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Smárason O, Selles RR, Højgaard DRMA, Best JR, Melin K, Ivarsson T, Thomsen PH, Weidle B, McBride NM, Storch EA, Geller D, Wilhelm S, Farrell LJ, Waters AM, Mathieu S, Soreni N, Stewart SE, Skarphedinsson G. Exploring latent clusters in pediatric OCD based on symptoms, severity, age, gender, and comorbidity. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02431-9. [PMID: 38634862 DOI: 10.1007/s00787-024-02431-9] [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: 09/06/2022] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture modeling was used to examine latent clusters based on their age- and gender adjusted symptom severity (as measured by the Children's Yale-Brown Obsessive-Compulsive Scale; CY-BOCS), symptom type (as measured by factor scores calculated from the CY-BOCS symptom checklist), and comorbid diagnoses (as assessed via diagnostic interviews). Fit statistics favored a four-cluster model with groups distinguished primarily by symptom expression and comorbidity type. Fit indices for 3-7 cluster models were only marginally different and characteristics of the clusters remained largely stable between solutions with small clusters of distinct presentations added in more complex models. Rather than identifying a single classification system, the findings support the utility of integrating dimensional, developmental, and transdiagnostic information in the conceptualization of OCD-affected children and adolescents. Identified clusters point to the centrality of contamination concerns to OCD, relationships between broader symptom expression and higher levels of comorbidity, and the potential for complex/neurodevelopmental presentations.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.
- Department of Child and Adolescent Psychiatry, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Robert R Selles
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - John R Best
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Bernhard Weidle
- Regional Center for Child Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
| | - Nicole Michelle McBride
- Embedded Preventive Behavioral Health Capability, III MEF, United States Marine Corps, Okinawa, Japan
| | | | - Daniel Geller
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Sabine Wilhelm
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Noam Soreni
- St. Joseph's Hospital, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - S Evelyn Stewart
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Burnaby, BC, Canada
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Weiss F, Schwarz K, Endrass T. Exploring the relationship between context and obsessions in individuals with obsessive-compulsive disorder symptoms: a narrative review. Front Psychiatry 2024; 15:1353962. [PMID: 38419899 PMCID: PMC10899460 DOI: 10.3389/fpsyt.2024.1353962] [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] [Received: 12/11/2023] [Accepted: 01/31/2024] [Indexed: 03/02/2024] Open
Abstract
Obsessions in obsessive-compulsive disorder (OCD) have long been proposed to differ from intrusive thoughts in unaffected individuals based on appraisal of the thoughts. However, more recent research indicates that cognitive processes behind obsessions may differ significantly from those in healthy individuals concerning their contextual relationship. This narrative literature review summarizes current evidence for the role of context-relatedness for obsessions in OCD and intrusive thoughts in affected and unaffected individuals. The review encompasses a total of five studies, two of which include individuals diagnosed with OCD (one study also includes a group of unaffected control individuals), while the other three studies investigate the relationship between OCD symptoms and context in unaffected individuals. As assessed by mainly self-reports, the review examines the connection between thoughts and their context, shedding light on how the repetition and automaticity of thoughts, as well as their detachment from context over time contribute to defining obsessions in contrast to intrusive thoughts. However, the link with context depends on the content of the obsessions. We propose the term "decontextualization of thoughts" to describe the phenomenon that obsessions gradually lose their connection with external context during the development of OCD. Future research should investigate whether this hypothesis can be supported by experimental evidence and identify whether this shift might be more likely a cause or a consequence of the disorder.
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Affiliation(s)
- Franziska Weiss
- Chair of Addiction Research, Institute of Clinical Psychology and Psychotherapy, Technische Universität Dresden, Dresden, Germany
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3
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Alexander-Bloch AF, Sood R, Shinohara RT, Moore TM, Calkins ME, Chertavian C, Wolf DH, Gur RC, Satterthwaite TD, Gur RE, Barzilay R. Connectome-wide Functional Connectivity Abnormalities in Youth With Obsessive-Compulsive Symptoms. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2022; 7:1068-1077. [PMID: 34375730 PMCID: PMC8821731 DOI: 10.1016/j.bpsc.2021.07.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 07/16/2021] [Accepted: 07/29/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Obsessive-compulsive symptomatology (OCS) is common in adolescence but usually does not meet the diagnostic threshold for obsessive-compulsive disorder. Nevertheless, both obsessive-compulsive disorder and subthreshold OCS are associated with increased likelihood of experiencing other serious psychiatric conditions, including depression and suicidal ideation. Unfortunately, there is limited information on the neurobiology of OCS. METHODS Here, we undertook one of the first brain imaging studies of OCS in a large adolescent sample (analyzed n = 832) from the Philadelphia Neurodevelopmental Cohort. We investigated resting-state functional magnetic resonance imaging functional connectivity using complementary analytic approaches that focus on different neuroanatomical scales, from known functional systems to connectome-wide tests. RESULTS We found a robust pattern of connectome-wide, OCS-related differences, as well as evidence of specific abnormalities involving known functional systems, including dorsal and ventral attention, frontoparietal, and default mode systems. Analysis of cerebral perfusion imaging and high-resolution structural imaging did not show OCS-related differences, consistent with domain specificity to functional connectivity. CONCLUSIONS The brain connectomic associations with OCS reported here, together with early studies of its clinical relevance, support the potential for OCS as an early marker of psychiatric risk that may enhance our understanding of mechanisms underlying the onset of adolescent psychopathology.
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Affiliation(s)
- Aaron F Alexander-Bloch
- Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania.
| | - Rahul Sood
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Russell T Shinohara
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Statistics in Imaging and Visualization Center, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Center for Biomedical Image Computing and Analytics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Tyler M Moore
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Monica E Calkins
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Casey Chertavian
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Daniel H Wolf
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ruben C Gur
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Theodore D Satterthwaite
- Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; Penn Lifespan Informatics and Neuroimaging Center, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Raquel E Gur
- Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ran Barzilay
- Department of Child and Adolescent Psychiatry and Behavioral Science, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania; CHOP/Penn Lifespan Brain Institute, University of Pennsylvania, Philadelphia, Pennsylvania
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Yıldız Miniksar D, Yüksel T, Öz B, Özdemir M. A comparison of phenomenological, clinical and familial psychiatric features of pediatric OCD and trichotillomania. Int J Psychiatry Clin Pract 2022; 26:139-147. [PMID: 34124985 DOI: 10.1080/13651501.2021.1933041] [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: 10/21/2022]
Abstract
OBJECTIVES Although trichotillomania (TTM) is classified in the obsessive-compulsive disorders (OCD) chapter of the DSM-5, several studies showed that it has several differences. The aim of this study was to examine the phenomenology, comorbidity, and family psychiatric characteristisc of childhood TTM and OCD. METHODS This study compared youth ages 6-17 years with a primary diagnosis of TTM (n = 63) to those with primary OCD (n = 65) on clinical and familial psychiatric characteristics. RESULTS In our study, the findings showed that family history of schizophrenia (42.3%) was higher among patients with TTM than the OCD group, while the history of OCD (55.8%) in the family was significantly higher among the OCD group (p < 0.001). The behaviour of plucking eyebrows was significantly higher among patients with TTM comorbid OCD than patients with only trichotillomania. TTM patients with comorbid OCD had one-dimensional symptom distribution than the presence of the OCD-only group, and the severity of OCD was lower. The incidence of pathological doubting was higher among the TTM group with comorbid OCD, than those with only OCD diagnosis. CONCLUSIONS These findings support significant differences between OCD and TTM. Differences between OCD and TTM may reflect differences in underlying psychobiology, and may necessitate contrasting treatment approaches.KEYPOINTSWe aimed to compare the trichotillomania in itself and in the presence of OCD with the OCD group.Even if OCD accompanied trichotillomania, OCD symptom dimensions and severity were found to be lower than in the OCD-only group.Trichotillomania is a heterogeneous disorder with different dimensions besides the OCD spectrum.
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Affiliation(s)
- Dilşad Yıldız Miniksar
- Department of Child and Adolescent Psychiatry, Yozgat Bozok University Faculty of Medicine, Yozgat, Turkey
| | - Tuğba Yüksel
- Department of Child and Adolescent Psychiatry, Dicle University Faculty of Medicine, Diyarbakır, Turkey
| | - Büşra Öz
- Department of Child and Adolescent Psychiatry, Düzce Atatürk Training and Research Hospital, Düzce, Turkey
| | - Mikail Özdemir
- Public Health Professional, Osmaniye Community Health Center, Tuberculosis Dispensary, Osmaniye, Turkey
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5
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Cervin M, McNeel MM, Wilhelm S, McGuire JF, Murphy TK, Small BJ, Geller DA, Storch EA. Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters. Behav Ther 2022; 53:240-254. [PMID: 35227401 PMCID: PMC9397538 DOI: 10.1016/j.beth.2021.08.001] [Citation(s) in RCA: 2] [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: 03/12/2021] [Revised: 08/06/2021] [Accepted: 08/12/2021] [Indexed: 02/03/2023]
Abstract
The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.
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Affiliation(s)
| | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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6
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de Matos MB, Pires AJ, Trettim JP, Scholl CC, Tabeleão VP, Stigger RS, Rubin BB, Molina ML, Pinheiro RT, Quevedo LDA. Family perception of the symptoms of Obsessive-Compulsive Disorder patient and the family accommodation. Int J Soc Psychiatry 2022; 68:73-81. [PMID: 33295244 DOI: 10.1177/0020764020981107] [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: 11/15/2022]
Abstract
BACKGROUND Family members tend to modify their routine by assisting or participating in the patient's rituals. These behaviors have been identified as family accommodation (FA). AIMS The aim of this study was to describe the relationship between family accommodation of relatives of Obsessive-Compulsive Disorder (OCD) patients and their perceptions about the obsessions and compulsions of the patient. METHOD This was a cross-sectional study with family members of Obsessive-Compulsive Disorder in a Southern Brazilian city. The family perception of the OCD symptoms and their accommodation were assessed through the Family Accommodation Scale for Obsessive-Compulsive Disorder - Interviewer-Rated (FAS-IR). RESULTS The level of family accommodation was higher in those family members who lived with the patient when compared to those who did not live with them (p = .011). The obsessions associated with higher levels of family accommodation were: contamination (p < .001), hoarding/saving (p = .001), symmetry/exactness (p = .001), religious (p = .019), and diverse (p = .003). Regarding compulsions, the perception of all symptoms was associated with higher levels of family accommodation (p < .05). CONCLUSION The family accommodation is present in family members of Obsessive-Compulsive Disorder patients, regardless of the type of obsessive/compulsive symptom perceived.
