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Hühne V, Dos Santos-Ribeiro S, Moreira-de-Oliveira ME, de Menezes GB, Fontenelle LF. Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis. CNS Spectr 2024:1-9. [PMID: 38685590 DOI: 10.1017/s1092852924000269] [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: 05/02/2024]
Abstract
Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database's inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.
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Affiliation(s)
- Verônica Hühne
- Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Samara Dos Santos-Ribeiro
- Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Maria E Moreira-de-Oliveira
- Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Gabriela B de Menezes
- Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
| | - Leonardo F Fontenelle
- Anxiety, Obsessions and Compulsions Program, Institute of Psychiatry of the Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
- D'Or Institute for Research and Education (IDOR), Rio de Janeiro, Brazil
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2
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Ferrão JVB, do Rosário MC, Fontenelle LF, Ferrão YA. Prevalence and psychopathology features of mental rituals in patients with obsessive-compulsive disorder: A descriptive exploratory study of 1001 patients. Clin Psychol Psychother 2023; 30:1520-1533. [PMID: 37554049 DOI: 10.1002/cpp.2890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 07/04/2023] [Accepted: 07/17/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Mental rituals (MR) are compulsions with no overt behavioural or motoric signs. It is presently unclear whether MR found in obsessive-compulsive disorder are associated with a distinctive clinical profile. OBJECTIVES The main objectives of this paper were to assess the prevalence and psychopathological correlates of mental rituals in a large sample of OCD patients. METHODS This exploratory case-control study compared 519 patients with versus 447 without MR in terms of sociodemographics, presence and severity of obsessive-compulsive symptoms, psychiatric comorbidities, sensory phenomena, suicidality, and insight. RESULTS Current MR were found in 51.8%, while lifetime MR were found in 55.4% of the sample. The multiple logistic regression model determined that the most relevant clinical factors independently associated with current MR in OCD patients were the absence of any sensory phenomena and the presence of lifetime suicide ideation. CONCLUSION Due to its relation to OCD clinical aspects, MR are a frequent feature among OCD patients. It also seems to be associated with a range of features that are probably relevant for treatment, especially sensory phenomena and suicidality.
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Affiliation(s)
- João Vítor Bueno Ferrão
- Medical School, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Maria Conceição do Rosário
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Unidade de Psiquiatria da Infância e Adolescência (UPIA), Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Leonardo F Fontenelle
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da Universidade Federal do Rio de Janeiro (UFRJ) e da Faculdade de Medicina da Universidade Federal Fluminense (UFF), Instituto DOr de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil
| | - Ygor Arzeno Ferrão
- Brazilian Consortium for Research on Obsessive-Compulsive Spectrum Disorders (C-TOC), Clinical Neurosciences, Medical School, Programa de Pós- Graduação em Ciências da Saúde, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre, Brazil
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3
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Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, Lu C, Garg K, Thomas TL, Au ACL, Selles RR, Højgaard DRMA, Skarphedinsson G, Stewart SE. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:703701. [PMID: 34858219 PMCID: PMC8631971 DOI: 10.3389/fpsyt.2021.703701] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs. Systematic Review Registration: Unique Identifier: CRD42020215904.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lavanya P. Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Srinivas Balachander
- Obsessive-Compulsive Disorders (OCD) Clinic, Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Boyee Lin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Harshini Manohar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Puneet Khanna
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Cynthia Lu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kabir Garg
- Oxleas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Tony Lazar Thomas
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anthony Chun Lam Au
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Robert R. Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Davíð R. M. A. Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Skejby, Denmark
| | | | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Chauhan A, Praharaj SK, Munoli RN, Udupa ST, Vaidyanathan S. Late-onset obsessive-compulsive disorder with memory obsessions: a case report. Psychogeriatrics 2021; 21:939-942. [PMID: 34418238 DOI: 10.1111/psyg.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/05/2021] [Accepted: 08/09/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Anisha Chauhan
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Samir Kumar Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Ravindra N Munoli
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Suma T Udupa
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Sivapriya Vaidyanathan
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
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Sharma E, Jacob P, Dharmendra A, Reddy YCJ, Seshadri SP, Girimaji SC, Vijaysagar KJ. Preschool-onset OCD: A review of literature and clinical experience. Bull Menninger Clin 2021; 85:298-315. [PMID: 34468213 DOI: 10.1521/bumc.2021.85.3.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2-3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those treated adequately.
