berlin, Germany
| | - Takahiro Soda
- Department of Psychiatry, Duke University, Durham, NC, USA
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, USA
| | - Lea K Davis
- Division of Genetic Medicine, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
- Department of Psychiatry and Behavioral Sciences, Vanderbilt University Medical Center, Nashville, TN, USA.
- Vanderbilt Genetics Institute, Vanderbilt University Medical Center, Nashville, TN, USA.
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13
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Snorrason I, Beard C, Peckham AD, Björgvinsson T. Transdiagnostic dimensions in obsessive-compulsive and related disorders: associations with internalizing and externalizing symptoms. Psychol Med 2021; 51:1657-1665. [PMID: 32138800 DOI: 10.1017/s0033291720000380] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Hierarchical structural models of psychopathology rarely extend to obsessive-compulsive spectrum disorders. The current study sought to examine the higher-order structure of the obsessive-compulsive and related disorders (OCRDs) in DSM-5: obsessive-compulsive disorder (OCD), hoarding disorder (HD), body dysmorphic disorder (BDD), trichotillomania (hair-pulling disorder; HPD) and excoriation (skin-picking) disorder (SPD). METHODS Adult patients in a partial hospital program (N = 532) completed a dimensional measure of the five OCRDs. We used confirmatory factor analysis to identify the optimal model of the comorbidity structure. We then examined the associations between the transdiagnostic factors and internalizing and externalizing symptoms (i.e. depression, generalized anxiety, neuroticism, and drug/alcohol cravings). RESULTS The best fitting model included two correlated higher-order factors: an obsessions-compulsions (OC) factor (OCD, BDD, and HD), and a body-focused repetitive behavior (BFRB) factor (HPD and SPD). The OC factor, not the BFRB factor, had unique associations with internalizing symptoms (standardized effects = 0.42-0.66) and the BFRB factor, not the OC factor, had small marginally significant unique association with drug/alcohol cravings (standardized effect = 0.22, p = 0.088). CONCLUSIONS The results mirror findings from twin research and indicate that OCD, BDD, and HD share liability that is significantly associated with internalizing symptoms, but this liability may be relatively less important for BFRBs. Further research is needed to better examine the associations between BFRBs and addictive disorders.
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Affiliation(s)
- Ivar Snorrason
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Courtney Beard
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew D Peckham
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
| | - Thröstur Björgvinsson
- McLean Hospital, Belmont, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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14
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Pascual-Vera B, Belloch A. Dysmorphic and illness anxiety-related unwanted intrusive thoughts in individuals with obsessive-compulsive disorder. Clin Psychol Psychother 2021; 29:313-327. [PMID: 34169614 DOI: 10.1002/cpp.2636] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/18/2021] [Accepted: 06/15/2021] [Indexed: 11/08/2022]
Abstract
BACKGROUND/OBJECTIVE Unwanted intrusive thoughts (UITs) are considered normal variants of the obsessions found in obsessive-compulsive disorder (OCD). Similarly, intrusive and persistent preoccupations about appearance defects in body dysmorphic disorder (BDD) and images and thoughts about illness in illness anxiety disorder (IAD) are abnormal variants of the thoughts and concerns about appearance and health found in non-clinical individuals. This study examines whether patients with OCD have frequent and distressing UITs with contents related to BDD and IAD, in addition to OCD-related UITs. METHOD Thirty-nine participants with OCD (Mage = 32.45, standard deviation [SD] = 11.57; 63% men) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT), designed to assess obsessional, dysmorphic and illness anxiety UITs and their associated functional consequences (emotions, appraisals, and neutralizing or control strategies). RESULTS Up to 71% of the individuals with OCD experienced the three UIT modalities. As expected, OCD-related UITs were the most frequent, although were no differences among the three UIT contents in terms of the disturbance they caused. The OCD intrusions were the most interfering, egodystonic and dysfunctionally appraised, and they instigated more neutralizing behaviours. Nonetheless, all UITs instigate the need to do something to alleviate the discomfort caused by their intrusion and attempts to suppress them. CONCLUSION UITs with different contents not always related to typical obsessive themes are a common experience in patients with OCD. These UITs could have detrimental consequences for the course of the disorder itself, and they should be adequately addressed in both the assessment and treatment of these patients.
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Affiliation(s)
- Belén Pascual-Vera
- Department of Personality Psychology, Universidad Nacional de Educación a Distancia (UNED), Madrid, Spain.,Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), University of Valencia, Valencia, Spain
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), University of Valencia, Valencia, Spain
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15
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Escobar AP, Martínez-Pinto J, Silva-Olivares F, Sotomayor-Zárate R, Moya PR. Altered Grooming Syntax and Amphetamine-Induced Dopamine Release in EAAT3 Overexpressing Mice. Front Cell Neurosci 2021; 15:661478. [PMID: 34234648 PMCID: PMC8255620 DOI: 10.3389/fncel.2021.661478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/17/2021] [Indexed: 01/06/2023] Open
Abstract
The excitatory amino acid transporter EAAT3 plays an important role in the neuronal uptake of glutamate regulating the activation of glutamate receptors. Polymorphisms in the gene-encoding EAAT3 have been associated with obsessive-compulsive disorder (OCD), although the mechanisms underlying this relationship are still unknown. We recently reported that mice with increased EAAT3 expression in forebrain neurons (EAAT3 g lo /CMKII) display behavioral and synaptic features relevant to OCD, including increased grooming, higher anxiety-like behavior and altered cortico-striatal synaptic function. The dopamine neurotransmitter system is implicated in ritualistic behaviors. Indeed, dopaminergic neurons express EAAT3, and mice lacking EAAT3 exhibit decreased dopamine release and decreased expression of the dopamine D1 receptor. Moreover, EAAT3 plays a role on the effect of the psychostimulant amphetamine. As such, we sought to determine if the OCD-like behavior in EAAT3 g lo /CMKII mice is accompanied by altered nigro-striatal dopaminergic transmission. The aim of this study was to analyze dopamine transmission both in basal conditions and after an acute challenge of amphetamine, using behavioral, neurochemical, molecular, and cellular approaches. We found that in basal conditions, EAAT3 g lo /CMKII mice performed more grooming events and that they remained in phase 1 of the grooming chain syntax compared with control littermates. Administration of amphetamine increased the number of grooming events in control mice, while EAAT3 g lo /CMKII mice remain unaffected. Interestingly, the grooming syntax of amphetamine-control mice resembled that of EAAT3 g lo /CMKII mice in basal conditions. Using in vivo microdialysis, we found decreased basal dopamine levels in EAAT3 g lo /CMKII compared with control mice. Unexpectedly, we found that after acute amphetamine, EAAT3 g lo /CMKII mice had a higher release of dopamine compared with that of control mice, suggesting that EAAT3 overexpression leads to increased dopamine releasability. To determine postsynaptic effect of EAAT3 overexpression over dopamine transmission, we performed Western blot analysis of dopaminergic proteins and found that EAAT3 g lo /CMKII mice have higher expression of D2 receptors, suggesting a higher inhibition of the indirect striatal pathway. Together, the data indicate that EAAT3 overexpression impacts on dopamine transmission, making dopamine neurons more sensitive to the effect of amphetamine and leading to a disbalance between the direct and indirect striatal pathways that favors the performance of repetitive behaviors.
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Affiliation(s)
- Angélica P Escobar
- Facultad de Ciencias, Centro Interdisciplinario de Neurociencia de Valparaíso (CINV), Universidad de Valparaíso, Valparaiso, Chile.,Facultad de Ciencias, Instituto de Fisiología, Universidad de Valparaíso, Valparaiso, Chile
| | - Jonathan Martínez-Pinto
- Facultad de Ciencias, Instituto de Fisiología, Universidad de Valparaíso, Valparaiso, Chile.,Facultad de Ciencias, Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Universidad de Valparaíso, Valparaiso, Chile
| | - Francisco Silva-Olivares
- Facultad de Ciencias, Instituto de Fisiología, Universidad de Valparaíso, Valparaiso, Chile.,Facultad de Ciencias, Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Universidad de Valparaíso, Valparaiso, Chile
| | - Ramón Sotomayor-Zárate
- Facultad de Ciencias, Instituto de Fisiología, Universidad de Valparaíso, Valparaiso, Chile.,Facultad de Ciencias, Centro de Neurobiología y Fisiopatología Integrativa (CENFI), Universidad de Valparaíso, Valparaiso, Chile
| | - Pablo R Moya
- Facultad de Ciencias, Centro Interdisciplinario de Neurociencia de Valparaíso (CINV), Universidad de Valparaíso, Valparaiso, Chile.,Facultad de Ciencias, Instituto de Fisiología, Universidad de Valparaíso, Valparaiso, Chile
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16
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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17
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Huang MH, Cheng CM, Tsai SJ, Bai YM, Li CT, Lin WC, Su TP, Chen TJ, Chen MH. Familial coaggregation of major psychiatric disorders among first-degree relatives of patients with obsessive-compulsive disorder: a nationwide study. Psychol Med 2021; 51:680-687. [PMID: 31907096 DOI: 10.1017/s0033291719003696] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Whether the first-degree relatives (FDRs) of patients with obsessive-compulsive disorder (OCD) have an increased risk of the major psychiatric disorders, namely schizophrenia, bipolar disorder, OCD, major depressive disorder (MDD), autism spectrum disorder (ASD), and attention deficit hyperactivity disorder (ADHD), remains unclear. METHODS Using the Taiwan National Health Insurance Research Database with the whole population sample size (n = 23 258 175), 89 500 FDRs, including parents, offspring, siblings, and twins, of patients with OCD were identified in our study. The relative risks (RRs) of major psychiatric disorders were assessed among FDRs of patients with OCD. RESULTS FDRs of patients with OCD had higher RRs of major psychiatric disorders, namely OCD (RR 8.11, 95% confidence interval (CI) 7.68-8.57), bipolar disorder (RR 2.85, 95% CI 2.68-3.04), MDD (RR 2.67, 95% CI 2.58-2.76), ASD (RR 2.38, 95% CI 2.10-2.71), ADHD (RR 2.19, 95% CI 2.07-2.32), and schizophrenia (RR 1.97, 95% CI 1.86-2.09), compared with the total population. Different familial kinships of FDRs, such as parents, offspring, siblings, and twins consistently had increased risks for these disorders. In addition, a dose-dependent relationship was found between the numbers of OCD probands and the risk of each major psychiatric disorder. CONCLUSIONS The FDRs, including parents, offspring, siblings, and twins, of patients with OCD have a higher risk of OCD, schizophrenia, bipolar disorder, MDD, ADHD, and ASD. The familial co-aggregation of OCD with OCD and other major psychiatric disorders was existent in a dose-dependent manner. Given the increased risks of psychiatric disorders, medical practitioners should closely monitor the mental health of the FDRs of patients with OCD.