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Affiliation(s)
- Mariana Bonati de Matos
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Andressa Jacondino Pires
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Jéssica Puchalski Trettim
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Carolina Coelho Scholl
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Viviane Porto Tabeleão
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Rafaelle Stark Stigger
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Bárbara Borges Rubin
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Mariane Lopez Molina
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Ricardo Tavares Pinheiro
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
| | - Luciana de Avila Quevedo
- Postgraduate Program in Health and Behavior, Universidade Católica de Pelotas, UCPel, Pelotas, RS, Brazil
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Efe A, Açıkel SB, Uygun SD, Canlı M, Temeltürk RD, Gürel Y, Çetinkaya M, Çakmak FH. A Retrospective Evaluation on Demographic, Phenomenological, and Comorbidity Features of Pediatric Obsessive-Compulsive Disorder. J Nerv Ment Dis 2022; 210:6-25. [PMID: 34417423 DOI: 10.1097/nmd.0000000000001402] [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] [Indexed: 11/25/2022]
Abstract
ABSTRACT The impacts of sex, age of onset, phenotype, and comorbidity on clinical features were explored in a large clinical sample with pediatric obsessive-compulsive disorder (p-OCD) (n = 457), along with concomitant specific features in the framework of different symptom dimensions/phenotypes, by a retrospective cross-sectional evaluation design. The most prevalent phenotype was obsession/checking (almost half), and the clinical features belonging to different phenotypes varied among sexes, age of onset, severity, and comorbidities. The contamination and aggressive obsessions, along with the compulsions such as cleaning and repeating routine activities, were the most prevalent symptoms, which were prevalently accompanied by generalized anxiety disorder, attention deficit hyperactivity disorder, and depression. Females with OCD were likely prone to exhibit comorbid internalizing disorders, whereas males were prone to externalizing. This recent study on a large Turkish clinical sample of p-OCD followed up within 5 years, highlighting separate evidence on subtyping of p-OCD in phenotype and comorbidity frame.
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Affiliation(s)
- Ayşegül Efe
- Department of Child and Adolescent Psychiatry, Dr. Sami Ulus Maternity, Children's Health and Diseases Training and Research Hospital, University of Health Sciences, Ankara, Turkey
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8
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Perez MI, Limon DL, Candelari AE, Cepeda SL, Ramirez AC, Guzick AG, Kook M, La Buissonniere Ariza V, Schneider SC, Goodman WK, Storch EA. Obsessive-Compulsive Disorder Misdiagnosis among Mental Healthcare Providers in Latin America. J Obsessive Compuls Relat Disord 2022; 32:100693. [PMID: 34840937 PMCID: PMC8612600 DOI: 10.1016/j.jocrd.2021.100693] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Mental healthcare professionals often have limited awareness of different obsessive-compulsive disorder (OCD) symptom presentations, which may contribute to years between OCD symptom onset and treatment initiation. While research has identified high rates of OCD misdiagnosis among clinicians from the United States and Canada, research on OCD symptom awareness among healthcare providers in Latin American (LATAM) regions is limited. In this study, LATAM mental healthcare providers (N = 83) provided diagnostic impressions based on five OCD vignettes: three with symptoms centered on taboo thoughts (sexual, harming others, and religion/scrupulosity) and two about contamination or symmetry obsessions. Rates of incorrect (non-OCD) diagnoses were significantly higher for the taboo thoughts vignettes (sexual, 52.7%; harm/aggression, 42.0%; and religious, 34.7%) vs. contamination obsessions (11.0%) and symmetry obsessions (6.9%). The OCD vignette depicting sexual obsessions was often attributed to a paraphilic disorder (36.5%). Bachelor's level clinicians had significantly lower odds of accurately identifying all three vignettes related to taboo thoughts compared to respondents with a graduate degree. Accurate identification of the three taboo vignettes was also associated with first-line psychological treatment recommendations (i.e., cognitive-behavioral therapy) even when controlling for respondents' theoretical orientation. Exposure was rarely mentioned when clinicians were prompted to provide treatment recommendations for each vignette (8-9% of the time for symmetry and contamination vignettes, 5-7% for taboo though vignettes). Like clinicians in the United States and Canada, mental health professionals in LATAM may misidentify OCD symptom presentations, particularly sexual obsessions, highlighting a need for education and training.
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Affiliation(s)
- Mayra I. Perez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Danica L. Limon
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- Department of Psychology, Brigham Young University
| | - Abigail E. Candelari
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- Department of Psychology, University of Houston
| | - Sandra L. Cepeda
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Ana C. Ramirez
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
- Department of Psychology, University of Texas – Rio Grande Valley
| | - Andrew G. Guzick
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Minjee Kook
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | | | - Sophie C. Schneider
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Wayne K. Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
| | - Eric A. Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine
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Schreck M, Georgiadis C, Garcia A, Benito K, Case B, Herren J, Walther M, Freeman J. Core Motivations of Childhood Obsessive-Compulsive Disorder: The Role of Harm Avoidance and Incompleteness. Child Psychiatry Hum Dev 2021; 52:957-965. [PMID: 33044664 DOI: 10.1007/s10578-020-01075-5] [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] [Accepted: 10/02/2020] [Indexed: 10/23/2022]
Abstract
In an effort to improve patient conceptualization and targeted treatment, researchers have sought to accurately classify OCD subtypes. To date, the most common form of OCD classification has used the content of symptom topography as opposed to functional links between symptoms to categorize OCD. The aim of the current study was to explore the associations between these two forms of OCD classification. Participant topographical symptoms were self-reported using the Obsessive-Compulsive Inventory-Child Version (OCI-CV). Clinicians assessed whether participant symptoms were motivated by harm avoidance and/or incompleteness. Structural equation modeling was employed to explore the associations between harm avoidance and incompleteness and symptom dimensions in youth with OCD. Results showed that harm avoidance was significantly associated with doubting/checking, obsessing, and neutralizing symptoms, whereas incompleteness was associated with doubting/checking, ordering, and neutralizing symptoms. Findings are consistent with child and adult literature and highlight the importance of assessing the underlying function of OC behaviors.
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Affiliation(s)
- Meghan Schreck
- Obsessive-Compulsive Disorder Institute, McLean Hospital/Harvard Medical School, 115 Mill St., Belmont, MA, 02478, USA.
| | | | - Abbe Garcia
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Kristen Benito
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Brady Case
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Jennifer Herren
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Michael Walther
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
| | - Jennifer Freeman
- Pediatric Anxiety Research Center, Bradley Hospital, Alpert Medical School of Brown University, East Providence, RI, USA
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10
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Raines AM, Koscinski B, Mathes BM, Portero AK, Allan NP, Schmidt NB. Examination of a brief computerized Cognitive Anxiety Sensitivity intervention on obsessive-compulsive symptoms. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2021; 61 Suppl 1:93-110. [PMID: 33945163 DOI: 10.1111/bjc.12298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/14/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Despite the existence of several first-line treatments for obsessive-compulsive disorder (OCD), many patients fail to experience symptom reduction and/or do not complete treatment. As a result, the field has increasingly moved towards identifying and treating malleable underlying risk factors that may in turn improve treatment efficacy. One salient underlying risk factor, anxiety sensitivity (AS) cognitive concerns, has been found to be uniquely associated with obsessive-compulsive (OC) symptom dimensions. However, no studies have yet examined whether reductions in AS cognitive concerns will lead to subsequent reductions in OC symptoms. METHODS The current study attempted to fill this gap by recruiting individuals reporting elevations on both AS cognitive concerns and at least one OC symptom dimension. Participants were randomly assigned to receive either a one-session AS cognitive concerns intervention (n = 35) or a single health information control session (n = 37). AS cognitive concerns were assessed at post-intervention and one-month follow-up. RESULTS The active intervention produced significantly greater reductions in AS cognitive concerns post-intervention than the control intervention. However, this effect was no longer significant at one-month follow-up. Further, while there was not an effect of treatment condition on OC symptoms at one-month follow-up, changes in AS cognitive concerns from baseline to post-intervention mediated changes in OC symptoms at one-month follow-up. CONCLUSIONS Findings support previous research attesting to the malleable nature of AS. Extending this research, findings provide initial support for the efficacy of AS interventions among individuals with elevated OC symptoms. PRACTITIONER POINTS Clinicians should consider assessing anxiety sensitivity (AS) among patients with obsessive-compulsive disorder. If elevated, clinicians should consider targeting AS as an adjunct to treatment as usual.
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Affiliation(s)
- Amanda M Raines
- Department of Psychology, Florida State University, Tallahassee, Florida, USA.,Southeast Louisiana Veterans Health Care System (SLVHCS), New Orleans, Louisiana, USA.,South Central Mental Illness Research, Education and Clinical Center (MIRECC), New Orleans, Louisiana, USA
| | | | - Brittany M Mathes
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | - Amberly K Portero
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
| | | | - Norman B Schmidt
- Department of Psychology, Florida State University, Tallahassee, Florida, USA
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11
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Hook RW, Grant JE, Ioannidis K, Tiego J, Yücel M, Wilkinson P, Chamberlain SR. Trans-diagnostic measurement of impulsivity and compulsivity: A review of self-report tools. Neurosci Biobehav Rev 2021; 120:455-469. [PMID: 33115636 PMCID: PMC7116678 DOI: 10.1016/j.neubiorev.2020.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 08/15/2020] [Accepted: 10/14/2020] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Impulsivity and compulsivity are important constructs, relevant to understanding behaviour in the general population, as well as in particular mental disorders (e.g. attention deficit hyperactivity disorder, obsessive-compulsive disorder). The current paper provides a narrative review of self-report impulsivity and compulsivity scales. METHODS A literature search was conducted using the following terms: ("impulsivity" OR "compulsivity") AND ("self-report" OR "questionnaire" OR "psychometric" OR "scale"). RESULTS 25 impulsive and 11 compulsive scales were identified, which varied considerably in psychometric properties, convenience, and validity. For impulsivity, the most commonly used scales were the BIS and the UPPS-P, whilst for compulsivity, the Padua Inventory was commonly used. The majority of compulsivity scales measured OCD symptoms (obsessions and compulsions) rather than being trans-diagnostic or specific to compulsivity (as opposed to obsessions). Scales capable of overcoming these limitations were highlighted. DISCUSSION This review provides clarity regarding relative advantages and disadvantages of different scales relevant to the measurement of impulsivity and compulsivity in many contexts. Areas for further research and refinement are highlighted.
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Affiliation(s)
- Roxanne W Hook
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom.
| | - Jon E Grant
- Department of Psychiatry, University of Chicago, Pritzker School of Medicine, USA
| | - Konstantinos Ioannidis
- Cambridge and Peterborough NHS Foundation Trust and Department of Psychiatry, University of Cambridge, UK
| | - Jeggan Tiego
- Neural Systems and Behaviour Lab, Turner Institute for Brain and Mental Health and School of Psychological Sciences, Monash University, Australia
| | - Murat Yücel
- BrainPark, Turner Institute for Brain and Mental Health, School of Psychological Sciences and Monash Biomedical Imaging Facility, Monash University, Australia
| | - Paul Wilkinson
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridge and Peterborough NHS Foundation Trust and Department of Psychiatry, University of Cambridge, UK
| | - Samuel R Chamberlain
- Department of Psychiatry, University of Cambridge, Cambridge Biomedical Campus, Cambridge, CB2 0SZ, United Kingdom; Cambridge and Peterborough NHS Foundation Trust and Department of Psychiatry, University of Cambridge, UK
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12
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Abstract
OCD most often arises before adulthood with adolescence being a particularly vulnerable period. This is also a time when both brain and cognition undergo fundamental developmental change and reorganisation. However, the neurocognitive mechanisms that drive the emergence of OCD during development are still largely unknown. In this chapter, I review the relatively sparse literature on the developmental aspects of OCD and I discuss the symptomatic, cognitive and neural patterns in OCD and the developing mind. I highlight how we need to understand the emergence of cognitive impairments and neural alteration in a developmental context if we want to understand more about the mechanisms that give rise to OCD. Moreover, I outline how we best approach this challenge to overcome the current limitations in research.