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Affiliation(s)
- Eesha Sharma
- Assistant professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Preeti Jacob
- Associate professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Apoorva Dharmendra
- PhD Scholar in Clinical Neurosciences in the Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Y C Janardhan Reddy
- Professor in the Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Shekhar P Seshadri
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sathish C Girimaji
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - K John Vijaysagar
- Professor and head in the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Vellozo AP, Fontenelle LF, Torresan RC, Shavitt RG, Ferrão YA, Rosário MC, Miguel EC, Torres AR. Symmetry Dimension in Obsessive-Compulsive Disorder: Prevalence, Severity and Clinical Correlates. J Clin Med 2021; 10:jcm10020274. [PMID: 33451078 PMCID: PMC7828517 DOI: 10.3390/jcm10020274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/11/2021] [Accepted: 01/11/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Obsessive–compulsive disorder (OCD) is a very heterogeneous condition that frequently includes symptoms of the “symmetry dimension” (i.e., obsessions and/or compulsions of symmetry, ordering, repetition, and counting), along with aggressive, sexual/religious, contamination/cleaning, and hoarding dimensions. Methods: This cross-sectional study aimed to investigate the prevalence, severity, and demographic and clinical correlates of the symmetry dimension among 1001 outpatients from the Brazilian Research Consortium on Obsessive–Compulsive Spectrum Disorders. The main assessment instruments used were the Dimensional Yale–Brown Obsessive–Compulsive Scale, the Yale–Brown Obsessive–Compulsive Scale, the USP-Sensory Phenomena Scale, the Beck Depression and Anxiety Inventories, the Brown Assessment of Beliefs Scale, and the Structured Clinical Interview for DSM-IV Axis I Disorders. Chi-square tests, Fisher’s exact tests, Student’s t-tests, and Mann–Whitney tests were used in the bivariate analyses to compare patients with and without symptoms of the symmetry dimension. Odds ratios (ORs) with confidence intervals and Cohen’s D were also calculated as effect size measures. Finally, a logistic regression was performed to control for confounders. Results: The symmetry dimension was highly prevalent (86.8%) in this large clinical sample and, in the logistic regression, it remained associated with earlier onset of obsessive–compulsive symptoms, insidious onset of compulsions, more severe depressive symptoms, and presence of sensory phenomena. Conclusions: A deeper knowledge about specific OCD dimensions is essential for a better understanding and management of this complex and multifaceted disorder.
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Affiliation(s)
- Aline P. Vellozo
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Leonardo F. Fontenelle
- Turner Institute for Brain and Mental Health, Monash University, Clayton, VIC 3168, Australia
- D’Or Institute for Research and Education & Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro 22290-140, Brazil
- Correspondence: ; Tel.: +61-3-990-29755
| | - Ricardo C. Torresan
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
| | - Roseli G. Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Ygor A. Ferrão
- Department of Psychiatry, Federal University of Health Sciences of Porto Alegre, Porto Alegre 90570-080, Brazil;
| | - Maria C. Rosário
- Department of Psychiatry, Universidade Federal de São Paulo, São Paulo 04038-000, Brazil;
| | - Euripedes C. Miguel
- Obsessive-Compulsive Spectrum Disorders Program, Department and Institute of Psychiatry, University of São Paulo, São Paulo 05403-010, Brazil; (R.G.S.); (E.C.M.)
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Universidade Estadual Paulista—UNESP, Botucatu 18618-687, Brazil; (A.P.V.); (R.C.T.); (A.R.T.)