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Affiliation(s)
- Mao-Hsuan Huang
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Ming Cheng
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Taipei Veterans General Hospital, Yuanshan Branch, Taiwan
| | - Shih-Jen Tsai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Ya-Mei Bai
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Cheng-Ta Li
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Chen Lin
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Tung-Ping Su
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
- Department of Psychiatry, Cheng Hsin General Hospital, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Hospital and Health Care Administration, National Yang-Ming University, Taipei, Taiwan
| | - Mu-Hong Chen
- Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Psychiatry, College of Medicine, National Yang-Ming University, Taipei, Taiwan
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18
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First MB, Gaebel W, Maj M, Stein DJ, Kogan CS, Saunders JB, Poznyak VB, Gureje O, Lewis-Fernández R, Maercker A, Brewin CR, Cloitre M, Claudino A, Pike KM, Baird G, Skuse D, Krueger RB, Briken P, Burke JD, Lochman JE, Evans SC, Woods DW, Reed GM. An organization- and category-level comparison of diagnostic requirements for mental disorders in ICD-11 and DSM-5. World Psychiatry 2021; 20:34-51. [PMID: 33432742 PMCID: PMC7801846 DOI: 10.1002/wps.20825] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
In 2013, the American Psychiatric Association (APA) published the 5th edition of its Diagnostic and Statistical Manual of Mental Disorders (DSM-5). In 2019, the World Health Assembly approved the 11th revision of the International Classification of Diseases (ICD-11). It has often been suggested that the field would benefit from a single, unified classification of mental disorders, although the priorities and constituencies of the two sponsoring organizations are quite different. During the development of the ICD-11 and DSM-5, the World Health Organization (WHO) and the APA made efforts toward harmonizing the two systems, including the appointment of an ICD-DSM Harmonization Group. This paper evaluates the success of these harmonization efforts and provides a guide for practitioners, researchers and policy makers describing the differences between the two systems at both the organizational and the disorder level. The organization of the two classifications of mental disorders is substantially similar. There are nineteen ICD-11 disorder categories that do not appear in DSM-5, and seven DSM-5 disorder categories that do not appear in the ICD-11. We compared the Essential Features section of the ICD-11 Clinical Descriptions and Diagnostic Guidelines (CDDG) with the DSM-5 criteria sets for 103 diagnostic entities that appear in both systems. We rated 20 disorders (19.4%) as having major differences, 42 disorders (40.8%) as having minor definitional differences, 10 disorders (9.7%) as having minor differences due to greater degree of specification in DSM-5, and 31 disorders (30.1%) as essentially identical. Detailed descriptions of the major differences and some of the most important minor differences, with their rationale and related evidence, are provided. The ICD and DSM are now closer than at any time since the ICD-8 and DSM-II. Differences are largely based on the differing priorities and uses of the two diagnostic systems and on differing interpretations of the evidence. Substantively divergent approaches allow for empirical comparisons of validity and utility and can contribute to advances in the field.
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Affiliation(s)
- Michael B First
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical Faculty, Heinrich-Heine University, Düsseldorf, Germany
| | - Mario Maj
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town and South African Medical Research Council Unit on Risk and Resilience in Mental Disorders, Cape Town, South Africa
| | - Cary S Kogan
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John B Saunders
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, QLD, Australia
| | - Vladimir B Poznyak
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Oye Gureje
- Department of Psychiatry, University of Ibadan, Ibadan, Nigeria
| | - Roberto Lewis-Fernández
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Andreas Maercker
- Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Chris R Brewin
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Marylene Cloitre
- National Center for PTSD Dissemination and Training Division, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Department of Psychiatry and Behavioural Sciences, Stanford University, Stanford, CA, USA
| | - Angelica Claudino
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Kathleen M Pike
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Gillian Baird
- Newcomen Centre, Evelina Children's Hospital, Guys & St. Thomas NHS Foundation Trust, London, UK
| | - David Skuse
- Brain and Behaviour Science Unit, Institute of Child Health, University College London, London, UK
| | - Richard B Krueger
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Peer Briken
- Institute for Sex Research, Sexual Medicine and Forensic Psychiatry, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeffrey D Burke
- Department of Psychological Sciences, University of Connecticut, Storrs, CT, USA
| | - John E Lochman
- Department of Psychology, University of Alabama, Tuscaloosa, AL, USA
| | | | - Douglas W Woods
- Offiice of the Provost and Department of Psychology, Marquette University, Milwaukee, WI, USA
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY, USA
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
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19
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Abstract
Obsessive compulsive disorder (OCD) and several other obsessive-compulsive related disorders (OCRDs) including hoarding disorder, body dysmorphic disorder (BDD), skin picking disorder, trichotillomania and the newly arising public health conditions of online gaming and gambling disorders, under the umbrella of Problematic Usage of the Internet (PUI), not only share some common phenotypes, but there is evidence to suggest share some genetic risk factors. The simple fact that these disorders segregate within families points to this notion. However, the current data are still scarce. This chapter focuses on identifying the shared genetic factors. To address this question, a systematic review of the literature investigating genetic findings in OCD and OCRDs including PUI was conducted, with a focus on their genetic similarities. Greater knowledge of the specific genetic risks shared among OCRDs would be expected to open new avenues in the understanding of the biological mechanisms causing the development of these phenotypes, as well as provide opportunities to develop new animal and cellular models testing new therapy avenues.
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Affiliation(s)
- Edna Grünblatt
- Department of Child and Adolescent Psychiatry and Psychotherapy, Psychiatric University Hospital Zurich, University of Zurich, Zurich, Switzerland.
- Neuroscience Center Zurich, University of Zurich and ETH Zurich, Zurich, Switzerland.
- Zurich Center for Integrative Human Physiology, University of Zurich, Zurich, Switzerland.
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20
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Heiman GA, Rispoli J, Seymour C, Leckman JF, King RA, Fernandez TV. Empiric Recurrence Risk Estimates for Chronic Tic Disorders: Implications for Genetic Counseling. Front Neurol 2020; 11:770. [PMID: 32849224 PMCID: PMC7432137 DOI: 10.3389/fneur.2020.00770] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/22/2020] [Indexed: 01/18/2023] Open
Abstract
Background: Tourette disorder (TD) and other chronic tic disorders are neurodevelopmental/neuropsychiatric disorders characterized by motor and/or vocal tics. Family studies indicate that TD strongly aggregates within families and that other chronic tic disorders are biologically related such that studies typically combine them into any chronic tic disorder (CTD). Because of stigma, bullying, and comorbidity with other neuropsychiatric disorders, CTDs can severely impact the quality of life of individuals with these disorders. Objectives: The genetic architecture of CTDs is complex and heterogeneous, involving a myriad of genetic variants. Thus, providing familial recurrence risks is based on empirical recurrence risk estimates rather than genetic testing. Because empiric recurrence risks for CTDs have not been published, the purpose of this study is to calculate and report these recurrence risks estimates. Methods: Based on population prevalence and increased risk to different relatives from a large population-based family study, we calculated the empiric recurrent risk estimate for each relative type (full sibling, parents, offspring, all first-degree, and all second-degree). Results: The recurrence risk estimate for CTDs in first-degree relatives is 29.9% [95% confidence interval (CI) = 23.2–38.5%]. The risk is higher in males, 33.7% (95% CI = 26.2–43.3%), than females, 24.3% (95% CI = 18.9–31.3%). Conclusions: Given the complex, heterogeneous genetic architecture of CTDs, individuals concerned about recurrence risk should be referred to genetic counseling. Such counseling should include discussion of the derivation and limitations of these empiric recurrence risk estimates, including the upper and lower limits of the range of risk.
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Affiliation(s)
- Gary A Heiman
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Jessica Rispoli
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - Christine Seymour
- Department of Genetics and the Human Genetics Institute of New Jersey, Rutgers, The State University of New Jersey, Piscataway, NJ, United States
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
| | - Robert A King
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States
| | - Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States.,Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States
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21
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Kogan CS, Stein DJ, Rebello TJ, Keeley JW, Chan KJ, Fineberg NA, Fontenelle LF, Grant JE, Matsunaga H, Simpson HB, Thomsen PH, van den Heuvel OA, Veale D, Grenier J, Kulygina M, Matsumoto C, Domínguez-Martínez T, Stona AC, Wang Z, Reed GM. Accuracy of diagnostic judgments using ICD-11 vs. ICD-10 diagnostic guidelines for obsessive-compulsive and related disorders. J Affect Disord 2020; 273:328-340. [PMID: 32560926 DOI: 10.1016/j.jad.2020.03.103] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 01/28/2020] [Accepted: 03/28/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND We report results of an internet-based field study evaluating the diagnostic guidelines for the newly introduced ICD-11 grouping of obsessive-compulsive and related disorders (OCRD). We examined accuracy of clinicians' diagnostic judgments applying draft ICD-11 as compared to the ICD-10 diagnostic guidelines to standardized case vignettes. METHODS 1,717 mental health professionals who are members of the World Health Organization's Global Clinical Practice Network completed the study in Chinese, English, French, Japanese, Russian or Spanish. Participants were randomly assigned to apply ICD-11 or ICD-10 guidelines to one of nine pairs of case vignettes. RESULTS Participants using ICD-11 outperformed those using ICD-10 in correctly identifying newly introduced OCRD, although results were mixed for differentiating OCRD from disorders in other groupings largely due to clinicians having difficulty differentiating challenging presentations of OCD. Clinicians had difficulty applying a three-level insight qualifier, although the 'poor to absent' level assisted with differentiating OCRD from psychotic disorders. Brief training on the rationale for an OCRD grouping did not improve diagnostic accuracy suggesting sufficient detail of the proposed guidelines. LIMITATIONS Standardized case vignettes were manipulated to include specific characteristics; the degree of accuracy of clinicians' diagnostic judgments about these vignettes may not generalize to application in routine clinical practice. CONCLUSIONS Overall, use of the ICD-11 guidelines resulted in more accurate diagnosis of case vignettes compared to the ICD-10 guidelines, particularly in differentiating OCRD presentations from one another. Specific areas in which the ICD-11 guidelines did not perform as intended provided the basis for further revisions to the guidelines.
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Affiliation(s)
- Cary S Kogan
- School of Psychology, Faculty of Social Sciences, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5, Canada.
| | - Dan J Stein
- SAMRC Unit on Risk & Resilience in Mental Disorders, University of Cape Town Dept of Psychiatry & Neuroscience Institute, Groote Schuur Hospital, J-Block, Anzio Road, Observatory 7925, Cape Town, South Africa.
| | - Tahilia J Rebello
- Global Mental Health Program, Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, Mailman School of Public Health, 722 West 168th, Floor R2, R-233, New York, NY 10032, USA.
| | - Jared W Keeley
- Department of Psychology, Virginia Commonwealth University, 806 West Franklin St, Box 842018, Richmond, VA 23284, USA.
| | - K Jacky Chan
- School of Psychology, Faculty of Social Sciences, 136 Jean-Jacques Lussier, Vanier Hall, Ottawa, ON K1N 6N5, Canada.
| | - Naomi A Fineberg
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK; Postgraduate Medical School, University of Hertfordshire, Hatfield, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK.
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; "D'Or' Institute for Research and Education, Rio de Janeiro, RJ, Brazil; School of Psychological Sciences, Monash University, Melbourne, Australia.