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Affiliation(s)
- T U Hauser
- Max Planck UCL Centre for Computational Psychiatry and Ageing Research, London, UK. .,Wellcome Centre for Human Neuroimaging, University College London, London, UK.
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13
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Georgiadis C, Schreck M, Gervasio M, Kemp J, Freeman J, Garcia A, Case B. Disgust propensity and sensitivity in childhood anxiety and obsessive-compulsive disorder: Two constructs differentially related to obsessional content. J Anxiety Disord 2020; 76:102294. [PMID: 32916505 DOI: 10.1016/j.janxdis.2020.102294] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 11/25/2022]
Abstract
The role of disgust in anxiety and related disorders has been extensively studied in adults, however its role in childhood psychopathology is in need of further investigation. The adult literature has suggested that two distinct sub-constructs within "disgust proneness" may differentially predict anxiety-related disorders. Namely, disgust propensity (DP) has been defined as the likelihood an individual will experience a disgust reaction, and disgust sensitivity (DS) as the degree to which an individual is distressed by their experience of disgust. The current study aimed to validate the Disgust Propensity and Sensitivity Scale-Revised (DPSS-R) in a sample of youth receiving intensive services for OCD and anxiety, examine the relationship between disgust sub-constructs and obsessional content in a sample of youth with OCD, and examine the relationship between disgust change and symptom severity at discharge. A confirmatory factor analysis supported a two-factor structure of the DPSS-R. DP was found to be uniquely predictive of contamination obsessions, and DS was found to be uniquely predictive of moral obsessions. Lastly, change in DP, but not DS, predicted overall change in OCD symptom severity. The present study provides a valid measure of DS and DP in youth with anxiety and related disorders, and suggests that subconstructs of disgust may serve as distinct risk factors for obsessional content in youth with OCD. Future research should examine the predictive validity of DP and DS longitudinally, as well as examine effective ways to more effectively target DP with exposure therapy.
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Affiliation(s)
| | - Meghan Schreck
- McLean Hospital, Harvard Medical School, Boston, MA, USA
| | - Maddi Gervasio
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital, USA
| | - Joshua Kemp
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital, USA
| | - Jennifer Freeman
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital, USA
| | - Abbe Garcia
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital, USA
| | - Brady Case
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital, USA
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14
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Koorenhof LJ, Dommett EJ. An Investigation Into Response Inhibition in Distinct Clinical Groups Within Obsessive-Compulsive Disorder. J Neuropsychiatry Clin Neurosci 2020; 31:228-238. [PMID: 30888920 DOI: 10.1176/appi.neuropsych.18070166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Response inhibition has been frequently studied in obsessive-compulsive disorder (OCD) with mixed results. The inconsistent findings may stem in part from failure to consider the heterogeneity of the disorder. METHODS The authors examined behavioral and event-related potential (ERP) components (N2 and P3) during a simple response inhibition go/nogo task in a sample of patients with OCD (N=48) and control subjects (N=53). Comparisons in behavioral and electrophysiological measures were made between groups (OCD compared with control) and within the OCD group in terms of symptom clusters (symmetry, forbidden thoughts, and cleaning) and comorbidity status (OCD only and OCD with depression). RESULTS In the OCD group, the N2 component appeared more frontally localized compared with the control group. Participants with OCD demonstrated longer N2 latency and a larger difference in N2 between the nogo and go conditions, suggesting slower but greater conflict monitoring. P3 had a larger amplitude in the OCD group compared with the control group, indicative of greater response inhibition, but was also reduced in the nogo compared with go condition, suggesting suppressed response inhibition. No significant differences were found between symptom clusters, but patients with OCD only made more omission errors compared with patients with OCD and comorbid depression. The latter cohort also had faster P3 latencies, which, combined with the behavioral data, indicates slightly improved response inhibition when comorbid depression is found. CONCLUSIONS On the basis of these results, it would seem unlikely that symptom clusters have contributed to previous inconsistencies in the literature. Comorbid depression, which may have affected previous results, should be considered in future research.
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Affiliation(s)
- Loes J Koorenhof
- The School of Life, Health and Chemical Sciences, Open University, Milton Keynes, United Kingdom (Koorenhof); and the Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Dommett)
| | - Eleanor J Dommett
- The School of Life, Health and Chemical Sciences, Open University, Milton Keynes, United Kingdom (Koorenhof); and the Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London (Dommett)
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15
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Rozenman M, McGuire J, Wu M, Ricketts E, Peris T, O'Neill J, Bergman RL, Chang S, Piacentini J. Hoarding Symptoms in Children and Adolescents With Obsessive-Compulsive Disorder: Clinical Features and Response to Cognitive-Behavioral Therapy. J Am Acad Child Adolesc Psychiatry 2019; 58:799-805. [PMID: 30877053 PMCID: PMC6658336 DOI: 10.1016/j.jaac.2019.01.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 10/22/2018] [Accepted: 01/23/2019] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Although adult hoarding disorder is relatively common and often debilitating, few studies have examined the phenomenology of pediatric hoarding. We examined the clinical phenomenology and response to cognitive-behavioral therapy (CBT) treatment in youths with a diagnosis of obsessive-compulsive disorder (OCD) with and without hoarding symptoms. Age was tested as a moderator across analyses, given prior findings that the impact of hoarding symptoms may not become apparent until adolescence. METHOD Youths (N = 215; aged 7-17 years) with OCD pursuing evaluation and/or treatment at a university-based specialty clinic participated in the current study. Presence of hoarding symptoms was assessed as part of a larger battery. Data from a subset of youths (n = 134) who received CBT were included in treatment response analyses. RESULTS Youths with hoarding symptoms did not differ from those without hoarding symptoms with respect to overall OCD symptom severity and impairment. Youths with hoarding met criteria for more concurrent diagnoses, including greater rates of internalizing and both internalizing/externalizing, but not externalizing-only, disorders. Youths with and without hoarding symptoms did not significantly differ in rate of response to CBT. Age did not moderate any of these relationships, suggesting that the presence of hoarding symptoms was not associated with greater impairments across the clinical presentation of OCD or its response to treatment by age. CONCLUSION We found no evidence that hoarding is associated with greater OCD severity or poorer treatment response in affected youth. Theoretical and clinical implications of these findings, including future directions for research on testing developmental models of hoarding across the lifespan, are discussed.
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Affiliation(s)
- Michelle Rozenman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA; University of Denver, CO.
| | | | - Monica Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Emily Ricketts
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Tara Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA
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16
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Cameron DH, Streiner DL, Summerfeldt LJ, Rowa K, McKinnon MC, McCabe RE. A comparison of cluster and factor analytic techniques for identifying symptom-based dimensions of obsessive-compulsive disorder. Psychiatry Res 2019; 278:86-96. [PMID: 31163302 DOI: 10.1016/j.psychres.2019.05.040] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 05/17/2019] [Accepted: 05/24/2019] [Indexed: 01/05/2023]
Abstract
A growing body of literature suggests that obsessive-compulsive disorder (OCD) is a heterogeneous condition. The studies investigating symptom dimensions have been limited by numerous methodological differences and sample characteristics. The purpose of this study was to compare the two most commonly applied statistical techniques used in addressing this question in the same large cohort of individuals with OCD. Both cluster analysis and factor analysis were used to examine OCD symptom data as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist for 355 individuals with a primary diagnosis of OCD. The factor analysis revealed a three-factor model best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions and aggressive obsessions/checking compulsions. In contrast, the cluster analysis yielded a stable four-cluster solution best described as symmetry obsessions/ordering compulsions, contamination obsessions/cleaning compulsions, aggressive-somatic-religious obsessions/checking compulsions and a mixed symptom profile. Although there was overlap in the models resulting from these two statistical approaches, cluster analysis better captured the dimensional nature of OCD by demonstrating the prevalence of symptom categories in each subgroup. Though both analyses are capable of providing similar outputs, the validity of these results is limited given the input of a priori symptom categories from the Y-BOCS.
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Affiliation(s)
- Duncan H Cameron
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada.
| | - David L Streiner
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Department of Psychiatry, University of Toronto, Canada
| | | | - Karen Rowa
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
| | - Margaret C McKinnon
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada; Mood Disorders Program, St. Joseph's Healthcare Hamilton, Canada
| | - Randi E McCabe
- Anxiety Treatment and Research Clinic, St. Joseph's Healthcare Hamilton, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Canada
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17
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Barzilay R, Patrick A, Calkins ME, Moore TM, Gur RC, Gur RE. Association between early-life trauma and obsessive compulsive symptoms in community youth. Depress Anxiety 2019; 36:586-595. [PMID: 31066996 DOI: 10.1002/da.22907] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 03/27/2019] [Accepted: 04/05/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Obsessive-compulsive symptoms (OCS) in youth are common, have heterogeneous manifestations, and have been shown to be associated with serious psychopathology. While early-life trauma exposure is associated with increased risk for obsessive-compulsive disorder (OCD), its association with different OCS and its clinical relevance for serious psychopathology is unclear. Here we aimed to evaluate associations among traumatic stressful events (TSE), OCS, and serious psychiatric conditions in community youth. METHODS We studied nonmental-help seeking youths from the Philadelphia Neurodevelopmental Cohort (N = 7054, aged 11-21, 54% females, 52% prepubertal), assessed for lifetime TSE exposure and OCS. Regression models investigated cross-sectional associations of TSEs with OCS, and associations with depression, suicide ideation and psychosis. Models examined sex and puberty effects, controlling for age and socioeconomic status. RESULTS Trauma exposure was associated with higher OCS rates, especially in females (Trauma × Sex interaction Wald = 7.93, p = 0.005) and prepuberty (Trauma × Puberty interaction Wald = 7.68, p = 0.006). TSEs were associated with all OCS manifestations, most prominently with bad intrusive thoughts (odds ratio [OR] = 1.63). Assaultive TSEs, especially sexual assault, showed stronger associations with OCS compared with nonassaultive TSEs. While TSEs and OCS were independently associated with depression, suicide ideation, and psychosis, a significant interaction was observed only in association with increased rates of psychosis (Trauma × OCS interaction Wald = 5.08, p = 0.024). CONCLUSION Early-life trauma is associated with OCS in a dose-response manner, more so in females and prepuberty. The trauma-OCS association varied by load, type of trauma, and by OCS subtypes. Trauma-OCS appears a detrimental combination in association with psychosis.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ariana Patrick
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Monica E Calkins
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Tyler M Moore
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Ruben C Gur
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
| | - Raquel E Gur
- Lifespan Brain Institute of CHOP and UPenn, Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States.,Department of Psychiatry, Neuropsychiatry Section, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States
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18
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Barzilay R, Patrick A, Calkins ME, Moore TM, Wolf DH, Benton TD, Leckman JF, Gur RC, Gur RE. Obsessive-Compulsive Symptomatology in Community Youth: Typical Development or a Red Flag for Psychopathology? J Am Acad Child Adolesc Psychiatry 2019; 58:277-286.e4. [PMID: 30738554 DOI: 10.1016/j.jaac.2018.06.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 06/13/2018] [Accepted: 06/22/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Obsessive-compulsive symptoms (OCS) are common throughout development and often considered developmentally appropriate. We evaluated the prevalence and phenotypic heterogeneity of self-reported OCS in a large community youth sample not ascertained for seeking mental-health help. We aimed to identify patterns in OCS that are associated with serious psychopathology and may thus represent a "red flag" that merits psychiatric evaluation. METHOD Data were analyzed from youth from the Philadelphia Neurodevelopmental Cohort (N = 7,054, aged 11-21 years, 54% female). Participants underwent structured psychiatric interviews, including screening for OCS (8 obsessions, 8 compulsions, and hoarding) and other major psychopathology domains. Factor analysis was conducted to identify clustering of OCS presentation. Regression models were used to investigate association of OCS with threshold lifetime diagnoses of obsessive-compulsive disorder (OCD), depressive episode, psychosis, and suicide ideation. RESULTS OCS were common in non-mental health-seeking individuals (38.2%), although only 3% met threshold OCD criteria. OCS were more common in female participants and postpuberty. Factor analyses resulted in 4 factors: F1 - Bad Thoughts; F2 - Repeating/Checking; F3 - Symmetry; F4 - Cleaning/Contamination; and Hoarding as a separate item. All OCS were associated with higher rates of OCD, depression, psychosis, and suicide ideation. However, endorsement of F1 symptoms, prevalent in more than 20% of the sample, showed the most substantial associations with major psychiatric conditions. CONCLUSION OCS are common in community youth. Although for most youths OCS symptoms may be benign, some patterns of OCS are associated with major psychiatric conditions. These findings may help to identify youth at risk for serious psychopathology.