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Frileux S, Millet B, Fossati P. Late-Onset OCD as a Potential Harbinger of Dementia With Lewy Bodies: A Report of Two Cases. Front Psychiatry 2020; 11:554. [PMID: 32714212 PMCID: PMC7344181 DOI: 10.3389/fpsyt.2020.00554] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 05/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Obsessive-compulsive disorder usually begins in adolescence or young adulthood. OCD cases appearing after the age of 50 years are rare, most often associated with inflammatory, brain lesions, or neurodegenerative comorbidities. We describe two cases of late-onset obsessive compulsive disorder followed by the development of Dementia with Lewy Bodies and review the links between these two disorders. METHODS AND RESULTS We describe the clinical history of two patients that first showed OCD symptoms at an atypical age (>60 years). After several failed treatment attempts, they were hospitalized in our unit. Both presented severe sensitivity to antipsychotic agents that led to a diagnosis of Dementia with Lewy Bodies. Administration of cholinesterase inhibitors was associated with decrease of psychiatric symptoms in both cases. In addition to those clinical observations, a systematic review of the literature suggests that, beyond prefrontal cortex, temporal lobe and putamen have important roles in OCD pathophysiology. Based on these findings, we discuss four hypotheses to explain the sequential appearance of OCD and DLB symptoms. First, we considered the possibility that comorbidity of OCD with DLB was coincidental. Second, we propose to interpret OCD symptoms as motor stereotypies. Third, we hypothesize that late-onset OCD might be a symptom of late-onset depression. Four, we hypothesize that through early deterioration of basal ganglia, DLB caused the onset of OCD. CONCLUSION In conclusion, we recommend that cases of late-onset treatment-resistant OCD should be carefully tested for possible organic etiologies, and for DLB in particular.
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Affiliation(s)
- Solène Frileux
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
| | - Bruno Millet
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
| | - Philippe Fossati
- Control-Interoception-Attention Team, Brain Institute of Paris, Paris, France.,Faculty of Medicine, University of Sorbonne Universités UPMC, Paris, France.,Department of Psychiatry, University Hospital La Pitié Salpêtrière, Paris, France
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Sharma E, Tripathi A, Grover S, Avasthi A, Dan A, Srivastava C, Goyal N, Manohari SM, Reddy J. Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India. Indian J Psychiatry 2019; 61:564-571. [PMID: 31896861 PMCID: PMC6862976 DOI: 10.4103/psychiatry.indianjpsychiatry_128_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents. AIMS To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD. SETTING AND DESIGN This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India. MATERIALS AND METHODS Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children's Depression Rating Scale, and Family Interview for Genetic Studies. RESULTS The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years. Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms. CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness. Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample. CONCLUSIONS This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.