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
| | - Hisato Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo, Japan.
| | - H Blair Simpson
- College of Physicians and Surgeons, Columbia University, New York, NY, USA; Anxiety Disorders Clinic and the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York, NY, USA.
| | - Per Hove Thomsen
- Department for Child and Adolescent Psychiatry, Aarhus University Hospital, Skejby, Aarhus, Denmark.
| | - Odile A van den Heuvel
- Amsterdam University Medical Centers, Vrije Universiteit, Department of Psychiatry and Department of Anatomy & Neurosciences, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - David Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Center for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK.
| | - Jean Grenier
- Institut du Savoir Montfort - Hôpital Montfort and Université d'Ottawa, Ottawa, Ontario, Canada.
| | - Mayya Kulygina
- Alekseev Mental Health Clinic, No. 1, Education Centre, Moscow, Russian Federation.
| | - Chihiro Matsumoto
- National Study Coordinator for ICD-11 Field Studies, ICD-11 Committee, Japanese Society of Psychiatry and Neurology, Hongo-Yumicho Building, 2-38-4, Hongo, Bunkyo-ku, Tokyo 113-0033. Japan.
| | - Tecelli Domínguez-Martínez
- Center for Research on Global Mental Health, Direction of Epidemiology and Psychosocial Research, National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico City, Mexico.
| | - Anne-Claire Stona
- Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Road, Singapore.
| | - Zhen Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai 200030, PR China.
| | - Geoffrey M Reed
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, 1051 Riverside Drive, New York, NY 10032, USA; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland.
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22
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Lamothe H, Baleyte JM, Mallet L, Pelissolo A. Trichotillomania is more related to Tourette disorder than to obsessive-compulsive disorder. REVISTA BRASILEIRA DE PSIQUIATRIA (SAO PAULO, BRAZIL : 1999) 2020; 42:87-104. [PMID: 31576938 PMCID: PMC6986481 DOI: 10.1590/1516-4446-2019-0471] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Accepted: 06/08/2019] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Trichotillomania (TTM) is characterized by the pulling out of one's hair. TTM was classified as an impulse control disorder in DSM-IV, but is now classified in the obsessive-compulsive related disorders section of DSM-5. Classification for TTM remains an open question, especially considering its impact on treatment of the disorder. In this review, we questioned the relation of TTM to tic disorder and obsessive-compulsive disorder (OCD). METHOD We reviewed relevant MEDLINE-indexed articles on clinical, neuropsychological, neurobiological, and therapeutic aspects of trichotillomania, OCD, and tic disorders. RESULTS Our review found a closer relationship between TTM and tic disorder from neurobiological (especially imaging) and therapeutic standpoints. CONCLUSION We sought to challenge the DSM-5 classification of TTM and to compare TTM with both OCD and tic disorder. Some discrepancies between TTM and tic disorders notwithstanding, several arguments are in favor of a closer relationship between these two disorders than between TTM and OCD, especially when considering implications for therapy. This consideration is essential for patients.
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Affiliation(s)
- Hugues Lamothe
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
| | - Jean-Marc Baleyte
- Centre Hospitalier Intercommunal de Créteil, Université Paris Est Créteil, Créteil, France
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Université de Caen Normandie (UNICAEN), INSERM, U1077, Caen, France
| | - Luc Mallet
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
- Department of Mental Health and Psychiatry, Geneva University Hospital, University of Geneva, Geneva, Switzerland
- Unité Mixte de Recherche (UMR) S1127, Centre National de la Recherche Scientifique (CNRS), UMR 7225, Institut du Cerveau et de la Moelle Epinière, Paris, France
| | - Antoine Pelissolo
- Institut National de la Santé et de la Recherche Médicale (INSERM), U955, Créteil, France
- Fondation FondaMental, Créteil, France
- Assistance Publique Hôspitaux de Paris (APHP), Hôpitaux Universitaires Henri Mondor Albert Chenevier, Université Paris Est Créteil, Créteil, France
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23
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Gadelkarim W, Shahper S, Reid J, Wikramanayake M, Kaur S, Kolli S, Osman S, Fineberg NA. Overlap of obsessive-compulsive personality disorder and autism spectrum disorder traits among OCD outpatients: an exploratory study. Int J Psychiatry Clin Pract 2019; 23:297-306. [PMID: 31375037 DOI: 10.1080/13651501.2019.1638939] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background: Whereas the phenomenology of obsessive-compulsive personality disorder (OCPD) shows similarities to that of obsessive compulsive and related disorders (OCRDs) as well as with autism spectrum disorder (ASD), the relationship between these disorders is poorly understood.Aims: Within a clinical sample, we aimed to investigate the distribution of OCD, OCPD and ASD symptoms and traits and their interrelationship, as well as to evaluate insight and treatment refractoriness.Methods: Consecutive adult OCD outpatients were assessed for OCPD traits (Compulsive Personality Assessment Scale (CPAS)), OCD symptoms (Yale-Brown Obsessive Compulsive Scale (Y-BOCS)), ASD traits (Autism Spectrum Quotient (AQ)), insight (Brown Assessment of Beliefs Scale (BABS)) and treatment resistance (clinical records). Those scoring highly on the AQ underwent a diagnostic interview for ASD.Results: Sixty-seven consenting individuals completed the CPAS, BABS and AQ, and 65 completed the Y-BOCS. Twenty-four patients (35.8%) were diagnosed with OCPD. Patients with OCPD were less likely to be employed (p=.04). They demonstrated elevated AQ scores (p=.004) and rates of ASD diagnosis (54.2%) (p <.001). OCPD traits (CPAS) showed a highly significant correlation with ASD traits (AQ) (p<.001), and no association with Y-BOCS, BABS or treatment resistance.Conclusions: In an OCD cohort limited by small size, OCPD associated strongly with unemployment and ASD, with implications for diagnosis, treatment and outcome.KEY POINTSClinicians should exercise a high level of vigilance for OCPD and ASD in patients presenting with obsessive compulsive symptoms.The presence of OCPD may indicate a likelihood of disabling ASD traits, including cognitive inflexibility, poor central coherence and poor social communication.These neuropsychological factors may require separate clinical intervention strategies.
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Affiliation(s)
- W Gadelkarim
- Rosanne House, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Derwent Centre, Essex Partnership University NHS Foundation Trust, Harlow, UK
| | - S Shahper
- Department of Life and Medical Science, University of Hertfordshire, Hatfield, UK
| | - J Reid
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - M Wikramanayake
- Cavell Centre, Cambridgeshire and Peterborough NHS Foundation Trust, Peterborough, UK
| | - S Kaur
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK
| | - S Kolli
- East London NHS Foundation Trust, Bedford, UK
| | - S Osman
- Northumberland, Tyne and Wear NHS Foundation Trust, Newcastle, UK
| | - N A Fineberg
- Highly Specialised OCD/BDD Services, Hertfordshire Partnership University NHS Foundation Trust, Welwyn Garden City, UK.,Postgraduate Medical School, University of Hertfordshire, Hatfield, UK.,University of Cambridge, School of Clinical Medicine, Cambridge, UK
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24
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Gerstenblith TA, Jaramillo-Huff A, Ruutiainen T, Nestadt PS, Samuels JF, Grados MA, Cullen BA, Riddle MA, Liang KY, Greenberg BD, Rasmussen SA, Rauch SL, McCracken JT, Piacentini J, Knowles JA, Nestadt G, Bienvenu OJ. Trichotillomania comorbidity in a sample enriched for familial obsessive-compulsive disorder. Compr Psychiatry 2019; 94:152123. [PMID: 31518848 PMCID: PMC6980465 DOI: 10.1016/j.comppsych.2019.152123] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 07/24/2019] [Accepted: 08/28/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND This study addresses the strength of associations between trichotillomania (TTM) and other DSM-IV Axis I conditions in a large sample (n = 2606) enriched for familial obsessive-compulsive disorder (OCD), to inform TTM classification. METHODS We identified participants with TTM in the Johns Hopkins OCD Family Study (153 families) and the OCD Collaborative Genetics Study, a six-site genetic linkage study of OCD (487 families). We used logistic regression (with generalized estimating equations) to assess the strength of associations between TTM and other DSM-IV disorders. RESULTS TTM had excess comorbidity with a number of conditions from different DSM-IV chapters, including tic disorders, alcohol dependence, mood disorders, anxiety disorders, impulse-control disorders, and bulimia nervosa. However, association strengths (odds ratios) were highest for kleptomania (6.6), pyromania (5.8), OCD (5.6), skin picking disorder (4.4), bulimia nervosa (3.5), and pathological nail biting (3.4). CONCLUSIONS TTM is comorbid with a number of psychiatric conditions besides OCD, and it is strongly associated with other conditions involving impaired impulse control. Though DSM-5 includes TTM as an OCD-related disorder, its comorbidity pattern also emphasizes the impulsive, appetitive aspects of this condition that may be relevant to classification.
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Affiliation(s)
- Ted Avi Gerstenblith
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Ashley Jaramillo-Huff
- University of New Mexico School of Medicine, Department of Obstetrics and Gynecology, United States of America
| | - Tuua Ruutiainen
- University of Pennsylvania Perelman School of Medicine, Department of Psychiatry, United States of America
| | - Paul S Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Jack F Samuels
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Marco A Grados
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Bernadette A Cullen
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - Mark A Riddle
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | | | - Benjamin D Greenberg
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Steven A Rasmussen
- Brown Medical School, Department of Psychiatry and Human Behavior, United States of America
| | - Scott L Rauch
- Harvard Medical School, Department of Psychiatry, United States of America
| | - James T McCracken
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - John Piacentini
- University of California, Los Angeles School of Medicine, Department of Psychiatry and Biobehavioral Sciences, United States of America
| | - James A Knowles
- SUNY Downstate Medical Center College of Medicine, Department of Cell Biology, United States of America
| | - Gerald Nestadt
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America
| | - O Joseph Bienvenu
- Johns Hopkins University School of Medicine, Department of Psychiatry and Behavioral Sciences, United States of America.