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Affiliation(s)
- Ran Barzilay
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia.
| | - Ariana Patrick
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - Monica E Calkins
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tyler M Moore
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Daniel H Wolf
- Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Tami D Benton
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, PA
| | - James F Leckman
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT
| | - Ruben C Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Raquel E Gur
- Lifespan Brain Institute, Children's Hospital of Philadelphia and Penn Medicine, and the Neuropsychiatry Section of the Perelman School of Medicine, University of Pennsylvania, Philadelphia
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19
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McGuire JF, Tan PZ, Piacentini J. Symptom Dimension Response in Children and Adolescents with Obsessive-Compulsive Disorder. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:529-538. [PMID: 30644767 DOI: 10.1080/15374416.2018.1540009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This report examined the nature of obsessive-compulsive disorder (OCD) symptoms nominated for treatment and investigate improvement in OCD symptom dimensions. Youth with OCD (N = 71) participated in a clinical trial that compared exposure-based cognitive behavior therapy (CBT) to psychoeducation plus relaxation training (PRT). Participants completed a baseline assessment to characterize OCD severity. Next, parents and youth collaboratively developed an OCD symptom treatment hierarchy. Afterward, these symptoms were independently reassessed at each session by youth and parents. After 12 sessions, a posttreatment assessment was completed by independent evaluators. A greater incidence of baseline aggressive/checking symptoms predicted a positive CBT treatment response. For parent ratings of youth distress, CBT outperformed PRT across symptom dimensions, but hoarding symptoms exhibited a slower rate of improvement relative to other dimensions across treatments. For youth distress ratings, CBT outperformed PRT across most symptom dimensions. Although symmetry/ordering symptoms exhibited a slower rate of improvement relative to other dimensions across treatments, post hoc tests found no difference in the average distress rating for symmetry/ordering symptoms between treatment groups. Finally, across symptom dimensions, parents reported a linear reduction in youth distress, whereas youth experienced a nonlinear reduction in distress that diminished over treatment. Exposure-based CBT is beneficial for OCD symptoms and remains the principle treatment for pediatric OCD. However, as symmetry/ordering symptoms exhibited improvement from CBT and PRT, there is some shared treatment mechanisms that improves these symptoms. Finally, as youth perceive diminishing distress reduction over time, clinicians are encouraged to employ appropriate reinforcement strategies in treatment.
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Affiliation(s)
- Joseph F McGuire
- a Division of Child and Adolescent Psychiatry , Johns Hopkins University School of Medicine.,b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
| | - Patricia Z Tan
- b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
| | - John Piacentini
- b Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry , University of California
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20
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Wu MS, Rozenman M, Peris TS, O'Neill J, Bergman RL, Chang S, Piacentini J. Comparing OCD-affected youth with and without religious symptoms: Clinical profiles and treatment response. Compr Psychiatry 2018; 86:47-53. [PMID: 30077806 PMCID: PMC6245548 DOI: 10.1016/j.comppsych.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/14/2018] [Accepted: 07/21/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth. METHOD Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response. RESULTS Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms. CONCLUSION Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.
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Affiliation(s)
- Monica S Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Michelle Rozenman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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21
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Heritability of obsessive-compulsive trait dimensions in youth from the general population. Transl Psychiatry 2018; 8:191. [PMID: 30228290 PMCID: PMC6143601 DOI: 10.1038/s41398-018-0249-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 05/30/2018] [Accepted: 08/09/2018] [Indexed: 11/16/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a heritable childhood-onset psychiatric disorder that may represent the extreme of obsessive-compulsive (OC) traits that are widespread in the general population. We report the heritability of the Toronto Obsessive-Compulsive Scale (TOCS), a new measure designed to assess the complete range of OC traits in youth. We also examined the dimensional nature of the TOCS and the degree to which genetic effects are unique or shared between dimensions. OC traits were measured using the TOCS in 16,718 youth (6-18 years) at a science museum. We conducted a factor analysis to identify OC trait dimensions. We used univariate and multivariate twin models to estimate the heritability of OC trait dimensions in a subset of twins (220 pairs). Six OC dimensions were identified: Cleaning/Contamination, Symmetry/Ordering, Rumination, Superstition, Counting/Checking, and Hoarding. The TOCS total score (74%) and each OC dimension was heritable (30-77%). Hoarding was not highly correlated with other OC dimensions, but did share genetic effects. Shared genetics accounted for most of the shared variance among dimensions, whereas unique environment accounted for the majority of dimension-specific variance. One exception was Hoarding, which had considerable unique genetic factors. A latent trait did not account for the shared variance between dimensions. In conclusion, OC traits and individual OC dimensions were heritable, although the degree of shared and dimension-specific etiological factors varied by dimension. The TOCS may be informative for genetic research of OC traits in youth. Genetic research of OC traits should consider both OC dimension and total trait scores.
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22
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Stewart SE. Use of Subclinical Phenotypes in Neuroimaging. J Am Acad Child Adolesc Psychiatry 2018; 57:14-15. [PMID: 29301660 DOI: 10.1016/j.jaac.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 11/08/2017] [Indexed: 11/19/2022]
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23
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Bey K, Lennertz L, Riesel A, Klawohn J, Kaufmann C, Heinzel S, Grützmann R, Kathmann N, Wagner M. Harm avoidance and childhood adversities in patients with obsessive-compulsive disorder and their unaffected first-degree relatives. Acta Psychiatr Scand 2017; 135:328-338. [PMID: 28160276 DOI: 10.1111/acps.12707] [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] [Accepted: 01/16/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVE The etiology of obsessive-compulsive disorder (OCD) is assumed to involve interactions between genetically determined vulnerability factors and significant environmental features. Here, we aim to investigate how the personality trait harm avoidance and the experience of childhood adversities contribute to OCD. METHOD A total of 169 patients with OCD, 157 healthy comparison subjects, and 57 unaffected first-degree relatives of patients with OCD participated in the study. Harm avoidance was assessed using the Temperament and Character Inventory, and the severity of childhood adversities was measured with the Childhood Trauma Questionnaire. RESULTS Both patients with OCD and relatives showed elevated levels of harm avoidance compared to controls. Furthermore, patients exhibited significantly higher scores than relatives. This linear pattern was observed throughout all subscales of harm avoidance, and remained stable after controlling for the severity of depressive and obsessive-compulsive symptoms. With regard to childhood adversities, patients with OCD reported higher levels than relatives and controls. CONCLUSION Our results provide further evidence for a diathesis-stress model of OCD. While patients and unaffected relatives share elevated levels of harm avoidance, supporting the role of harm avoidance as an endophenotype of OCD, a heightened severity of childhood adversity was only observed in patients. The assumed biological underpinnings of these findings are discussed.
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Affiliation(s)
- K Bey
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
| | - L Lennertz
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany
| | - A Riesel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - J Klawohn
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - C Kaufmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - S Heinzel
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany.,Clinical Psychology and Psychotherapy, Freie Universität Berlin, Berlin, Germany
| | - R Grützmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - N Kathmann
- Department of Psychology, Humboldt University of Berlin, Berlin, Germany
| | - M Wagner
- Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany.,German Center for Neurodegenerative Diseases (DZNE), Bonn, Germany
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24
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Bernstein GA, Hadjiyanni T, Cullen KR, Robinson JW, Harris EC, Young AD, Fasching J, Walczak N, Lee S, Morellas V, Papanikolopoulos N. Use of Computer Vision Tools to Identify Behavioral Markers of Pediatric Obsessive-Compulsive Disorder: A Pilot Study. J Child Adolesc Psychopharmacol 2017; 27:140-147. [PMID: 27830935 DOI: 10.1089/cap.2016.0067] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES The clinical presentation of pediatric obsessive-compulsive disorder (OCD) is heterogeneous, which is a stumbling block to understanding pathophysiology and to developing new treatments. A major shift in psychiatry, embodied in the Research Domain Criteria (RDoC) initiative of National Institute of Mental Health, recognizes the pitfalls of categorizing mental illnesses using diagnostic criteria. Instead, RDoC encourages researchers to use a dimensional approach, focusing on narrower domains of psychopathology to characterize brain-behavior relationships. Our aim in this multidisciplinary pilot study was to use computer vision tools to record OCD behaviors and to cross-validate these behavioral markers with standard clinical measures. METHODS Eighteen youths with OCD and 21 healthy controls completed tasks in an innovation laboratory (free arrangement of objects, hand washing, arrangement of objects on contrasting carpets). Tasks were video-recorded. Videos were coded by blind raters for OCD-related behaviors. Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and other scales were administered. We compared video-recorded measures of behavior in OCD versus healthy controls and correlated video measures and clinical measures of OCD. RESULTS Behavioral measures on the videos were significantly correlated with specific CY-BOCS dimension scores. During the free arrangement task, more time spent ordering objects and more moves of objects were both significantly associated with higher CY-BOCS ordering/repeating dimension scores. Longer duration of hand washing was significantly correlated with higher scores on CY-BOCS ordering/repeating and forbidden thoughts dimensions. During arrangement of objects on contrasting carpets, more moves and more adjustment of objects were significantly associated with higher CY-BOCS ordering/repeating dimension scores. CONCLUSION Preliminary data suggest that measurement of behavior using video recording is a valid approach for quantifying OCD psychopathology. This methodology could serve as a new tool for investigating OCD using an RDoC approach. This objective, novel behavioral measurement technique may benefit both researchers and clinicians in assessing pediatric OCD and in identifying new behavioral markers of OCD. Clinical Trial Registry: Development of an Instrument That Monitors Behaviors Associated With OCD. NCT02866422. http://clinicaltrials.gov.