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Affiliation(s)
- Eesha Sharma
- Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences Hospital, Bengaluru, Karnataka, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Chhitij Srivastava
- Department of Psychiatry, Motilal Nehru Medical College, Allahabad and Institute of Psychiatry, King's College London, London, UK.,Centre of Behavioral and Cognitive Sciences, University of Allahabad, Allahabad, Uttar Pradesh, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkahnd, India
| | - S M Manohari
- Department of Psychiatry, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences Hospital, Bengaluru, Karnataka, India
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Abstract
Obsessive-compulsive disorder (OCD) is generally believed to follow a chronic waxing and waning course. The onset of illness has a bimodal peak - in early adolescence and in early adulthood. Consultation and initiation of treatment are often delayed for several years. Studies over the past 2-3 decades have found that the long-term outcomes in OCD are not necessarily bleak and that at least half the treatment-seeking patients with OCD show symptomatic remission over long term. A short duration illness, of low severity that is treated early and intensively, with continued maintenance treatment over long term possibly has a good outcome. Recent studies have also identified neuroimaging and neuropsychological correlates of good outcome, but these need further replication. This paper presents an overview of conceptual issues and studies on long-term outcome of OCD and predictors of outcome.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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10
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Tripathi A, Avasthi A, Grover S, Sharma E, Lakdawala BM, Thirunavukarasu M, Dan A, Sinha V, Sareen H, Mishra KK, Rastogi P, Srivastava S, Dhingra I, Behere PB, Solanki RK, Sinha VK, Desai M, Reddy YCJ. Gender differences in obsessive-compulsive disorder: Findings from a multicentric study from India. Asian J Psychiatr 2018; 37:3-9. [PMID: 30086467 DOI: 10.1016/j.ajp.2018.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 07/31/2018] [Indexed: 11/28/2022]
Abstract
Obsessive-compulsive disorder (OCD) is phenotypically heterogeneous. Gender is an important factor mediating this heterogeneity. We examined gender differences in a large sample (n = 945) of OCD patients under a multi-centric study in India. Cross-sectional assessments were done on consecutive adult (>18 years) treatment-seeking patients with a DSM-5 diagnosis of OCD. Subjects were assessed on Structured Clinical Interview for DSM-5-Research Version for comorbid psychiatric illnesses, Yale Brown Obsessive Compulsive Scale for OCD phenomenology and symptom severity, Brown Assessment of Beliefs Scale for insight, Beck's Depression Inventory for severity of depressive symptoms, and the Obsessive Beliefs Questionnaire. On multivariate backward Wald logistic regression analysis, males (59.7%) had more years of education, had a higher rate of checking compulsions and comorbid substance use disorders. Women were more likely to be married, more commonly reported precipitating factors, had a higher rate of hoarding compulsions and comorbid agoraphobia. Findings from this large study validate gender as an important mediator of phenotypic heterogeneity in OCD. The mechanistic basis for these differences might involve complex interactions between biological, cultural and environmental factors.
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Affiliation(s)
| | - Ajit Avasthi
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Sandeep Grover
- Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Eesha Sharma
- National Institute of Mental Health and Neurosciences, Bangalore, India.
| | | | - M Thirunavukarasu
- SRM Medical College Hospital & Research Center, Kattankulathur, Kanchipuram District, 603203, India
| | | | | | | | | | - Pali Rastogi
- MGM Medical College & MYH Hospital, Indore, India
| | - Shruti Srivastava
- University College of Medical Sciences and GTBH, Dilshad Garden, Delhi, India
| | | | - Prakash B Behere
- Dr D.Y. Patil University Kasba Bawda, Kolhapur 416006, Maharashtra, India
| | | | - Vinod K Sinha
- Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Mahesh Desai
- Karnataka Institute of Medical Sciences (KIMS), Hubli, Karnataka India
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11
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Dell'Osso B, Benatti B, Hollander E, Fineberg N, Stein DJ, Lochner C, Nicolini H, Lanzagorta N, Palazzo C, Altamura AC, Marazziti D, Pallanti S, Van Ameringen M, Karamustafalioglu O, Drummond LM, Hranov L, Figee M, Grant JE, Zohar J, Denys D, Menchon JM. Childhood, adolescent and adult age at onset and related clinical correlates in obsessive-compulsive disorder: a report from the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS). Int J Psychiatry Clin Pract 2016; 20:210-7. [PMID: 27433835 DOI: 10.1080/13651501.2016.1207087] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Many studies suggest that age at onset (AAO) is an important factor for clinically differentiating patients with juvenile and adult onset of obsessive-compulsive disorder (OCD). The present international study aimed to assess the prevalence of different AAO groups and compare related socio-demographic and clinical features in a large sample of OCD patients. METHODS A total of 431 OCD outpatients, participating in the ICOCS network, were first categorised in groups with childhood (≤12 years), adolescent (13-17 years) and adult-onset (≥18 years), then in pre-adult and adult onset (≥18 years) and their socio-demographic and clinical features compared. RESULTS Twenty-one percent (n = 92) of the sample reported childhood onset, 36% (n = 155) adolescent onset, and 43% (n = 184) adult onset. Patients with adult onset showed a significantly higher proportion of females compared with the other subgroups (χ(2 )=( )10.9, p< 0.05). Childhood- and adolescent-onset patients had been more frequently treated with cognitive behavioural therapy (CBT), compared to adult-onset patients (χ(2 )=( )11.5; p < 0.05). The pre-adult- versus adult-onset analysis did not show any additional significant difference. CONCLUSIONS The present international multicentre study confirms that OCD onset occurs more frequently before adult age, with approximately one out of five patients showing childhood onset. Pre-adult onset was associated with higher rate of CBT, while adult onset was more prevalent in females.