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25
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Reed GM, First MB, Kogan CS, Hyman SE, Gureje O, Gaebel W, Maj M, Stein DJ, Maercker A, Tyrer P, Claudino A, Garralda E, Salvador‐Carulla L, Ray R, Saunders JB, Dua T, Poznyak V, Medina‐Mora ME, Pike KM, Ayuso‐Mateos JL, Kanba S, Keeley JW, Khoury B, Krasnov VN, Kulygina M, Lovell AM, de Jesus Mari J, Maruta T, Matsumoto C, Rebello TJ, Roberts MC, Robles R, Sharan P, Zhao M, Jablensky A, Udomratn P, Rahimi‐Movaghar A, Rydelius P, Bährer‐Kohler S, Watts AD, Saxena S. Innovations and changes in the ICD-11 classification of mental, behavioural and neurodevelopmental disorders. World Psychiatry 2019; 18:3-19. [PMID: 30600616 PMCID: PMC6313247 DOI: 10.1002/wps.20611] [Citation(s) in RCA: 299] [Impact Index Per Article: 59.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Following approval of the ICD-11 by the World Health Assembly in May 2019, World Health Organization (WHO) member states will transition from the ICD-10 to the ICD-11, with reporting of health statistics based on the new system to begin on January 1, 2022. The WHO Department of Mental Health and Substance Abuse will publish Clinical Descriptions and Diagnostic Guidelines (CDDG) for ICD-11 Mental, Behavioural and Neurodevelopmental Disorders following ICD-11's approval. The development of the ICD-11 CDDG over the past decade, based on the principles of clinical utility and global applicability, has been the most broadly international, multilingual, multidisciplinary and participative revision process ever implemented for a classification of mental disorders. Innovations in the ICD-11 include the provision of consistent and systematically characterized information, the adoption of a lifespan approach, and culture-related guidance for each disorder. Dimensional approaches have been incorporated into the classification, particularly for personality disorders and primary psychotic disorders, in ways that are consistent with current evidence, are more compatible with recovery-based approaches, eliminate artificial comorbidity, and more effectively capture changes over time. Here we describe major changes to the structure of the ICD-11 classification of mental disorders as compared to the ICD-10, and the development of two new ICD-11 chapters relevant to mental health practice. We illustrate a set of new categories that have been added to the ICD-11 and present the rationale for their inclusion. Finally, we provide a description of the important changes that have been made in each ICD-11 disorder grouping. This information is intended to be useful for both clinicians and researchers in orienting themselves to the ICD-11 and in preparing for implementation in their own professional contexts.
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Affiliation(s)
- Geoffrey M. Reed
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland,Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - Michael B. First
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Cary S. Kogan
- School of PsychologyUniversity of OttawaOttawaONCanada
| | - Steven E. Hyman
- Stanley Center for Psychiatric ResearchBroad Institute of Harvard and Massachusetts Institute of TechnologyCambridgeMAUSA
| | - Oye Gureje
- Department of PsychiatryUniversity of IbadanIbadanNigeria
| | - Wolfgang Gaebel
- Department of Psychiatry and Psychotherapy, Medical FacultyHeinrich‐Heine UniversityDüsseldorfGermany
| | - Mario Maj
- Department of PsychiatryUniversity of Campania “L. Vanvitelli”NaplesItaly
| | - Dan J. Stein
- Department of PsychiatryUniversity of Cape Town, and South African Medical Research Council Unit on Risk and Resilience in Mental DisordersCape TownSouth Africa
| | | | - Peter Tyrer
- Centre for Mental HealthImperial CollegeLondonUK
| | - Angelica Claudino
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | - Luis Salvador‐Carulla
- Research School of Population HealthAustralian National UniversityCanberraACTAustralia
| | - Rajat Ray
- National Drug Dependence Treatment Centre, All India Institute of Medical Sciences, New Delhi, India
| | - John B. Saunders
- Centre for Youth Substance Abuse ResearchUniversity of QueenslandBrisbaneQLDAustralia
| | - Tarun Dua
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | - Vladimir Poznyak
- Department of Mental Health and Substance AbuseWorld Health OrganizationGenevaSwitzerland
| | | | - Kathleen M. Pike
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA
| | - José L. Ayuso‐Mateos
- Department of PsychiatryUniversidad Autonoma de Madrid; Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Instituto de Investigación Sanitaria La PrincesaMadridSpain
| | | | - Jared W. Keeley
- Department of PsychologyVirginia Commonwealth UniversityRichmondVAUSA
| | - Brigitte Khoury
- Department of PsychiatryAmerican University of Beirut Medical CenterBeirutLebanon
| | - Valery N. Krasnov
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Maya Kulygina
- Moscow Research Institute of PsychiatryNational Medical Research Centre for Psychiatry and NarcologyMoscowRussian Federation
| | - Anne M. Lovell
- Institut National de la Santé et de la Recherche Médicale U988ParisFrance
| | - Jair de Jesus Mari
- Department of PsychiatryUniversidade Federal de São Paulo (UNIFESP/EPM)São PauloBrazil
| | | | | | - Tahilia J. Rebello
- Department of PsychiatryColumbia University Medical CenterNew YorkNYUSA,New York State Psychiatric InstituteNew YorkNYUSA
| | - Michael C. Roberts
- Office of Graduate Studies and Clinical Child Psychology ProgramUniversity of KansasLawrenceKSUSA
| | - Rebeca Robles
- National Institute of Psychiatry Ramón de la Fuente MuñizMexico CityMexico
| | - Pratap Sharan
- Department of PsychiatryAll India Institute of Medical SciencesNew DelhiIndia
| | - Min Zhao
- Shanghai Mental Health Center and Department of PsychiatryShanghai Jiao Tong University School of MedicineShanghaiPeople's Republic of China
| | - Assen Jablensky
- Centre for Clinical Research in NeuropsychiatryUniversity of Western AustraliaPerthWAAustralia
| | - Pichet Udomratn
- Department of PsychiatryPrince of Songkla UniversityHat YaiThailand
| | - Afarin Rahimi‐Movaghar
- Iranian National Center for Addiction Studies, Tehran University of Medical SciencesTehranIran
| | - Per‐Anders Rydelius
- Department of Child and Adolescent PsychiatryKarolinska InstituteStockholmSweden
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Kloft L, Steinel T, Kathmann N. Systematic review of co-occurring OCD and TD: Evidence for a tic-related OCD subtype? Neurosci Biobehav Rev 2018; 95:280-314. [PMID: 30278193 DOI: 10.1016/j.neubiorev.2018.09.021] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 09/19/2018] [Accepted: 09/25/2018] [Indexed: 10/28/2022]
Abstract
OBJECTIVE The aim of this review is to summarize the current knowledge of associated features of co-occurring obsessive-compulsive disorder (OCD) and tic disorders (TD) and to critically evaluate hypotheses regarding the nature of their comorbidity. METHOD We conducted a systematic review following PRISMA guidelines. To this aim, the PubMed, PsychInfo and ISI Web of Knowledge databases were searched up to August 30, 2018. For gender and age-of-onset we additionally conducted meta-analyses. RESULTS One hundred eighty-nine studies met inclusion criteria. We substantiate some acknowledged features and report evidence for differential biological mechanisms and treatment response. In general, studies were of limited methodological quality. CONCLUSIONS Several specific features are reliable associated with co-occurring OCD + TD. The field lacks methodological sound studies. The review found evidence against and in favor for different hypotheses regarding the nature of comorbidity of OCD and TD. This could indicate the existence of a stepwise model of co-morbidity, or could be an artefact of the low methodological quality of studies.
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Affiliation(s)
- Lisa Kloft
- Humboldt-Universität zu Berlin, Berlin, Germany.
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27
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Prevalence and predictors of hair pulling disorder and excoriation disorder in Tourette syndrome. Eur Child Adolesc Psychiatry 2018; 27:569-579. [PMID: 29098466 PMCID: PMC5932289 DOI: 10.1007/s00787-017-1074-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 10/24/2017] [Indexed: 10/18/2022]
Abstract
Trichotillomania/hair pulling disorder (HPD) and excoriation/skin picking disorder (SPD) are childhood-onset, body-focused repetitive behaviors that are thought to share genetic susceptibility and underlying pathophysiology with obsessive-compulsive disorder (OCD) and Tourette syndrome (TS). We sought to determine the prevalence of DSM-5 HPD and SPD in TS patients, and to identify clinical factors most associated with their co-morbidity with TS. Participants included 811 TS patients recruited from TS specialty clinics for a multi-center genetic study. Patients were assessed using standardized, validated semi-structured interviews. HPD and SPD diagnoses were determined using a validated self-report questionnaire. HPD/SPD prevalence rates were calculated, and clinical predictors were evaluated using regression modeling. 3.8 and 13.0% of TS patients met DSM-5 criteria for HPD and SPD, respectively. In univariable analyses, female sex, OCD, and both tic and obsessive-compulsive symptom severity were among those associated with HPD and/or SPD. In multivariable analyses, only lifetime worst-ever motor tic severity remained significantly associated with HPD. Female sex, co-occurring OCD, ADHD, and motor tic severity remained independently associated with SPD. This is the first study to examine HPD and SPD prevalence in a TS sample using semi-structured diagnostic instruments. The prevalence of HPD and SPD in TS patients, and their association with increased tic severity and co-occurring OCD, suggests that clinicians should screen children with TS and related disorders for HPD/SPD, particularly in females and in those with co-occurring OCD. This study also helps set a foundation for subsequent research regarding HPD/SPD risk factors, pathophysiology, and treatment models.
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28
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Gillett CB, Bilek EL, Hanna GL, Fitzgerald KD. Intolerance of uncertainty in youth with obsessive-compulsive disorder and generalized anxiety disorder: A transdiagnostic construct with implications for phenomenology and treatment. Clin Psychol Rev 2018; 60:100-108. [DOI: 10.1016/j.cpr.2018.01.007] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 12/12/2017] [Accepted: 01/31/2018] [Indexed: 12/15/2022]
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29
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López-Solà C, Bui M, Hopper JL, Fontenelle LF, Davey CG, Pantelis C, Alonso P, van den Heuvel OA, Harrison BJ. Predictors and consequences of health anxiety symptoms: a novel twin modeling study. Acta Psychiatr Scand 2018; 137:241-251. [PMID: 29336012 DOI: 10.1111/acps.12850] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2017] [Indexed: 12/20/2022]
Abstract
OBJECTIVE The question of how to best conceptualize health anxiety (HA) from a diagnostic and etiological perspective remains debated. The aim was to examine the relationship between HA and the symptoms of anxiety and obsessive-compulsive-related disorders in a normative twin population. METHOD Four hundred and ninety-six monozygotic adult twin pairs from the Australian Twin Registry participated in the study (age, 34.4 ± 7.72 years; 59% females). Validated scales were used to assess each domain. We applied a twin regression methodology-ICE FALCON-to determine whether there was evidence consistent with 'causal' relationships between HA and other symptoms by fitting and comparing model estimates. RESULTS Estimates were consistent with higher levels of obsessing ('unwanted thoughts') (P = 0.008), social anxiety (P = 0.03), and body dysmorphic symptoms (P = 0.008) causing higher levels of HA symptoms, and with higher levels of HA symptoms causing higher levels of physical/somatic anxiety symptoms (P = 0.001). CONCLUSION Obsessional thoughts, body dysmorphic concerns, and social anxiety symptoms may have a causal influence on HA. To report physical/somatic anxiety appears to be a consequence of the underlying presence of HA-related fears. Should our results be confirmed by longitudinal studies, the evaluation and treatment of HA may benefit from the consideration of these identified risk factors.