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Affiliation(s)
- Gail A Bernstein
- 1 Division of Child and Adolescent Psychiatry, University of Minnesota Medical School , Minneapolis, Minnesota
| | | | - Kathryn R Cullen
- 1 Division of Child and Adolescent Psychiatry, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Julia W Robinson
- 2 College of Design, University of Minnesota , Minneapolis, Minnesota
| | - Elizabeth C Harris
- 1 Division of Child and Adolescent Psychiatry, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Austin D Young
- 2 College of Design, University of Minnesota , Minneapolis, Minnesota
| | - Joshua Fasching
- 3 Department of Computer Science and Engineering, University of Minnesota , Minneapolis, Minnesota
| | - Nicholas Walczak
- 3 Department of Computer Science and Engineering, University of Minnesota , Minneapolis, Minnesota
| | - Susanne Lee
- 1 Division of Child and Adolescent Psychiatry, University of Minnesota Medical School , Minneapolis, Minnesota
| | - Vassilios Morellas
- 3 Department of Computer Science and Engineering, University of Minnesota , Minneapolis, Minnesota
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25
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Højgaard DRMA, Mortensen EL, Ivarsson T, Hybel K, Skarphedinsson G, Nissen JB, Valderhaug R, Dahl K, Weidle B, Torp NC, Grados M, Lewin AB, Melin KH, Storch EA, Wolters LH, Murphy TK, Sonuga-Barke EJS, Thomsen PH. Structure and clinical correlates of obsessive-compulsive symptoms in a large sample of children and adolescents: a factor analytic study across five nations. Eur Child Adolesc Psychiatry 2017; 26:281-291. [PMID: 27388606 DOI: 10.1007/s00787-016-0887-5] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 06/30/2016] [Indexed: 11/24/2022]
Abstract
The underlying structure of obsessive-compulsive disorder (OCD) remains to be confirmed in child and adolescent populations. In this paper we report the first factor analytic study of individual OCD items from Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). OCD symptoms were assessed using the CY-BOCS symptom checklist in a sample of 854 patients with OCD (7-18 years of age) recruited from clinics in five countries. Pooled data were subjected to exploratory and confirmatory factor analysis (CFA) to identify the optimal factor structure. Various models were tested for age and gender subgroups. Also, the invariance of the solution across age and gender was tested and associations with demographic and clinical factors were explored. A three-factor model provided the best-fit solution. It consisted of the following factors: (1) harm/sexual, (2) symmetry/hoarding, (3) contamination/cleaning. The factor structure was invariant for age and gender across subgroups. Factor one was significantly correlated with anxiety, and factor two with depression and anxiety. Factor three was negatively correlated with tic disorder and attention-deficit/hyperactivity disorder (ADHD). Females had higher scores on factor two than males. The OCD symptom structure in children and adolescents is consistent across age and gender and similar to results from recent child and adolescents although hoarding may not be a separate factor. Our three-factor structure is almost identical to that seen in early studies on adults. Common mental disorders had specific patterns of associations with the different factors.
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Affiliation(s)
- D R M A Højgaard
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark.
| | - E L Mortensen
- Department of Public Health and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - T Ivarsson
- The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - K Hybel
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark
| | - G Skarphedinsson
- The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - J B Nissen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark
| | - R Valderhaug
- Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, Hospital of Aalesund, Aalesund, Norway
| | - K Dahl
- The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - B Weidle
- Regional Centre for Child and Youth Mental Health and Child Welfare, Central Norway, Trondheim, Norway.,Department of Child and Adolescent Psychiatry, St. Olavs Hospital, Trondheim, Norway
| | - N C Torp
- The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway.,Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - M Grados
- John Hopkins Children's Center, Baltimore, USA
| | - A B Lewin
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - K H Melin
- Department of Child and Adolescent Psychiatry, Queen Silvia's Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E A Storch
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA.,Department of Psychology, University of South Florida, St. Petersburg, FL, USA
| | - L H Wolters
- Department of Child and Adolescent Psychiatry, Academic Medical Center, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands.,Academic Center for Child and Adolescent Psychiatry, de Bascule, Meibergdreef 5, 1105 AZ, Amsterdam, The Netherlands
| | - T K Murphy
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, FL, USA.,Department of Psychiatry and Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | | | - P H Thomsen
- Center for Child and Adolescent Psychiatry, Aarhus University Hospital Risskov, Risskov, Denmark
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26
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Rozenman M, Peris T, Bergman RL, Chang S, O'Neill J, McCracken JT, Piacentini J. Distinguishing Fear Versus Distress Symptomatology in Pediatric OCD. Child Psychiatry Hum Dev 2017; 48:63-72. [PMID: 27225633 PMCID: PMC5860879 DOI: 10.1007/s10578-016-0653-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Prior research has identified OCD subtypes or "clusters" of symptoms that differentially relate to clinical features of the disorder. Given the high comorbidity between OCD and anxiety, OCD symptom clusters may more broadly associate with fear and/or distress internalizing constructs. This study examines fear and distress dimensions, including physical concerns (fear), separation anxiety (fear), perfectionism (distress), and anxious coping (distress), as predictors of previously empirically-derived OCD symptom clusters in a sample of 215 youth diagnosed with primary OCD (ages 7-17, mean age = 12.25). Self-reported separation fears predicted membership in Cluster 1 (aggressive, sexual, religious, somatic obsessions, and checking compulsions) while somatic/autonomic fears predicted membership in Cluster 2 (symmetry obsessions and ordering, counting, repeating compulsions). Results highlight the diversity of pediatric OCD symptoms and their differential association with fear, suggesting the need to carefully assess both OCD and global fear constructs that might be directly targeted in treatment.
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Affiliation(s)
- Michelle Rozenman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA.
| | - Tara Peris
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - R Lindsey Bergman
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Susanna Chang
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - Joseph O'Neill
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - James T McCracken
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
| | - John Piacentini
- Division of Child and Adolescent Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, 67-455, Los Angeles, CA, 90095, USA
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Sambrani T, Jakubovski E, Müller-Vahl KR. New Insights into Clinical Characteristics of Gilles de la Tourette Syndrome: Findings in 1032 Patients from a Single German Center. Front Neurosci 2016; 10:415. [PMID: 27672357 PMCID: PMC5018493 DOI: 10.3389/fnins.2016.00415] [Citation(s) in RCA: 83] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/26/2016] [Indexed: 01/23/2023] Open
Abstract
Background: Gilles de la Tourette syndrome (TS) is a complex neuropsychiatric disorder defined by the presence of motor and phonic tics, but often associated with psychiatric comorbidities. The main objective of this study was to explore the clinical presentation and comorbidities of TS. Method: We analyzed clinical data obtained from a large sample (n = 1032; 529 children and 503 adults) of patients with tic disorders from one single German TS center assessed by one investigator. Data was collected with the help of an expert-reviewed semi-structured interview, designed to assess tic severity and certain comorbidities. Group comparisons were carried out via independent sample t-tests and chi-square tests. Results: The main findings of the study are: (1) tic severity is associated with the presence of premonitory urges (PU), copro-, echo-, and paliphenomena and the number of comorbidities, but not age at tic onset; it is higher in patients with comorbid obsessive-compulsive disorder (OCD) than in patients with comorbid attention deficit/hyperactivity disorder (ADHD). (2) PU were found to be highly associated with “not just right experiences” and to emerge much earlier than previously thought alongside with the ability to suppress tics (PU in >60% and suppressibility in >75% at age 8–10 years). (3) Self-injurious behavior (SIB) is highly associated with complex motor tics and coprophenomena, but not with OCD/obsessive-compulsive behavior (OCB). While comorbid ADHD is associated with a lower ability to suppress tics, comorbid depression is associated with sleeping problems. Discussion: Our results demonstrate that tic severity is not influenced by age at onset. From our data, it is suggested that PU represent a specific type of “not just right experience” that is not a prerequisite for tic suppression. Comorbid ADHD reduces patients' ability of successful tic suppression. Our data suggest that SIB belongs to the coprophenomena spectrum and hence should be conceptualized as a complex tic rather than a compulsion. Finally, this study strongly supports the hypothesis that TS+OCD is a more severe form of TS and that comorbid OCD/OCB, depression, and anxiety belong to the TS spectrum, while ADHD should be better conceptualized as a separate problem.
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Affiliation(s)
- Tanvi Sambrani
- Department of Education, Monash UniversityMelbourne, VIC, Australia; Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical SchoolHannover, Germany
| | - Ewgeni Jakubovski
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany
| | - Kirsten R Müller-Vahl
- Clinic of Psychiatry, Social Psychiatry, and Psychotherapy, Hannover Medical School Hannover, Germany
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28
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Dos Santos-Ribeiro S, Lins-Martins NM, Frydman I, Conceição do Rosário M, Ferrão YA, Shavitt RG, Yücel M, Miguel EC, Fontenelle LF. Prevalence and correlates of electroconvulsive therapy delivery in 1001 obsessive-compulsive disorder outpatients. Psychiatry Res 2016; 239:145-8. [PMID: 27137976 DOI: 10.1016/j.psychres.2016.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 03/03/2016] [Accepted: 03/07/2016] [Indexed: 11/17/2022]
Abstract
Individuals with obsessive-compulsive disorder (OCD) who sought treatment in seven different specialized centers (n=1001) were evaluated with a structured assessment battery. Thirteen OCD patients (1.3% of the sample) reported having been treated with electroconvulsive therapy (ECT) in the past. They were older and exhibited higher global severity of OCD symptoms, but were less likely to display symmetry/ordering and contamination/washing symptoms. They also had greater suicidality and increased rates of psychosis. Finally, OCD patients exposed to ECT were more frequently treated with antipsychotics, although they did not differ in terms of responses to adequate trials with serotonin reuptake inhibitors.
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Affiliation(s)
| | | | - Ilana Frydman
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Ygor A Ferrão
- Department of Psychiatry and Legal Medicine, Health Sciences Federal University of Porto Alegre, Rio Grande do Sul, Brazil
| | - Roseli G Shavitt
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Murat Yücel
- School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia
| | - Euripedes C Miguel
- Department and Institute of Psychiatry, University of São Paulo, São Paulo, Brazil
| | - Leonardo F Fontenelle
- Institute of Psychiatry, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil; School of Psychological Sciences and Monash Institute of Cognitive and Clinical Neurosciences, Monash University, Victoria, Australia; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, Brazil.
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29
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Norr AM, Oglesby ME, Raines AM, Macatee RJ, Allan NP, Schmidt NB. Relationships between cyberchondria and obsessive-compulsive symptom dimensions. Psychiatry Res 2015; 230:441-6. [PMID: 26429148 DOI: 10.1016/j.psychres.2015.09.034] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/28/2015] [Accepted: 09/22/2015] [Indexed: 10/23/2022]
Abstract
Researchers have recently begun to investigate a vicious cycle of escalating physical health concerns and online medical information seeking coined "cyberchondria". Research has shown that cyberchondria is strongly associated with health anxiety (HA), but there is a dearth of work investigating the potential relationships between cyberchondria and other anxiety-related pathologies. One such condition is obsessive-compulsive disorder (OCD), which could theoretically be related to cyberchondria given the physical health relevant focus of certain types of OC symptoms. The current study sought to investigate the potential relationship between cyberchondria OCD across OC symptom dimensions. Community participants (N=468) were recruited via online crowdsourcing to complete a battery of self-report questionnaires including cyberchondria and OC measures. Structural equation modeling revealed significant unique associations between both contamination/washing and responsibility for harm/checking symptoms, and cyberchondria, such that greater cyberchondria was associated with greater OC symptoms after controlling for HA and trait negative affect. These results suggest that similar to proposed models of cyberchondria and HA, cyberchondria could potentially play a role in the development/maintenance of two dimensions of OC symptoms, or vice versa. Future work will need to determine the causal nature of these relationships or whether they are simply co-occurring phenomena.