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Affiliation(s)
- Bernardo Dell'Osso
- a Department of Neuroscience and Mental Health , University of Milan, Fondazione IRCCS Ca'Granda , Ospedale Maggiore Policlinico , Milano , Italy ;,b Bipolar Disorders Clinic; Stanford University , Stanford, CA , USA
| | - Beatrice Benatti
- a Department of Neuroscience and Mental Health , University of Milan, Fondazione IRCCS Ca'Granda , Ospedale Maggiore Policlinico , Milano , Italy
| | - Eric Hollander
- c Department of Psychiatry and Behavioral Sciences , Albert Einstein College of Medicine and Montefiore Medical Center , New York , USA
| | - Naomi Fineberg
- d Mental Health Unit , Hertfordshire Partnership Foundation Trust, Queen Elizabeth II Hospital , Welwyn Garden City , UK
| | - Dan J Stein
- e Department of Psychiatry and Mental Health, MRC Unit on Anxiety and Stress Disorders , University of Cape Town , Cape Town , South Africa
| | - Christine Lochner
- f Department of Psychiatry, MRC Unit on Anxiety and Stress Disorders , University of Stellenbosch , Stellenbosch , South Africa
| | | | | | - Carlotta Palazzo
- a Department of Neuroscience and Mental Health , University of Milan, Fondazione IRCCS Ca'Granda , Ospedale Maggiore Policlinico , Milano , Italy
| | - A Carlo Altamura
- a Department of Neuroscience and Mental Health , University of Milan, Fondazione IRCCS Ca'Granda , Ospedale Maggiore Policlinico , Milano , Italy
| | - Donatella Marazziti
- h Dipartimento Di Psichiatria, Neurobiologia, Farmacologia E Biotechnologie , Università Di Pisa , Italy
| | - Stefano Pallanti
- i Department of Psychiatry , University of Florence, and Institute of Neurosciences , Florence , Italy
| | - Michael Van Ameringen
- j Department of Psychiatry and Behavioural Neurosciences , McMaster University, MacAnxiety Research Center Hamilton , Canada
| | - Oguz Karamustafalioglu
- k Department of Psychiatry , Sisli Eftal Teaching and Research Hospital , Istanbul , Turkey
| | - Lynne M Drummond
- l National and Trustwide Services for OCD/BDD, SW London and St George's NHS Trust , London
| | - Luchezar Hranov
- m University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry Sveti Naum , Sofia , Bulgaria
| | - Martijn Figee
- n Department of Psychiatry , Academic Medical Center , Amsterdam , the Netherlands
| | - Jon E Grant
- o Department of Psychiatry and Behavioral Neuroscience , University of Chicago, Pritzker School of Medicine , Chicago , IL , USA
| | - Joseph Zohar
- p National Post-Trauma Center , Research Foudation by the Sheba Medical Center , Israel
| | - Damiaan Denys
- q Department of Psychiatry , Academic Medical Center, University of Amsterdam , Amsterdam , The Netherlands
| | - Jose M Menchon
- r Department of Psychiatry , Hospital Universitari De Bellvitge-IDIBELL, University of Barcelona, Cibersam , Barcelona , Spain
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