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Affiliation(s)
- C López-Solà
- Adult Mental Health Department, Parc Taulí University Hospital, Universitat Autònoma de Barcelona, Sabadell, Spain.,Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain
| | - M Bui
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia
| | - J L Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Family Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnamgu, Seoul, South Korea
| | - L F Fontenelle
- Department of Epidemiology, School of Public Health, Seoul National University, Seoul, South Korea.,Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.,Brain & Mental Health Laboratory, Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Melbourne, Vic, Australia
| | - C G Davey
- Orygen, The National Centre of Excellence in Youth Mental Health, Melbourne, Vic, Australia.,Centre for Youth Mental Health, The University of Melbourne, Melbourne, Vic, Australia.,Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - C Pantelis
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
| | - P Alonso
- Carlos III Health Institute, CIBERSAM (Centro de Investigación en Red de Salud Mental), Barcelona, Spain.,Department of Psychiatry, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), Barcelona, Spain.,Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
| | - O A van den Heuvel
- Department of Anatomy and Neurosciences, VU university medical center (VUmc), Amsterdam, The Netherlands.,Department of Psychiatry, VUmc, Amsterdam, The Netherlands.,Neuroscience Campus Amsterdam, VU/VUmc, Amsterdam, The Netherlands.,The OCD team, Haukeland University Hospital, Bergen, Norway
| | - B J Harrison
- Department of Psychiatry, Melbourne Neuropsychiatry Centre, The University of Melbourne and Melbourne Health, Melbourne, Vic, Australia
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Bowen R, Rahman H, Dong LY, Khalaj S, Baetz M, Peters E, Balbuena L. Suicidality in People With Obsessive-Compulsive Symptoms or Personality Traits. Front Psychiatry 2018; 9:747. [PMID: 30692943 PMCID: PMC6339952 DOI: 10.3389/fpsyt.2018.00747] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/18/2018] [Indexed: 12/20/2022] Open
Abstract
Objective: Obsessive-Compulsive Disorder (OCD) and Obsessive-Compulsive Personality Disorder (OCPD) have been reported to be associated with mood instability (MI), depression and suicide-related outcomes. We examined whether obsessive-compulsive symptoms and personality traits as well as obsessional thoughts of death, are associated with suicidal thoughts, non-suicidal self-injury and attempted suicide. Methods: We used data from 7,839 people from the 2000 British Adult Psychiatric Morbidity Survey that elicited symptoms of OCD with a computerized version of the Clinical Interview Schedule-Revised (CIS-R) and traits of OCPD with a self-completed version of the SCID-II. We created a series of logistic regression models, first entering only OCD symptoms and OCPD traits in separate models, to which depression and mood instability (MI) were added. We also examined the relation of obsessional thoughts about death with self-harm in a network analysis model that included the main symptoms of mood instability and depression. Results: OCD symptoms were associated with suicidal thoughts (OR: 1.23, 95% CI: 1.14-1.32), and suicide attempts (OR: 1.13, 95% CI: 1.04-1.24) in the fully-adjusted model. OCPD traits were associated with suicidal thoughts (OR: 1.14, 95% CI: 1.10-1.19), non-suicidal self-injury (OR: 1.14 95% CI: 1.03-1.26), and suicide attempts (OR: 1.09; 1.01-1.17). Depression and MI were both associated with all three suicide-related outcomes. In the network analysis, MI was the most prominent correlate of suicide-related outcomes, being associated with suicidal ideas (partial r = 0.15) and non-suicidal self-injury (partial r = 0.07). Limitation: This was a cross-sectional study that used a single-item measure for mood instability. Conclusions: Obsessive-compulsive symptoms and personality traits are related to suicide-related outcomes independently of depressive symptoms and mood instability. This relationship is not accounted for by obsessional thoughts of death alone.
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Affiliation(s)
- Rudy Bowen
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Hiba Rahman
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lisa Yue Dong
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Sara Khalaj
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Marilyn Baetz
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Evyn Peters
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
| | - Lloyd Balbuena
- Department of Psychiatry, University of Saskatchewan, Saskatoon, SK, Canada
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Schneider SC, Baillie AJ, Mond J, Turner CM, Hudson JL. The classification of body dysmorphic disorder symptoms in male and female adolescents. J Affect Disord 2018; 225:429-437. [PMID: 28858657 DOI: 10.1016/j.jad.2017.08.062] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 08/10/2017] [Accepted: 08/20/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) was categorised in DSM-5 within the newly created 'obsessive-compulsive and related disorders' chapter, however this classification remains subject to debate. Confirmatory factor analysis was used to test competing models of the co-occurrence of symptoms of BDD, obsessive-compulsive disorder, unipolar depression, anxiety, and eating disorders in a community sample of adolescents, and to explore potential sex differences in these models. METHODS Self-report questionnaires assessing disorder symptoms were completed by 3149 Australian adolescents. The fit of correlated factor models was calculated separately in males and females, and measurement invariance testing compared parameters of the best-fitting model between males and females. RESULTS All theoretical models of the classification of BDD had poor fit to the data. Good fit was found for a novel model where BDD symptoms formed a distinct latent factor, correlated with affective disorder and eating disorder latent factors. Metric non-invariance was found between males and females, and the majority of factor loadings differed between males and females. Correlations between some latent factors also differed by sex. LIMITATIONS Only cross-sectional data were collected, and the study did not assess a broad range of DSM-5 defined eating disorder symptoms or other disorders in the DSM-5 obsessive-compulsive and related disorders chapter. CONCLUSIONS This study is the first to statistically evaluate competing models of BDD classification. The findings highlight the unique features of BDD and its associations with affective and eating disorders. Future studies examining the classification of BDD should consider developmental and sex differences in their models.
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Affiliation(s)
- Sophie C Schneider
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Andrew J Baillie
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; NHMRC Centre of Research Excellence in Mental Health and Substance Use, Australia
| | - Jonathan Mond
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston, Australia; Centre for Health Research, School of Medicine, Western Sydney University, Sydney, Australia
| | - Cynthia M Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
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32
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The neurobiology of body dysmorphic disorder: A systematic review and theoretical model. Neurosci Biobehav Rev 2017; 83:83-96. [DOI: 10.1016/j.neubiorev.2017.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/27/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
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33
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Abrantes AM, Brown RA, Strong DR, McLaughlin N, Garnaat SL, Mancebo M, Riebe D, Desaulniers J, Yip AG, Rasmussen S, Greenberg B. A pilot randomized controlled trial of aerobic exercise as an adjunct to OCD treatment. Gen Hosp Psychiatry 2017; 49:51-55. [PMID: 29122148 PMCID: PMC5726421 DOI: 10.1016/j.genhosppsych.2017.06.010] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The purpose of the current study was to conduct a randomized controlled trial testing the efficacy of aerobic exercise for decreasing OCD symptom severity, other mental health outcomes, and increasing exercise behaviors and cardiorespiratory fitness among individuals with OCD. METHOD Fifty-six patients (64% female; mean age=38.8years) with OCD and a Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score of 16 or greater despite engaging in OCD treatment were randomized to 12-weeks of supervised plus home-based moderate-intensity aerobic exercise (AE; n=28) or to 12-weeks of health education sessions (HE; n=28). RESULTS Random intercepts mixed models examined differences between conditions at post-treatment. Though no difference between conditions on outcomes was observed, both AE and HE showed significant reduction in OCD symptom severity, depression and anxiety at post-treatment. Relative to HE, significant increases were noted in amount of exercise and cardiorespiratory fitness for those in the AE condition. At post-treatment, 30.4% of the AE condition (7 of 23) were treatment-responders (using the commonly accepted measure of 35% symptom reduction from baseline). In the HE condition, 7.7% of the sample (2 of 26) met this criterion at post-treatment. CONCLUSION The results of this preliminary study suggest that exercise and health-focused interventions may be beneficial adjuncts to existing OCD treatment. Future studies with larger samples are needed to more definitively answer questions the efficacy of AE for reducing OCD symptoms and improving related clinical outcomes.
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Affiliation(s)
- Ana M. Abrantes
- Butler Hospital, Providence, RI 02906,Alpert Medical School of Brown University, Providence, RI 02906
| | - Richard A. Brown
- Alpert Medical School of Brown University, Providence, RI 02906,University of Texas at Austin, Austin, TX, 78712
| | | | - Nicole McLaughlin
- Butler Hospital, Providence, RI 02906,Alpert Medical School of Brown University, Providence, RI 02906
| | - Sarah L. Garnaat
- Butler Hospital, Providence, RI 02906,Alpert Medical School of Brown University, Providence, RI 02906
| | - Maria Mancebo
- Butler Hospital, Providence, RI 02906,Alpert Medical School of Brown University, Providence, RI 02906
| | | | | | | | | | - Benjamin Greenberg
- Butler Hospital, Providence, RI 02906,Alpert Medical School of Brown University, Providence, RI 02906,Providence Veterans Affairs Medical Center, Providence, RI 02908
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Pascual-Vera B, Belloch A. Functional links of obsessive, dysmorphic, hypochondriac, and eating-disorders related mental intrusions. Int J Clin Health Psychol 2017; 18:43-51. [PMID: 30487909 PMCID: PMC6220904 DOI: 10.1016/j.ijchp.2017.09.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/11/2017] [Indexed: 11/17/2022] Open
Abstract
Unwanted mental intrusions (UMIs) are the normal variants of obsessions in Obsessive-Compulsive Disorder (OCD), preoccupations about defects in Body Dysmorphic Disorder (BDD), images about illness in Hypochondriasis (HYP), and thoughts about eating in Eating Disorders (EDs). The aim was to examine the similarities and differences in the functional links of four UMI contents, adopting a within-subject perspective. Method: 438 university students and community participants (M age = 29.84, SD = 11.41; 70.54% women) completed the Questionnaire of Unpleasant Intrusive Thoughts (QUIT) to assess the functional links (emotions, appraisals, and neutralizing/control strategies) of the most upsetting UMIs with OCD, BDD, HYP and EDs-contents. Results: HYP-related intrusions caused the highest emotional impact, OCD-related intrusions were the most interfering, and EDs-related intrusions interfered the least. The four UMI were equally ego-dystonic. Women appraised OCD-related intrusions more dysfunctionally, but men appraised the four intrusive contents similarly. All UMI instigated the urge to "do something", to keep them under control and/or neutralizing them. Conclusions: Similarities among the functional links of intrusions related to OCD, BDD, HYP and EDs contents support their transdiagnostic nature and they might contribute to understanding common factors in these disorders.
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Affiliation(s)
- Belén Pascual-Vera
- Research and Treatment Unit for Obsessions and Compulsions (I'TOC), Universidad de Valencia, Spain
| | - Amparo Belloch
- Research and Treatment Unit for Obsessions and Compulsions (I'TOC), Universidad de Valencia, Spain
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35
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Abstract
Hypochondriasis (HYPO), an obsessive-compulsive spectrum disorder, is frequent in patients with schizophrenia (SCH) (20%), especially among those treated with clozapine (36.7%). Treatment options for OCS/OCD in patients under clozapine (CLZ) include combining clozapine with amisulpride/aripiprazole or a mood stabilizer, augmenting clozapine with a serotoninergic reuptake inhibitor, adding cognitive behavioural therapy, and gradually reducing dosage. No treatments have been proposed for HYPO in patients using clozapine so we examine these options in 2 cases and report the results. Among treatments delivered, only dosage reduction adequately worked. We recommend caution when thinking about escalating treatment and suggest trying it only when alternative interventions were not successful and weighing risk and benefits of this therapeutic strategy. Further research is needed to confirm the hypothesis that CLZ treatment induces hypochondriac symptoms, to investigate the prevalence of the phenomenon, and, mostly, to identify possible treatment strategies.