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Affiliation(s)
- Aaron M Norr
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Mary E Oglesby
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Amanda M Raines
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Richard J Macatee
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Nicholas P Allan
- Department of Psychology, Florida State University Tallahassee, FL, USA
| | - Norman B Schmidt
- Department of Psychology, Florida State University Tallahassee, FL, USA.
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30
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Examination of the relations between obsessive-compulsive symptom dimensions and fear and distress disorder symptoms. J Affect Disord 2015; 183:253-7. [PMID: 26042633 DOI: 10.1016/j.jad.2015.05.013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 05/07/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Whereas prior work has established fear and distress clusters underlying unipolar mood and anxiety disorders, the optimal placement of obsessive-compulsive disorder (OCD) within this model is unclear. One likely contributor to this ambiguity is the heterogeneous nature of OCD. There is increasing evidence for distinct symptom dimensions that are more homogenous than the broad OCD phenotype. Using structural equation modeling, the current study examined the relations between various OCD symptom dimensions and symptoms associated with fear/distress disorders. METHODS Participants included 526 individuals recruited from an online crowdsourcing marketplace. RESULTS Results revealed that the symmetry obsessions/arranging compulsions, harm obsessions/checking compulsions, and unacceptable thoughts/neutralizing compulsions were related to both fear and distress disorder symptoms, whereas the contamination obsessions/washing compulsions dimension of OCD was specifically related to fear disorder symptoms. LIMITATIONS Limitations include the use of self-report questionnaires to measure all constructs of interest. CONCLUSIONS These findings add to a growing body of literature attesting to the multidimensional nature of OCD and progress our understanding of the etiological underpinnings of this severe and debilitating condition.
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31
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Obsessive-compulsive symptom dimensions in a population-based, cross-sectional sample of school-aged children. J Psychiatr Res 2015; 62:108-14. [PMID: 25702286 DOI: 10.1016/j.jpsychires.2015.01.018] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 11/03/2014] [Accepted: 01/29/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Obsessive-compulsive disorder can be expressed as four potentially overlapping obsessive-compulsive symptom (OCS) dimensions (OCSD) ("symmetry/ordering", "contamination/cleaning", "aggressive/sexual/religious" and "collecting/hoarding"). In clinical samples, some dimensions are more familial and associated with increased psychiatric comorbidity and malfunctioning. However, data concerning OCS and OCSD are scarce in non-clinical samples, particularly among children. The present study aims to estimate: (1) the prevalence and sex/age distribution of OCS/OCSD in a community-based sample of schoolchildren; (2) the association between OCS and additional clinical factors; and (3) the degree of familial aggregation of OCS/OCSD. METHODS OCS and OCSD were evaluated in 9937 Brazilian school-children (6-12 years-old) and their biological relatives using the Family History Screen. Data analyses included gradient estimated equations and post-hoc tests. RESULTS We included data on 9937 index-children, 3305 siblings (13-18 years-old), and 16,218 parents. Biological mothers were the informants in 87.6% of the interviews. OCS were present in 14.7% of the index-children; 15.6% of their siblings; 34.6% of their mothers and 12.1% of their fathers. The prevalence of OCS and each of the OCSD gradually increased from ages 6 to 12 years. Overall, OCS in children were associated with the presence of other psychiatric symptoms, as well as behavioral/school impairment. OCS and each of the four OCSD aggregated significantly within families. CONCLUSIONS OCS are prevalent and associated with psychiatric symptoms and clinical impairment among school-aged children. OCSD aggregate within families in a dimension-specific fashion. These findings suggest a natural continuum between OCS and OCD with regard to their dimensional character.
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32
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Brain white matter integrity and association with age at onset in pediatric obsessive-compulsive disorder. BIOLOGY OF MOOD & ANXIETY DISORDERS 2014; 4:13. [PMID: 25540681 PMCID: PMC4275938 DOI: 10.1186/s13587-014-0013-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Accepted: 11/14/2014] [Indexed: 11/29/2022]
Abstract
Background Obsessive-compulsive disorder (OCD) is a common and debilitating neuropsychiatric illness thought to involve abnormal connectivity of widespread brain networks, including frontal-striatal-thalamic circuits. At least half of OCD cases arise in childhood and their underlying neuropathology may differ at least in part from that of adult-onset OCD. Yet, only a few studies have examined brain white matter (WM) integrity in childhood-onset OCD using diffusion tensor imaging (DTI), and none have examined potential associations with age at onset. Results In this study, 17 youth with OCD and 19 healthy control subjects, ages 10 to 19 years, underwent DTI on a 3T Siemens scanner. DSM-IV diagnoses were established with standardized interviews, and OCD symptom severity was evaluated using the Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Voxel-wise analyses were conducted on data processed with tract-based spatial statistics (TBSS) to derive measures of fractional anisotropy (FA), axial diffusivity (AD), radial diffusivity (RD), and mean diffusivity (MD). OCD patients had significantly lower FA in seven WM clusters, with over 80% of significant voxels in bilateral frontal cortex and corpus callosum (CC). There were no regions of significantly higher FA in patients compared with controls. Patients also had significantly higher RD in right frontal cortex and right body of the CC. Earlier age at onset of OCD correlated significantly with lower FA in the right thalamus and with higher RD in the right CC. FA and RD were not significantly associated with symptom severity. Conclusions These findings point to compromised WM integrity and reduced myelination in some brain regions of children with OCD, particularly the CC and fiber tracts that connect the frontal lobes to widespread cortical and subcortical targets. They also suggest that age at onset may be a moderator of some of the WM changes in pediatric OCD.
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33
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McGuire JF, Crawford EA, Park JM, Storch EA, Murphy TK, Larson MJ, Lewin AB. Neuropsychological performance across symptom dimensions in pediatric obsessive compulsive disorder. Depress Anxiety 2014; 31:988-96. [PMID: 24523044 DOI: 10.1002/da.22241] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Revised: 12/07/2013] [Accepted: 01/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Few studies have examined neuropsychological functioning among youth with obsessive compulsive disorder (OCD), with inconclusive results. Although methodological differences may contribute to inconsistent findings, clinical factors may also account for differential performance. Symptom dimensions are associated with specific patterns of genetic transmission, comorbidity, and treatment outcome, and may also be uniquely associated with neuropsychological performance. This study examined differences in cognitive sequelae and neurocognitive impairment across symptom dimensions among youth with OCD. METHOD Participants included 93 treatment-seeking youth diagnosed with OCD. A trained clinician administered the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) to parents and children together. Afterward, youth completed a battery of neuropsychological tests that assessed nonverbal memory and fluency, verbal memory, verbal fluency, verbal learning, processing speed, and inhibition/switching. RESULTS Across five symptom dimensions, youth exhibiting Hoarding symptoms (χ(2) = 5.21, P = .02) and Symmetry/Ordering symptoms had a greater occurrence of cognitive sequelae (χ(2) = 4.86, P = .03). Additionally, youth with Symmetry/Ordering symptoms had a greater magnitude of cognitive impairment (Mann-Whitney U = 442.50, Z = -2.49, P < .02), with specific deficits identified on nonverbal fluency (P < .01), processing speed (P < .01), and inhibition and switching (P < .02). CONCLUSIONS Neuropsychological deficits identified in youth with Hoarding and Symmetry/Ordering symptoms may suggest that these symptoms have characteristics specific to neurocognitive impairment. Alternatively, symptoms associated with these dimensions may impede youth's performance during testing. Findings advise neuropsychological testing for youth with symptoms on either of these dimensions when concerns about neuropsychological and/or academic impairment are present.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, Tampa, Florida; Department of Pediatrics, University of South Florida, Saint Petersburg, Florida
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Abstract
From the existing self-report measures for youth Obsessive-Compulsive (OC) symptoms, several challenges can be delineated to further improve the assessment of youth OC-related pathology. The current manuscript incorporates these challenges and reports on the development and validation of a new self-report OC scale for younger age groups, that was labeled the Youth Obsessive-Compulsive Symptoms Scale (YOCSS), assessing OC symptoms and impairment in adolescents (three independent samples: N = 336; N = 289; and N = 209). Study 1 reports on the construction of the items and facets, and their higher-order structure, whereas Study 2 focuses on the confirmation of this structure, measurement invariance across age, and on the convergent and incremental predictive validity. These psychometric analyses resulted in ten symptom facets (structured in three domains) and one impairment facet, and further suggest that the YOCSS is a promising tool for describing early OC symptoms along a dimensional perspective.
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35
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Samuels J, Grados MA, Riddle MA, Bienvenu OJ, Goes FS, Cullen B, Wang Y, Greenberg BD, Fyer AJ, McCracken JT, Geller D, Murphy DL, Knowles JA, Rasmussen SA, McLaughlin NC, Piacentini J, Pauls DL, Stewart SE, Shugart YY, Maher B, Pulver AE, Nestadt G. Hoarding in Children and Adolescents with Obsessive-Compulsive Disorder. J Obsessive Compuls Relat Disord 2014; 3:325-331. [PMID: 25309849 PMCID: PMC4187108 DOI: 10.1016/j.jocrd.2014.08.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Compared to studies in adults, there have been few studies of hoarding in children and adolescents with obsessive-compulsive disorder (OCD). In the current study, we evaluated OCD clinical features, Axis I disorders, and social reciprocity scores in 641 children and adolescents with OCD, of whom 163 (25%) had hoarding compulsions and 478 did not. We found that, as a group, youth with hoarding had an earlier age at onset and more severe lifetime OCD symptoms, poorer insight, more difficulty making decisions and completing tasks, and more overall impairment. The hoarding group also had a greater lifetime prevalence of panic disorder, specific phobia, Tourette disorder, and tics. As measured with the Social Reciprocity Scale, the hoarding group had more severe deficits in parent-rated domains of social communication, social motivation, and restricted interests and repetitive behavior. In a multivariable model, the overall social reciprocity score, age at onset of OCD symptoms, symmetry obsessions, and indecision were independently related to hoarding in these children and adolescents with OCD. These features should be considered as candidate risk factors for the development of hoarding behavior in pediatric OCD.