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36
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Cognitive dysfunction in body dysmorphic disorder: new implications for nosological systems and neurobiological models. CNS Spectr 2017; 22:51-60. [PMID: 27899165 PMCID: PMC5322826 DOI: 10.1017/s1092852916000468] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction Body dysmorphic disorder (BDD) is a debilitating disorder, characterized by obsessions and compulsions relating specifically to perceived appearance, and which has been newly classified within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Obsessive-Compulsive and Related Disorders grouping. Until now, little research has been conducted into the cognitive profile of this disorder. METHODS Participants with BDD (n=12) and participants without BDD (n=16) were tested using a computerized neurocognitive battery investigating attentional set-shifting (Intra/Extra Dimensional Set Shift Task), decision-making (Cambridge Gamble Task), motor response-inhibition (Stop-Signal Reaction Time Task), and affective processing (Affective Go-No Go Task). The groups were matched for age, IQ, and education. RESULTS In comparison to controls, patients with BDD showed significantly impaired attentional set-shifting, abnormal decision-making, impaired response inhibition, and greater omission and commission errors on the emotional processing task. CONCLUSION Despite the modest sample size, our results showed that individuals with BDD performed poorly compared to healthy controls on tests of cognitive flexibility, reward and motor impulsivity, and affective processing. Results from separate studies in OCD patients suggest similar cognitive dysfunction. Therefore, these findings are consistent with the reclassification of BDD alongside OCD. These data also hint at additional areas of decision-making abnormalities that might contribute specifically to the psychopathology of BDD.
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Otowa T, Hek K, Lee M, Byrne EM, Mirza SS, Nivard MG, Bigdeli T, Aggen SH, Adkins D, Wolen A, Fanous A, Keller MC, Castelao E, Kutalik Z, Van der Auwera S, Homuth G, Nauck M, Teumer A, Milaneschi Y, Hottenga JJ, Direk N, Hofman A, Uitterlinden A, Mulder CL, Henders AK, Medland SE, Gordon S, Heath AC, Madden PA, Pergadia M, van der Most PJ, Nolte IM, van Oort FV, Hartman CA, Oldehinkel AJ, Preisig M, Grabe HJ, Middeldorp CM, Penninx BWJH, Boomsma D, Martin NG, Montgomery G, Maher BS, van den Oord EJ, Wray NR, Tiemeier H, Hettema JM. Meta-analysis of genome-wide association studies of anxiety disorders. Mol Psychiatry 2016; 21:1391-9. [PMID: 26754954 PMCID: PMC4940340 DOI: 10.1038/mp.2015.197] [Citation(s) in RCA: 264] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 10/16/2015] [Accepted: 11/05/2015] [Indexed: 11/08/2022]
Abstract
Anxiety disorders (ADs), namely generalized AD, panic disorder and phobias, are common, etiologically complex conditions with a partially genetic basis. Despite differing on diagnostic definitions based on clinical presentation, ADs likely represent various expressions of an underlying common diathesis of abnormal regulation of basic threat-response systems. We conducted genome-wide association analyses in nine samples of European ancestry from seven large, independent studies. To identify genetic variants contributing to genetic susceptibility shared across interview-generated DSM-based ADs, we applied two phenotypic approaches: (1) comparisons between categorical AD cases and supernormal controls, and (2) quantitative phenotypic factor scores (FS) derived from a multivariate analysis combining information across the clinical phenotypes. We used logistic and linear regression, respectively, to analyze the association between these phenotypes and genome-wide single nucleotide polymorphisms. Meta-analysis for each phenotype combined results across the nine samples for over 18 000 unrelated individuals. Each meta-analysis identified a different genome-wide significant region, with the following markers showing the strongest association: for case-control contrasts, rs1709393 located in an uncharacterized non-coding RNA locus on chromosomal band 3q12.3 (P=1.65 × 10(-8)); for FS, rs1067327 within CAMKMT encoding the calmodulin-lysine N-methyltransferase on chromosomal band 2p21 (P=2.86 × 10(-9)). Independent replication and further exploration of these findings are needed to more fully understand the role of these variants in risk and expression of ADs.
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Affiliation(s)
- Takeshi Otowa
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
- Department of Neuropsychiatry, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Karin Hek
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Epidemiological and Social Psychiatric Research institute, Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Minyoung Lee
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Enda M. Byrne
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Saira S. Mirza
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Michel G. Nivard
- Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Timothy Bigdeli
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Steven H. Aggen
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | - Daniel Adkins
- Department of Pharmacy, Center for Biomarker Research and Personalized Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Aaron Wolen
- Center for Clinical and Translational Research, Virginia Commonwealth University, Richmond, VA, USA
| | - Ayman Fanous
- Mental Health Service Line, Washington VA Medical Center, Washington, DC, USA
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, USA
| | - Matthew C. Keller
- Department of Psychology and Neuroscience, University of Colorado, Boulder
- Institute for Behavioral Genetics, University of Colorado, Boulder
| | - Enrique Castelao
- Department of Psychiatry, Lausanne University Hospital, Switzerland
| | - Zoltan Kutalik
- Department of Medical Genetics, University of Lausanne, Lausanne, Switzerland
- Institute of Social and Preventive Medicine, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
- Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | | | - Georg Homuth
- Interfaculty Institute for Genetics and Functional Genomics, University Medicine and Ernst Moritz Arndt-University Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Germany
| | - Alexander Teumer
- Institute for Community Medicine, University Medicine Greifswald, Germany
| | - Yuri Milaneschi
- Department of Psychiatry, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Jouke-Jan Hottenga
- Department of Psychiatry, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Nese Direk
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Andre Uitterlinden
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Cornelis L. Mulder
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Anjali K. Henders
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Sarah E. Medland
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Scott Gordon
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Andrew C. Heath
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Pamela A.F. Madden
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
| | - Michelle Pergadia
- Department of Psychiatry, Washington University School of Medicine, St Louis, USA
- Florida Atlantic University, Boca Raton, Florida, USA
| | - Peter J. van der Most
- Department of Genetic Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ilja M. Nolte
- Department of Genetic Epidemiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Floor V.A. van Oort
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center, Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Catharina A. Hartman
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Albertine J. Oldehinkel
- Department of Psychiatry, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Martin Preisig
- Department of Psychiatry, Lausanne University Hospital, Switzerland
| | - Hans Jörgen Grabe
- Department of Psychiatry and Psychotherapy, University Medicine Greifswald, Germany
- Department of Psychiatry and Psychotherapy, Helios Hospital Stralsund, Germany
| | - Christel M. Middeldorp
- Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, GGZ inGeest/VU University Medical Center, Amsterdam, The Netherlands
| | - Brenda WJH Penninx
- Department of Psychiatry, VU University Medical Center/GGZ inGeest, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | - Dorret Boomsma
- Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
- EMGO+ Institute for Health and Care Research, VU University Medical Centre, Amsterdam, The Netherlands
| | | | - Grant Montgomery
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
| | - Brion S. Maher
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Edwin J. van den Oord
- Department of Pharmacy, Center for Biomarker Research and Personalized Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Naomi R. Wray
- QIMR Berghofer Institute of Medical Research, Brisbane, Australia
- Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Henning Tiemeier
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Psychiatry, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - John M. Hettema
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
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Pinto R, Monzani B, Leckman JF, Rück C, Serlachius E, Lichtenstein P, Mataix-Cols D. Understanding the covariation of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms: A population-based adult twin study. Am J Med Genet B Neuropsychiatr Genet 2016; 171:938-47. [PMID: 26919823 DOI: 10.1002/ajmg.b.32436] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/09/2016] [Indexed: 11/11/2022]
Abstract
Chronic tic disorders (TD), attention-deficit/hyperactivity-disorder (ADHD), and obsessive-compulsive disorder (OCD) frequently co-occur in clinical and epidemiological samples. Family studies have found evidence of shared familial transmission between TD and OCD, whereas the familial association between these disorders and ADHD is less clear. This study aimed to investigate to what extent liability of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms is caused by shared or distinct genetic or environmental influences, in a large population-representative sample of Swedish adult twins (n = 21,911). Tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms showed modest, but significant covariation. Model fitting suggested a latent liability factor underlying the three phenotypes. This common factor was relatively heritable, and explained significantly less of the variance of attention-deficit/hyperactivity symptom liability. The majority of genetic variance was specific rather than shared. The greatest proportion of total variance in liability of tics, attention-deficit/hyperactivity, and obsessive-compulsive symptoms was attributed to specific non-shared environmental influences. Our findings suggest that the co-occurrence of tics and obsessive-compulsive symptoms, and to a lesser extent attention-deficit/hyperactivity symptoms, can be partly explained by shared etiological influences. However, these phenotypes do not appear to be alternative expressions of the same underlying genetic liability. Further research examining sub-dimensions of these phenotypes may serve to further clarify the association between these disorders and identify more genetically homogenous symptom subtypes. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Rebecca Pinto
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | - Benedetta Monzani
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, United Kingdom
| | | | - Christian Rück
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Eva Serlachius
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Sweden
| | - David Mataix-Cols
- Centre for Psychiatric Research and Education, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
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Schönenberg M, Mayer SV, Christian S, Louis K, Jusyte A. Facial Affect Recognition in Violent and Nonviolent Antisocial Behavior Subtypes. J Pers Disord 2016; 30:708-719. [PMID: 26168326 DOI: 10.1521/pedi_2015_29_217] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Prior studies provide evidence for impaired recognition of distress cues in individuals exhibiting antisocial behavior. However, it remains unclear whether this deficit is generally associated with antisociality or may be specific to violent behavior only. To examine whether there are meaningful differences between the two behavioral dimensions rule-breaking and aggression, violent and nonviolent incarcerated offenders as well as control participants were presented with an animated face recognition task in which a video sequence of a neutral face changed into an expression of one of the six basic emotions. The participants were instructed to press a button as soon as they were able to identify the emotional expression, allowing for an assessment of the perceived emotion onset. Both aggressive and nonaggressive offenders demonstrated a delayed perception of primarily fearful facial cues as compared to controls. These results suggest the importance of targeting impaired emotional processing in both types of antisocial behavior.
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Affiliation(s)
- Michael Schönenberg
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Germany
| | - Sarah Verena Mayer
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Germany
| | - Sandra Christian
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Germany
| | - Katharina Louis
- Department of Clinical Psychology and Psychotherapy, University of Tübingen, Germany
| | - Aiste Jusyte
- LEAD Graduate School, University of Tübingen, Germany
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Abstract
Obsessive-compulsive disorder (OCD) has been recognized as mainly characterized by compulsivity rather than anxiety and, therefore, was removed from the anxiety disorders chapter and given its own in both the American Psychiatric Association (APA) Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the Beta Draft Version of the 11th revision of the World Health Organization (WHO) International Classification of Diseases (ICD-11). This revised clustering is based on increasing evidence of common affected neurocircuits between disorders, differently from previous classification systems based on interrater agreement. In this article, we focus on the classification of obsessive-compulsive and related disorders (OCRDs), examining the differences in approach adopted by these 2 nosological systems, with particular attention to the proposed changes in the forthcoming ICD-11. At this stage, notable differences in the ICD classification are emerging from the previous revision, apparently converging toward a reformulation of OCRDs that is closer to the DSM-5.
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The cost and impact of compulsivity: A research perspective. Eur Neuropsychopharmacol 2016; 26:800-9. [PMID: 27235690 DOI: 10.1016/j.euroneuro.2016.02.006] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 12/13/2015] [Accepted: 02/05/2016] [Indexed: 11/20/2022]
Abstract
Compulsivity is the defining feature of various psychiatric disorders including Obsessive Compulsive Related Disorders (OCRDs), and other compulsive, impulsive, and addictive disorders. These disorders are disabling, chronic conditions with an early onset and high rates of comorbidity, misdiagnoses, and delay in treatment onset. Disorders of compulsivity are responsible for considerable socioeconomic burden to society. We review the costs and impacts of compulsivity. In order to facilitate earlier diagnosis and targeted treatments, we examine the overlapping mechanisms that underlie compulsivity. We reconceptualize psychiatric disorders based on core features of compulsivity, highlight challenges in harmonizing research in children and adults, describe newer research methodologies, and point to future directions that can impact the costs and impact of disorders of compulsivity.
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Chamberlain SR, Lochner C, Stein DJ, Goudriaan AE, van Holst RJ, Zohar J, Grant JE. Behavioural addiction-A rising tide? Eur Neuropsychopharmacol 2016; 26:841-55. [PMID: 26585600 DOI: 10.1016/j.euroneuro.2015.08.013] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2015] [Revised: 07/17/2015] [Accepted: 08/15/2015] [Indexed: 01/21/2023]
Abstract
The term 'addiction' was traditionally used in relation to centrally active substances, such as cocaine, alcohol, or nicotine. Addiction is not a unitary construct but rather incorporates a number of features, such as repetitive engagement in behaviours that are rewarding (at least initially), loss of control (spiralling engagement over time), persistence despite untoward functional consequences, and physical dependence (evidenced by withdrawal symptoms when intake of the substance diminishes). It has been suggested that certain psychiatric disorders characterized by maladaptive, repetitive behaviours share parallels with substance addiction and therefore represent 'behavioural addictions'. This perspective has influenced the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), which now has a category 'Substance Related and Addictive Disorders', including gambling disorder. Could other disorders characterised by repetitive behaviours, besides gambling disorder, also be considered 'addictions'? Potential examples include kleptomania, compulsive sexual behaviour, 'Internet addiction', trichotillomania (hair pulling disorder), and skin-picking disorder. This paper seeks to define what is meant by 'behavioural addiction', and critically considers the evidence for and against this conceptualisation in respect of the above conditions, from perspectives of aetiology, phenomenology, co-morbidity, neurobiology, and treatment. Research in this area has important implications for future diagnostic classification systems, neurobiological models, and novel treatment directions.
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Affiliation(s)
- Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, UK; Cambridge and Peterborough NHS Foundation Trust (CPFT), UK.
| | - Christine Lochner
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry, Stellenbosch University, South Africa
| | - Dan J Stein
- MRC Unit on Anxiety and Stress Disorders, Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Anna E Goudriaan
- Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands
| | - Ruth Janke van Holst
- Amsterdam Institute for Addiction Research, Academic Medical Center, University of Amsterdam, The Netherlands and Arkin Mental Health, Amsterdam, The Netherlands
| | - Joseph Zohar
- Division of Psychiatry, Chaim Sheba Medical Center, Ramat Gan, Israel
| | - Jon E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Pritzker School of Medicine, Chicago, IL, USA
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43
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Ortiz AE, Morer A, Moreno E, Plana MT, Cordovilla C, Lázaro L. Clinical significance of psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder: subtyping a complex disorder. Eur Arch Psychiatry Clin Neurosci 2016; 266:199-208. [PMID: 26374751 DOI: 10.1007/s00406-015-0642-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Accepted: 09/07/2015] [Indexed: 12/18/2022]
Abstract
A promising approach in relation to reducing phenotypic heterogeneity involves the identification of homogeneous subtypes of OCD based on age of onset, gender, clinical course and comorbidity. This study aims to assess the sociodemographic characteristics and clinical features of OCD patients in relation to gender and the presence or absence of another comorbid disorder. The sample comprised 112 children and adolescents of both sexes and aged 8-18 years, all of whom had a diagnosis of OCD. Overall, 67 % of OCD patients had one comorbid diagnosis, 20.5 % had two such diagnoses and 2.6 % had three comorbid diagnoses. The group of OCD patients with a comorbid neurodevelopmental disorder had significantly more family history of OCD in parents (p = .049), as compared with the no comorbidity group and the group with a comorbid internalizing disorder, and they also showed a greater predominance of males (p = .013) than did the group with a comorbid internalizing disorder. The group of OCD patients with internalizing comorbidity had a later age of onset of OCD (p = .001) compared with both the other groups. Although the initial severity was similar in all three groups, the need for pharmacological treatment and for hospitalization due to OCD symptomatology was greater in the groups with a comorbid neurodevelopmental disorder (p = .038 and p = .009, respectively) and a comorbid internalizing disorder (p = .008 and p = .004, respectively) than in the group without comorbidity. Our findings suggest that two subtypes of OCD can be defined on the basis of the comorbid pathology presented. The identification of different subtypes according to comorbidity is potentially useful in terms of understanding clinical variations, as well as in relation to treatment management and the use of therapeutic resources.
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Affiliation(s)
- A E Ortiz
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain.
| | - A Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain
| | - E Moreno
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain
| | - M T Plana
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain
| | - C Cordovilla
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain
| | - L Lázaro
- Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain.,Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain.,CIBERSAM, Madrid, Spain
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44
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López-Solà C, Fontenelle LF, Verhulst B, Neale MC, Menchón JM, Alonso P, Harrison BJ. DISTINCT ETIOLOGICAL INFLUENCES ON OBSESSIVE-COMPULSIVE SYMPTOM DIMENSIONS: A MULTIVARIATE TWIN STUDY. Depress Anxiety 2016; 33:179-91. [PMID: 26630089 PMCID: PMC4775288 DOI: 10.1002/da.22455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Revised: 10/15/2015] [Accepted: 11/01/2015] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is characterized by five major dimensions, including contamination/washing, harm/checking, symmetry/ordering, hoarding, and forbidden thoughts. How these dimensions may relate etiologically to the symptoms of other obsessive-compulsive related disorders (OCRDs) and anxiety disorders (ADs) is not well known. The aim of this study was to examine the genetic and environmental overlap between each major obsessive-compulsive dimension with the symptoms of other OCRDs and ADs. METHODS Two thousand four hundred ninety-five twins of both sexes, aged between 18 and 45 years, were recruited from the Australian Twin Registry. Measures used scores on four dimensions (obsessing (forbidden thoughts), washing, checking, and ordering) of the Obsessive-Compulsive Inventory-Revised, Dysmorphic Concerns Questionnaire, Hoarding Rating Scale, Anxiety Sensitivity Index, Social Phobia Inventory, and Stress subscale of the Depression, Anxiety, and Stress Scale. Multivariate twin modeling methods using continuous and categorized variables were performed, also controlling for age and gender. RESULTS Our findings suggested that forbidden thoughts and washing demonstrated the strongest genetic overlap with other AD symptoms, while ordering was genetically related to OCRD symptoms. Common genetic influences on checking symptoms were best estimated when modeling OCRDs together with AD symptoms. Common environmental factors of ordering and checking were shared with AD symptoms. CONCLUSIONS Important shared genetic and environmental risk factors exist between OCD, OCRDs, and ADs, but which vary alongside the expression of its major dimensions.
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Affiliation(s)
- Clara López-Solà
- Department of Psychiatry, Bellvitge Biomedical Research Institute—IDIBELL, Bellvitge University Hospital, CIBERSAM (G17), Barcelona, Spain,Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Leonardo F. Fontenelle
- Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil,lnstituto D’Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil,Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, RJ, Brazil
| | - Brad Verhulst
- Virginia Institute for Psychiatric and Behavioral Genetics (VIPBG), Virginia Commonwealth University, Richmond, Virginia
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics (VIPBG), Virginia Commonwealth University, Richmond, Virginia
| | - José M. Menchón
- Department of Psychiatry, Bellvitge Biomedical Research Institute—IDIBELL, Bellvitge University Hospital, CIBERSAM (G17), Barcelona, Spain,Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Pino Alonso
- Department of Psychiatry, Bellvitge Biomedical Research Institute—IDIBELL, Bellvitge University Hospital, CIBERSAM (G17), Barcelona, Spain,Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Barcelona, Spain
| | - Ben J. Harrison
- Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Melbourne, Australia,Correspondence: Ben J. Harrison, Melbourne Neuropsychiatry Centre, The University of Melbourne, Level 3, 161 Barry Street, Carlton, 3053 Melbourne, Australia.
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45
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Stein DJ, Kogan CS, Atmaca M, Fineberg NA, Fontenelle LF, Grant JE, Matsunaga H, Reddy YCJ, Simpson HB, Thomsen PH, van den Heuvel OA, Veale D, Woods DW, Reed GM. The classification of Obsessive-Compulsive and Related Disorders in the ICD-11. J Affect Disord 2016; 190:663-674. [PMID: 26590514 DOI: 10.1016/j.jad.2015.10.061] [Citation(s) in RCA: 116] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 09/24/2015] [Accepted: 10/23/2015] [Indexed: 02/03/2023]
Abstract
BACKGROUND To present the rationale for the new Obsessive-Compulsive and Related Disorders (OCRD) grouping in the Mental and Behavioural Disorders chapter of the Eleventh Revision of the World Health Organization's International Classification of Diseases and Related Health Problems (ICD-11), including the conceptualization and essential features of disorders in this grouping. METHODS Review of the recommendations of the ICD-11 Working Group on the Classification for OCRD. These sought to maximize clinical utility, global applicability, and scientific validity. RESULTS The rationale for the grouping is based on common clinical features of included disorders including repetitive unwanted thoughts and associated behaviours, and is supported by emerging evidence from imaging, neurochemical, and genetic studies. The proposed grouping includes obsessive-compulsive disorder, body dysmorphic disorder, hypochondriasis, olfactory reference disorder, and hoarding disorder. Body-focused repetitive behaviour disorders, including trichotillomania and excoriation disorder are also included. Tourette disorder, a neurological disorder in ICD-11, and personality disorder with anankastic features, a personality disorder in ICD-11, are recommended for cross-referencing. LIMITATIONS Alternative nosological conceptualizations have been described in the literature and have some merit and empirical basis. Further work is needed to determine whether the proposed ICD-11 OCRD grouping and diagnostic guidelines are mostly likely to achieve the goals of maximizing clinical utility and global applicability. CONCLUSION It is anticipated that creation of an OCRD grouping will contribute to accurate identification and appropriate treatment of affected patients as well as research efforts aimed at improving our understanding of the prevalence, assessment, and management of its constituent disorders.