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Affiliation(s)
- Jack Samuels
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Marco A. Grados
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Mark A. Riddle
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - O. Joseph Bienvenu
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Fernando S. Goes
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Bernadette Cullen
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Ying Wang
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Benjamin D. Greenberg
- Department of Psychiatry and Human Behavior, Brown Medical
School, Butler Hospital, Providence, Rhode Island
| | - Abby J. Fyer
- Department of Psychiatry, College of Physicians and
Surgeons at Columbia University and the New York State Psychiatric Institute, New
York City, New York
| | - James T. McCracken
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, School of Medicine, Los Angeles,
California
| | - Dan Geller
- Department of Psychiatry, Harvard Medical School, Boston,
Massachusetts
| | - Dennis L. Murphy
- Laboratory of Clinical Science, National Institute of
Mental Health, National Institute of Health, Bethesda, Maryland
| | - James A. Knowles
- Department of Psychiatry, University of Southern California
School of Medicine, Los Angeles, California
| | - Steven A. Rasmussen
- Department of Psychiatry and Human Behavior, Brown Medical
School, Butler Hospital, Providence, Rhode Island
| | - Nicole C. McLaughlin
- Department of Psychiatry and Human Behavior, Brown Medical
School, Butler Hospital, Providence, Rhode Island
| | - John Piacentini
- Department of Psychiatry and Biobehavioral Sciences,
University of California, Los Angeles, School of Medicine, Los Angeles,
California
| | - David L. Pauls
- Department of Psychiatry and Psychiatric and
Neurodevelopmental Genetics Unit, Massachusetts General Hospital and Harvard Medical
School, Boston, Massachusetts
| | - S. Evelyn Stewart
- Department of Psychiatry, Faculty of Medicine, University
of British Columbia, Vancouver
| | - Yin-Yao Shugart
- Unit of Statistical Genomics, Division of Intramural
Research, National Institute of Mental Health, Bethesda, MD, USA
| | - Brion Maher
- Department of Mental Health, Bloomberg School of Public
Health, Johns Hopkins University, Baltimore, Maryland
| | - Ann E. Pulver
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns
Hopkins University School of Medicine, Baltimore, Maryland
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Mas S, Pagerols M, Gassó P, Ortiz A, Rodriguez N, Morer A, Plana MT, Lafuente A, Lazaro L. Role ofGAD2andHTR1Bgenes in early-onset obsessive-compulsive disorder: results from transmission disequilibrium study. GENES BRAIN AND BEHAVIOR 2014; 13:409-17. [DOI: 10.1111/gbb.12128] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 12/16/2013] [Accepted: 02/24/2014] [Indexed: 01/09/2023]
Affiliation(s)
- S. Mas
- Department of Anatomic Pathology, Pharmacology and Microbiology; University of Barcelona; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Spain
| | - M. Pagerols
- Department of Anatomic Pathology, Pharmacology and Microbiology; University of Barcelona; Barcelona Spain
| | - P. Gassó
- Department of Anatomic Pathology, Pharmacology and Microbiology; University of Barcelona; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Spain
| | - A. Ortiz
- Department of Child and Adolescent Psychiatry and Psychology; Institute of Neurosciences, Hospital Clinic de Barcelona; Barcelona Spain
| | - N. Rodriguez
- Department of Anatomic Pathology, Pharmacology and Microbiology; University of Barcelona; Barcelona Spain
| | - A. Morer
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Spain
- Department of Child and Adolescent Psychiatry and Psychology; Institute of Neurosciences, Hospital Clinic de Barcelona; Barcelona Spain
| | - M. T. Plana
- Department of Child and Adolescent Psychiatry and Psychology; Institute of Neurosciences, Hospital Clinic de Barcelona; Barcelona Spain
| | - A. Lafuente
- Department of Anatomic Pathology, Pharmacology and Microbiology; University of Barcelona; Barcelona Spain
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Spain
| | - L. Lazaro
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS); Barcelona Spain
- Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM); Barcelona Spain
- Department of Child and Adolescent Psychiatry and Psychology; Institute of Neurosciences, Hospital Clinic de Barcelona; Barcelona Spain
- Department of Psychiatry and Clinical Psychobiology; University of Barcelona; Barcelona Spain
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37
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Benito K, Storch EA. Assessment of obsessive–compulsive disorder: review and future directions. Expert Rev Neurother 2014; 11:287-98. [DOI: 10.1586/ern.10.195] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Are the symptoms of obsessive-compulsive disorder temporally stable in children/adolescents? A prospective naturalistic study. Psychiatry Res 2013; 209:196-201. [PMID: 23261183 DOI: 10.1016/j.psychres.2012.11.033] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 10/17/2012] [Accepted: 11/22/2012] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) symptoms tend to be temporally stable in adults, but much less is known about their stability in young people. We examined the temporal stability of OCD symptoms in a clinical pediatric sample. As part of a naturalistic longitudinal study, 74 children and adolescents with OCD were assessed with the Children's Yale-Brown Obsessive Compulsive Scale on two separate occasions ranging from 1 to 11 years apart (average 5 years). Analysis of variance and multiple regression models examined changes within and between symptoms and symptom dimensions. Changes within individual symptom categories were observed in approximately 15-45% of the cases, depending on the specific symptom. In most of those cases, symptoms went from present to absent at follow-up rather than from absent to present. Changes were no longer significant when individuals who were in remission at follow-up were excluded. Multiple regression analyses indicated that the strongest predictor of a particular symptom dimension at follow-up was the presence of the same dimension at baseline. Shifts from one dimension to another were rare. The content of OCD symptoms is relatively stable across time in young people. Most changes observed were attributable to clinical improvement/remission and occurred within rather than between symptom dimensions.
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39
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Masi G, Pfanner C, Brovedani P. Antipsychotic augmentation of selective serotonin reuptake inhibitors in resistant tic-related obsessive-compulsive disorder in children and adolescents: a naturalistic comparative study. J Psychiatr Res 2013; 47:1007-12. [PMID: 23664673 DOI: 10.1016/j.jpsychires.2013.04.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2012] [Revised: 03/18/2013] [Accepted: 04/02/2013] [Indexed: 11/28/2022]
Abstract
The aim of this study is to assess efficacy of augmentation of SSRIs with risperidone or aripiprazole in youths with tic-related Obsessive-Compulsive Disorder (OCD) non responders to an SSRI monotherapy. 120 consecutive patients (age range 7-18 years) were treated with an SSRI monotherapy for at least 12 weeks, 51 (42.5%) were responders, and the 69 non-responders (mean age 13.7 ± 2.4 years) were included in this study. 35 patients received an augmentation with risperidone (1.7 ± .8 mg/day), and 34 with aripiprazole (8.9 ± 3.1 mg/day) for 12 weeks. Regarding the OCD symptomatology, at the endpoint the Clinical Global Impression-Severity score (CGI-S) improved from 5.6 ± .8 (severely ill), to 3.2 ± .9 (mild to moderately ill) (p < .0001), and the Children-Global Assessment Scale (C-GAS) from 40.3 ± 5.2 to 53.8 ± 9.2 (p < .0001). Thirty-nine patients (56.5%) were responders in OCD symptomatology (CGI-I score 1 or 2, CGI-S score 3 or less and C-GAS score 50 or more during three consecutive months after a 12-week treatment). Compared to non responders, they were less impaired at the baseline in CGI-S (p < .0001) and C-GAS (p < .0001). Subtypes of OCD and comorbidity did not affect the response. No differences were found between risperidone and aripiprazole augmentation. 47 patients (68.1%) significantly improved tics, without differences between risperidone and aripiprazole. None discontinued medications because of side effects, but risperidone was associated with weight gain and sedation, and aripiprazole to mild/moderate agitation. In tic-related pediatric OCD, augmentation of SSRIs with risperidone or aripiprazole was tolerated and effective in about half of the patients non responding to an SSRI.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute Child Neurology and Psychiatry, Calambrone, Pisa, Italy.
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40
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Stewart SE, Mayerfeld C, Arnold PD, Crane JR, O'Dushlaine C, Fagerness JA, Yu D, Scharf JM, Chan E, Kassam F, Moya PR, Wendland JR, Delorme R, Richter MA, Kennedy JL, Veenstra-VanderWeele J, Samuels J, Greenberg BD, McCracken JT, Knowles JA, Fyer AJ, Rauch SL, Riddle MA, Grados MA, Bienvenu OJ, Cullen B, Wang Y, Shugart YY, Piacentini J, Rasmussen S, Nestadt G, Murphy DL, Jenike MA, Cook EH, Pauls DL, Hanna GL, Mathews CA. Meta-analysis of association between obsessive-compulsive disorder and the 3' region of neuronal glutamate transporter gene SLC1A1. Am J Med Genet B Neuropsychiatr Genet 2013; 162B:367-79. [PMID: 23606572 DOI: 10.1002/ajmg.b.32137] [Citation(s) in RCA: 74] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Accepted: 01/15/2013] [Indexed: 12/12/2022]
Abstract
The neuronal glutamate transporter gene SLC1A1 is a candidate gene for obsessive-compulsive disorder (OCD) based on linkage studies and convergent evidence implicating glutamate in OCD etiology. The 3' end of SLC1A1 is the only genomic region with consistently demonstrated OCD association, especially when analyzing male-only probands. However, specific allele associations have not been consistently replicated, and recent OCD genome-wide association and meta-analysis studies have not incorporated all previously associated SLC1A1 SNPs. To clarify the nature of association between SLC1A1 and OCD, pooled analysis was performed on all available relevant raw study data, comprising a final sample of 815 trios, 306 cases and 634 controls. This revealed weak association between OCD and one of nine tested SLC1A1 polymorphisms (rs301443; uncorrected P = 0.046; non-significant corrected P). Secondary analyses of male-affecteds only (N = 358 trios and 133 cases) demonstrated modest association between OCD and a different SNP (rs12682807; uncorrected P = 0.012; non-significant corrected P). Findings of this meta-analysis are consistent with the trend of previous candidate gene studies in psychiatry and do not clarify the putative role of SLC1A1 in OCD pathophysiology. Nonetheless, it may be important to further examine the potential associations demonstrated in this amalgamated sample, especially since the SNPs with modest associations were not included in the more highly powered recent GWAS or in a past meta-analysis including five SLC1A1 polymorphisms. This study underscores the need for much larger sample sizes in future genetic association studies and suggests that next-generation sequencing may be beneficial in examining the potential role of rare variants in OCD.
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Affiliation(s)
- S E Stewart
- McLean Hospital, Belmont, Massachusetts, USA.
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41
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Jones AM, De Nadai AS, Arnold EB, McGuire JF, Lewin AB, Murphy TK, Storch EA. Psychometric properties of the obsessive compulsive inventory: child version in children and adolescents with obsessive-compulsive disorder. Child Psychiatry Hum Dev 2013; 44:137-51. [PMID: 22711294 DOI: 10.1007/s10578-012-0315-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The psychometric properties of the Obsessive Compulsive Inventory-Child Version (OCI-CV) were examined in ninety-six youth with a primary/co-primary diagnosis of obsessive-compulsive disorder (OCD). A confirmatory factor analysis revealed an acceptable model of fit with factors consisting of doubting/checking, obsessing, hoarding, washing, ordering, and neutralizing. The internal consistency of the OCI-CV total score was good, while internal consistency for subscale scores ranged from poor to good. The OCI-CV was modestly correlated with obsessive-compulsive symptom severity on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) Severity Scale, as well as with clinician-reported OCD severity. All OCI-CV subscales significantly correlated with the corresponding CY-BOCS Symptom Checklist dimension. The OCI-CV significantly correlated with child-reported depressive symptoms and OCD-related functional impairment, but was not significantly correlated with parent-reported irritability or clinician-reported overall functioning. Taken together, these data suggest the psychometric properties of the OCI-CV are adequate for assessing obsessive-compulsive symptom presence among youth with OCD.
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Affiliation(s)
- Anna M Jones
- Department of Pediatrics, University of South Florida Morsani College of Medicine, Tampa, FL, USA
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42
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Lack CW. Obsessive-compulsive disorder: Evidence-based treatments and future directions for research. World J Psychiatry 2012; 2:86-90. [PMID: 24175173 PMCID: PMC3782190 DOI: 10.5498/wjp.v2.i6.86] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 09/14/2012] [Accepted: 09/21/2012] [Indexed: 02/05/2023] Open
Abstract
Over the past three decades, obsessive-compulsive disorder (OCD) has moved from an almost untreatable, life-long psychiatric disorder to a highly manageable one. This is a very welcome change to the 1%-3% of children and adults with this disorder as, thanks to advances in both pharmacological and psychological therapies, prognosis for those afflicted with OCD is quite good in the long term, even though most have comorbid disorders that are also problematic. We still have far to go, however, until OCD can be described as either easily treatable or the effective treatments are widely known about among clinicians. This review focuses on the current state of the art in treatment for OCD and where we still are coming up short in our work as a scientific community. For example, while the impact of medications is quite strong for adults in reducing OCD symptoms, current drugs are only somewhat effective for children. In addition, there are unacceptably high relapse rates across both populations when treated with pharmacological alone. Even in the cognitive-behavioral treatments, which show higher effect sizes and lower relapse rates than drug therapies, drop-out rates are at a quarter of those who begin treatment. This means a sizable portion of the OCD population who do obtain effective treatments (which appears to be only a portion of the overall population) are not effectively treated. Suggestions for future avenues of research are also presented. These are primarily focused on (1) increased dissemination of effective therapies; (2) augmentation of treatments for those with residual symptoms, both for psychotherapy and pharmacotherapy; and (3) the impact of comorbid disorders on treatment outcome.
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Affiliation(s)
- Caleb W Lack
- Caleb W Lack, Department of Psychology, University of Central Oklahoma, Edmond, OK 73034, United States
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McGuire JF, Lewin AB, Horng B, Murphy TK, Storch EA. The nature, assessment, and treatment of obsessive-compulsive disorder. Postgrad Med 2012; 124:152-65. [PMID: 22314125 DOI: 10.3810/pgm.2012.01.2528] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects between 1% to 2% of individuals and causes considerable impairment and disability. Although > 50% of individuals experience symptom onset in childhood, symptoms can continue to develop throughout adulthood. Accurate and timely assessment of clinical presentation is critical to limit impairment and improve prognosis. Presently, there are 2 empirically supported treatments available for OCD in children and adults, namely cognitive-behavioral therapy and pharmacotherapy with serotonin reuptake inhibitors. This article provides an introduction to the phenomenology, etiology, and clinical course of OCD. Assessment practices used to evaluate symptom severity are described, and evidence-based treatment options are reviewed, with appropriate distinctions drawn between children and adults. Finally, recommendations for assessment and treatment practices for OCD are explicated.
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Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, St. Petersburg, FL 33701, USA
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Affiliation(s)
- Randy O. Frost
- Department of Psychology, Smith College, Northampton, Massachusetts 01063;
| | - Gail Steketee
- School of Social Work, Boston University, Boston, Massachusetts 02215
| | - David F. Tolin
- The Institute of Living and Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut 06520
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45
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Nikolajsen KH, Nissen JB, Thomsen PH. Obsessive-compulsive disorder in children and adolescents: symptom dimensions in a naturalistic setting. Nord J Psychiatry 2011; 65:244-50. [PMID: 21062123 DOI: 10.3109/08039488.2010.533386] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a frequent and clinically heterogeneous disorder. The complex clinical presentation can be summarized using a few consistent and temporally stable symptom dimensions. Only few studies in children and adolescents have examined the importance of symptom dimensions. AIMS This retrospective study was undertaken to describe the relation between symptom dimensions, pattern of comorbidity and family disposition, in a sample of Danish children and adolescents with OCD assessed in a naturalistic setting. METHODS A retrospective study of children and adolescents (n=83) diagnosed with OCD in the period 1998-2004, at the Psychiatric Hospital for Children and Adolescents, Risskov, Denmark. Information from clinical records was systematically collected and Children's Yale-Brown Obsessive-compulsive Scale (CY-BOCS) scores and symptom checklists were obtained. RESULTS High scores on the symmetry/ordering dimension were related to OCD in first-degree relatives and high scores on the aggressive/checking dimension were associated to comorbidity with tic disorders. We showed a correlation between limited insight and younger age. CONCLUSION This is one of the first studies to examine symptom dimensions in children and adolescents in naturalistic settings. The results were comparable with those in adult studies, showing an association between the occurrence of the symmetry/ordering dimension and family OCD and the occurrence of the aggressive/checking dimension and comorbid tic disorders. In small children, insight into symptoms may be limited.
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46
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Storch EA, Benito K, Goodman W. Assessment scales for obsessive–compulsive disorder. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.11.22] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Lafleur DL, Petty C, Mancuso E, McCarthy K, Biederman J, Faro A, Levy HC, Geller DA. Traumatic events and obsessive compulsive disorder in children and adolescents: is there a link? J Anxiety Disord 2011; 25:513-9. [PMID: 21295942 PMCID: PMC3074033 DOI: 10.1016/j.janxdis.2010.12.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Revised: 12/20/2010] [Accepted: 12/20/2010] [Indexed: 11/21/2022]
Abstract
BACKGROUND The extant literature supports an association between psychological trauma and development of OCD in adults, and this link is a plausible mediator for environment-gene interactions leading to phenotypic expression of OCD. OBJECTIVE To explore the relationship between OCD and traumatic life events in children and adolescents. METHODS We examined the prevalence of traumatic life events and PTSD in a large sample of systematically assessed children with OCD. OCD symptoms and severity were assessed using the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS) in those with and without concurrent PTSD. RESULTS Rate of PTSD and trauma exposure was higher in children with OCD than in a comparable control group of non-OCD youth matched for age, gender and SES. Children with concurrent PTSD had more intrusive fears and distress and less control over their rituals than children with OCD but without PTSD. Total CY-BOCS scores were higher in those with concurrent PTSD. Specific type of OCD symptoms was not altered by a PTSD diagnosis. CONCLUSIONS A history of psychologically traumatic events may be over-represented in children with OCD. Given the need to search for non-genetic factors that may lead to onset of OCD, better and more systematic methods to obtain and quantify psychologically traumatic life events are needed in clinical populations.
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Affiliation(s)
- Daniel L Lafleur
- Child and Youth Mental Health Program, British Columbia Children's Hospital, Vancouver, Canada
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48
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Storch EA, Rahman O, Park JM, Reid J, Murphy TK, Lewin AB. Compulsive hoarding in children. J Clin Psychol 2011; 67:507-16. [PMID: 21381027 DOI: 10.1002/jclp.20794] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
This article discusses the nature and treatment of compulsive hoarding among children. We summarize the phenomenology of compulsive hoarding, including its clinical presentation, comorbidity with varied mental disorders, and associated impairment. The limited data on treatment outcome are presented along with a behavioral framework that we utilized to treat youth who hoard. Our approach is highlighted in the context of a case illustration of an 11-year-old girl suffering from compulsive hoarding and several comorbid mental health disorders. We conclude with recommendations for clinical work with this challenging and neglected population.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, 800 6th Street, South, Box 7523, St. Petersburg, FL 33701, USA.
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49
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Delucchi KL, Katerberg H, Stewart SE, Denys DA, Lochner C, Stack DE, den Boer JA, van Balkom AJ, Jenike MA, Stein DJ, Cath DC, Mathews CA. Latent class analysis of the Yale-Brown Obsessive-Compulsive Scale symptoms in obsessive-compulsive disorder. Compr Psychiatry 2011; 52:334-41. [PMID: 21145539 PMCID: PMC3086656 DOI: 10.1016/j.comppsych.2010.06.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2010] [Revised: 06/23/2010] [Accepted: 06/24/2010] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is phenomenologically heterogeneous, and findings of underlying structure classification based on symptom grouping have been ambiguous to date. Variable-centered approaches, primarily factor analysis, have been used to identify homogeneous groups of symptoms; but person-centered latent methods have seen little use. This study was designed to uncover sets of homogeneous groupings within 1611 individuals with OCD based on symptoms. METHOD Latent class analysis models using 61 obsessive-compulsive symptoms collected from the Yale-Brown Obsessive-Compulsive Scale were fit. Relationships between latent class membership and treatment response, sex, symptom severity, and comorbid tic disorders were tested for relationship to class membership. RESULTS Latent class analysis models of best fit yielded 3 classes. Classes differed only in frequency of symptom endorsement. Classes with higher symptom endorsement were associated with earlier age of onset, being male, higher Yale-Brown Obsessive-Compulsive Scale symptom severity scores, and comorbid tic disorders. There were no differences in treatment response between classes. CONCLUSIONS These results provide support for the validity of a single underlying latent OCD construct, in addition to the distinct symptom factors identified previously via factor analyses.
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Affiliation(s)
- Kevin L. Delucchi
- Department of Psychiatry, University of California, San Francisco, California, USA
| | - Hilga Katerberg
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands & GGZ Buitenamstel, Amsterdam, The Netherlands
| | - S. Evelyn Stewart
- Obsessive-Compulsive Disorder Clinics (Adult and Pediatric), Massachusetts General Hospital, Boston, Massachusetts, USA, Psychiatric and Neurodevelopmental Genetics Unit, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA, Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts, USA
| | - Damiaan A.J.P. Denys
- Department of Psychiatry, Academic Medical Center, University of Amsterdam, & the Netherlands Institute for Neuroscience, an institute of the Royal Netherlands Academy of Arts and Sciences, Amsterdam, The Netherlands
| | - Christine Lochner
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa
| | - Denise E. Stack
- Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts, USA
| | - Johan A. den Boer
- Department of Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Anton J.L.M. van Balkom
- Department of Clinical & Health Psychology, Utrecht University & Altrecht Anxiety Outpatient program, Utrecht, the Netherlands
| | - Michael A. Jenike
- Obsessive-Compulsive Disorder Clinics (Adult and Pediatric), Massachusetts General Hospital, Boston, Massachusetts, USA, Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, Massachusetts, USA
| | - Dan J. Stein
- MRC Unit on Anxiety & Stress Disorders, Department of Psychiatry, University of Stellenbosch, South Africa, Department of Psychiatry, University of Cape Town, South Africa
| | - Danielle C. Cath
- Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands & GGZ Buitenamstel, Amsterdam, The Netherlands, Department of Clinical & Health Psychology, Utrecht University & Altrecht Anxiety Outpatient program, Utrecht, the Netherlands
| | - Carol A. Mathews
- Department of Psychiatry, University of California, San Francisco, California, USA
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Jang JH, Kim HS, Ha TH, Shin NY, Kang DH, Choi JS, Ha K, Kwon JS. Nonverbal memory and organizational dysfunctions are related with distinct symptom dimensions in obsessive-compulsive disorder. Psychiatry Res 2010; 180:93-8. [PMID: 20483482 DOI: 10.1016/j.psychres.2010.04.016] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2009] [Revised: 11/16/2009] [Accepted: 04/14/2010] [Indexed: 12/01/2022]
Abstract
Recent acceptance that obsessive-compulsive disorder (OCD) represents a heterogeneous phenomenon has underscored the need for dimensional approaches to this disorder. However little is known about the relation between neuropsychological functions and symptom dimensions. The purpose of this study was to identify the cognitive deficits correlated with specific symptom dimensions. Thirteen categories in the Yale-Brown Obsessive Compulsive Scale symptom checklist from 144 patients with OCD were analyzed by principal component analysis. Correlations between identified symptom dimensions and neuropsychological functioning, measured by the Boston Qualitative Scoring System, were analyzed. Five factors or dimensions were identified: contamination/cleaning, hoarding, symmetry/ordering, obsessions/checking, and repeating/counting. Dysfunctions in nonverbal memory and organizational strategies were related to the symmetry/ordering dimension and the obsessions/checking dimension, respectively. The results of the present study support a transculturally stable symptom structure for OCD. They also suggest the possibility that nonverbal memory dysfunction and organizational impairment are mediated by distinct obsessive-compulsive dimensions.
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Affiliation(s)
- Joon Hwan Jang
- Department of Psychiatry, Seoul National University College of Medicine, Chongno-gu, Seoul, Republic of Korea
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