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Affiliation(s)
- D J Stein
- Department of Psychiatry and MRC Unit on Anxiety and Stress Disorders, University of Cape Town, Groote Schuur Hospital, Cape Town, South Africa.
| | - C S Kogan
- School of Psychology, University of Ottawa, Ottawa, Canada
| | - M Atmaca
- Department of Psychiatry, School of Medicine, Firat (Euphrates) University, Elazig, Turkey
| | - N A Fineberg
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House, Welwyn Garden City, UK; Postgraduate Medical School, University of Hertfordshire, Hatfield, UK; University of Cambridge, School of Clinical Medicine, Cambridge, UK
| | - L F Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil; "D'Or' Institute for Research and Education, Rio de Janeiro, RJ, Brazil; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - J E Grant
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA
| | - H Matsunaga
- Department of Neuropsychiatry, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya Hyogo, Japan
| | - Y C J Reddy
- National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India
| | - H B Simpson
- College of Physicians and Surgeons, Columbia University Medical College, New York, NY, USA; Anxiety Disorders Clinic and the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York, NY, USA
| | - P H Thomsen
- Centre for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - O A van den Heuvel
- Department of Psychiatry, VU University Medical Center (VUmc), Amsterdam, The Netherlands; Department of Anatomy & Neurosciences, VUmc, Amsterdam, The Netherlands
| | - D Veale
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Center for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
| | - D W Woods
- Psychology Department, Texas A&M University, College Station, TX, USA
| | - G M Reed
- Department of Psychology, National Autonomous University of Mexico (UNAM), Mexico, DF, Mexico; National Institute of Psychiatry "Ramón de la Fuente Muñiz", Mexico, DF, Mexico; Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
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46
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López-Solà C, Fontenelle LF, Bui M, Hopper JL, Pantelis C, Yücel M, Menchón JM, Alonso P, Harrison BJ. Aetiological overlap between obsessive-compulsive related and anxiety disorder symptoms: multivariate twin study. Br J Psychiatry 2016; 208:26-33. [PMID: 26494870 DOI: 10.1192/bjp.bp.114.156281] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/27/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND The aetiological boundary between obsessive-compulsive related disorders (OCRDs) including obsessive-compulsive disorder (OCD) and anxiety disorders is unclear and continues to generate debate. AIMS To determine the genetic overlap and the pattern of causal relationships among OCRDs and anxiety disorders. METHOD Multivariate twin modelling methods and a new regression analysis to infer causation were used, involving 2495 male and female twins. RESULTS The amount of common genetic liability observed for OCD symptoms was higher when considering anxiety disorders and OCRDs in the model v. modelling OCRD symptoms alone. OCD symptoms emerged as risk factors for the presence of generalised anxiety, panic and hoarding symptoms, whereas social phobia appeared as a risk factor for OCD symptoms. CONCLUSIONS OCD represents a complex phenotype that includes important shared features with anxiety disorders and OCRDs. The novel patterns of risk identified between OCD and anxiety disorder may help to explain their frequent co-occurrence.
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Affiliation(s)
- Clara López-Solà
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Leonardo F Fontenelle
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Minh Bui
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - John L Hopper
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Christos Pantelis
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Murat Yücel
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - José M Menchón
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Pino Alonso
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
| | - Ben J Harrison
- Clara López-Solà, MSc, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Leonardo F. Fontenelle, MD, PhD, Programa de Transtornos Obsessivo-Compulsivos e de Ansiedade, Instituto de Psiquiatria, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro and Instituto de Saúde da Comunidade, Universidade Federal Fluminense (UFF), Rio de Janeiro, Brazil; Minh Bui, PhD, John L. Hopper, PhD, Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, The University of Melbourne, Australia; Christos Pantelis, MD, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia; Murat Yücel, PhD, Monash Clinical and Imaging Neuroscience Laboratory, School of Psychology and Psychiatry, Monash University, Australia; José M. Menchón, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Pino Alonso, MD, PhD, Bellvitge Biomedical Research Institute-IDIBELL, Department of Psychiatry, Bellvitge University Hospital, CIBERSAM (G17), Barcelona and Department of Clinical Sciences, Bellvitge Campus, University of Barcelona, Spain; Ben J. Harrison, PhD, Melbourne Neuropsychiatry Centre, Department of Psychiatry, The University of Melbourne, Australia
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Khumalo NP, Shaboodien G, Hemmings SM, Moolman-Smook JC, Stein DJ. Pathologic grooming (acne excoriee, trichotillomania, and nail biting) in 4 generations of a single family. JAAD Case Rep 2016; 2:51-3. [PMID: 27051827 PMCID: PMC4809443 DOI: 10.1016/j.jdcr.2015.11.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Affiliation(s)
- Nonhlanhla P. Khumalo
- Division of Dermatology, Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, Cape Town, Tygerberg, South Africa
| | - Gasnat Shaboodien
- Division of Cardiovascular Genetics Laboratory, Hatter Institute for Cardiovascular Research in Africa, Department of Medicine, University of Cape Town, Cape Town, Tygerberg, South Africa
| | - Sian M.J. Hemmings
- MRC Unit on Anxiety and Stress Disorders, University of Stellenbosch, Tygerberg Hospital, South Africa
| | - Johanna C. Moolman-Smook
- MRC Unit on Anxiety and Stress Disorders, University of Stellenbosch, Tygerberg Hospital, South Africa
| | - Dan J. Stein
- Division of Psychiatry, Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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Wood J, Ahmari SE. A Framework for Understanding the Emerging Role of Corticolimbic-Ventral Striatal Networks in OCD-Associated Repetitive Behaviors. Front Syst Neurosci 2015; 9:171. [PMID: 26733823 PMCID: PMC4681810 DOI: 10.3389/fnsys.2015.00171] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2015] [Accepted: 11/23/2015] [Indexed: 11/13/2022] Open
Abstract
Significant interest in the mechanistic underpinnings of obsessive-compulsive disorder (OCD) has fueled research on the neural origins of compulsive behaviors. Converging clinical and preclinical evidence suggests that abnormal repetitive behaviors are driven by dysfunction in cortico-striatal-thalamic-cortical (CSTC) circuits. These findings suggest that compulsive behaviors arise, in part, from aberrant communication between lateral orbitofrontal cortex (OFC) and dorsal striatum. An important body of work focused on the role of this network in OCD has been instrumental to progress in the field. Disease models focused primarily on these regions, however, fail to capture an important aspect of the disorder: affective dysregulation. High levels of anxiety are extremely prevalent in OCD, as is comorbidity with major depressive disorder. Furthermore, deficits in processing rewards and abnormalities in processing emotional stimuli are suggestive of aberrant encoding of affective information. Accordingly, OCD can be partially characterized as a disease in which behavioral selection is corrupted by exaggerated or dysregulated emotional states. This suggests that the networks producing OCD symptoms likely expand beyond traditional lateral OFC and dorsal striatum circuit models, and highlights the need to cast a wider net in our investigation of the circuits involved in generating and sustaining OCD symptoms. Here, we address the emerging role of medial OFC, amygdala, and ventral tegmental area projections to the ventral striatum (VS) in OCD pathophysiology. The VS receives strong innervation from these affect and reward processing regions, and is therefore poised to integrate information crucial to the generation of compulsive behaviors. Though it complements functions of dorsal striatum and lateral OFC, this corticolimbic-VS network is less commonly explored as a potential source of the pathology underlying OCD. In this review, we discuss this network's potential role as a locus of OCD pathology and effective treatment.
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Affiliation(s)
- Jesse Wood
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
| | - Susanne E. Ahmari
- Translational Neuroscience Program, Department of Psychiatry, University of PittsburghPittsburgh, PA, USA
- Center for Neuroscience, University of PittsburghPittsburgh, PA, USA
- Center for the Neural Basis of Cognition, University of PittsburghPittsburgh, PA, USA
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Grados M, Prazak M, Saif A, Halls A. A review of animal models of obsessive-compulsive disorder: a focus on developmental, immune, endocrine and behavioral models. Expert Opin Drug Discov 2015; 11:27-43. [PMID: 26558411 DOI: 10.1517/17460441.2016.1103225] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by intrusive thoughts (obsessions) and/or repetitive behaviors (compulsions). Several models of OCD exist, many which employ behaviors such as over-grooming or hoarding as correlates for compulsive behaviors - often using a response to serotonergic agents as evidence for their validity. Recent discoveries in the genetics of OCD and the identification of aberrancies of glutamatergic, hormonal, and immune pathways in the OCD phenotype highlight a need to review existing of animal models of OCD. The focus of attention to these pathways may lead to possible new targets for drug discovery. AREAS COVERED In this review, the authors describe frameworks for animal models in OCD conceptualized as either biological (e.g., developmental, genetic, and endocrine pathways), or behavioral (e.g., repetitive grooming, and stereotypies). In addition, the authors give special attention to the emerging role of glutamate in OCD. EXPERT OPINION While many animal models for OCD demonstrate pathologic repetitive behavior phenotypes, which are relieved by serotoninergic agents, animal models based on reversal learning, perseverative responding, and neurodevelopmental mechanisms represent robust new paradigms. Glutamatergic influences in these new animal models suggest that drug discovery using neuroprotective approaches may represent a new stage for pharmacologic developments in OCD.
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Affiliation(s)
- Marco Grados
- a Department of Psychiatry , Johns Hopkins University , 1800 Orleans St. - 12th floor, Baltimore , MD 21287 , USA
| | - Michael Prazak
- b Department of Medicine , Dow University of Health Sciences , Karachi , Pakistan
| | - Aneeqa Saif
- c Department of Psychology Grand Forks , University of North Dakota , ND , USA
| | - Andrew Halls
- a Department of Psychiatry , Johns Hopkins University , 1800 Orleans St. - 12th floor, Baltimore , MD 21287 , USA
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Ahmari SE. Using mice to model Obsessive Compulsive Disorder: From genes to circuits. Neuroscience 2015; 321:121-137. [PMID: 26562431 DOI: 10.1016/j.neuroscience.2015.11.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/27/2015] [Accepted: 11/04/2015] [Indexed: 01/10/2023]
Abstract
Obsessive Compulsive Disorder (OCD) is a severe, chronic, and highly prevalent psychiatric disorder that affects between 1.5% and 3% of people worldwide. Despite its severity, high prevalence, and clear societal cost, current OCD therapies are only partially effective. In order to ultimately develop improved treatments for this severe mental illness, we need further research to gain an improved understanding of the pathophysiology that underlies obsessions and compulsions. Though studies in OCD patients can provide some insight into the disease process, studies in humans are inherently limited in their ability to dissect pathologic processes because of their non-invasive nature. The recent development of strategies for genetic and circuit-specific manipulation in rodent models finally allows us to identify the molecular, cellular, and circuit events that lead to abnormal repetitive behaviors and affect dysregulation relevant to OCD. This review will highlight recent studies in mouse model systems that have used transgenic and optogenetic tools in combination with classic pharmacology and behavioral techniques to advance our understanding of these pathologic processes.
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Affiliation(s)
- Susanne E Ahmari
- Department of Psychiatry, Translational Neuroscience Program, University of Pittsburgh, Pittsburgh, PA, United States; Center for Neuroscience Program and Center for the Neural Basis of Cognition, University of Pittsburgh, Pittsburgh, PA, United States.
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