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Hapakova L, Necpal J, Kosutzka Z. The antisaccadic paradigm: A complementary neuropsychological tool in basal ganglia disorders. Cortex 2024; 178:116-140. [PMID: 38991475 DOI: 10.1016/j.cortex.2024.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/20/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
This review explores the role of the antisaccadic task in understanding inhibitory mechanisms in basal ganglia disorders. It conducts a comparative analysis of saccadic profiles in conditions such as Parkinson's disease, Tourette syndrome, obsessive-compulsive disorder, Huntington's disease, and dystonia, revealing distinct patterns and proposing mechanisms for impaired performance. The primary focus is on two inhibitory mechanisms: global, pre-emptive inhibition responsible for suppressing prepotent responses, and slower, selective response inhibition. The antisaccadic task demonstrates practicality in clinical applications, aiding in differential diagnoses, treatment monitoring and reflecting gait control. To further enhance its differential diagnostic value, future directions should address issues such as the standardization of eye-tracking protocol and the integration of eye-tracking data with other disease indicators in a comprehensive dataset.
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Affiliation(s)
- Lenka Hapakova
- 2nd Department of Neurology, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
| | - Jan Necpal
- Neurology Department, Hospital Zvolen, a. s., Zvolen, Slovakia.
| | - Zuzana Kosutzka
- 2nd Department of Neurology, Comenius University Faculty of Medicine, University Hospital Bratislava, Bratislava, Slovakia.
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2
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Rozenman M, Gonzalez A, Vreeland A, Thamrin H, Perez J, Peris TS. Resting State Psychophysiology in Youth with OCD and Their Caregivers: Preliminary Evidence for Trend Synchrony and Links to Family Functioning. Child Psychiatry Hum Dev 2024; 55:635-643. [PMID: 36107282 DOI: 10.1007/s10578-022-01426-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Revised: 07/27/2022] [Accepted: 08/26/2022] [Indexed: 11/27/2022]
Abstract
The burden of OCD in children and adolescents extends to their caregivers. Prior work in other disorders and unaffected youth has found synchrony in psychophysiological arousal for youth-caregiver dyads. This preliminary study explored whether psychophysiological trend synchrony in youth-caregiver dyads (N = 48) occurred and was moderated by youth OCD diagnosis. We also explored whether psychophysiological indices (i.e., electrodermal activity, heart rate, respiratory sinus arrhythmia) were correlated with reported family functioning in the OCD subsample (n = 25). Youth with OCD had higher resting heart rate than unaffected peers; this was not replicated in caregivers. Trend synchrony was found across the full sample of dyads for electrodermal activity and heart rate, with no moderation by diagnostic group. In the OCD group, youth heart rate was correlated with family conflict and caregiver heart rate with expressiveness. Findings provide preliminary support for further examination of heart rate and family factors in OCD-affected youth and their caregivers.
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Affiliation(s)
- Michelle Rozenman
- Department of Psychology, University of Denver, 2155 S. Race St, 80209, Denver, CO, USA.
| | - Araceli Gonzalez
- Department of Psychology, California State University Long Beach, Long Beach, CA, USA
| | - Allison Vreeland
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Hardian Thamrin
- Department of Psychology, Arizona State University, Tempe, AZ, USA
| | - Jocelyn Perez
- Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute Division of Child & Adolescent Psychiatry, Los Angeles, CA, USA
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Chessell C, Halldorsson B, Walters S, Farrington A, Harvey K, Creswell C. Therapist guided, parent-led cognitive behavioural therapy (CBT) for pre-adolescent children with obsessive compulsive disorder (OCD): a non-concurrent multiple baseline case series. Behav Cogn Psychother 2024; 52:243-261. [PMID: 37840150 DOI: 10.1017/s1352465823000450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2023]
Abstract
BACKGROUND Cognitive behavioural therapy (CBT) including exposure and response prevention (ERP) is an effective treatment for preadolescent children with obsessive compulsive disorder (OCD); however, there is a need to increase access to this treatment for affected children. AIMS This study is a preliminary evaluation of the efficacy and acceptability of a brief therapist-guided, parent-led CBT intervention for pre-adolescent children (5-12 years old) with OCD using a non-concurrent multiple baseline approach. METHOD Parents of 10 children with OCD were randomly allocated to no-treatment baselines of 3, 4 or 5 weeks before receiving six to eight individual treatment sessions with a Psychological Wellbeing Practitioner. Diagnostic measures were completed prior to the baseline, 1-week post-treatment, and at a 1-month follow-up, and parents completed weekly measures of children's OCD symptoms/impairment. RESULTS Seventy percent of children were 'responders' and/or 'remitters' on diagnostic measures at post-treatment, and 60% at the 1-month follow-up. At least 50% of children showed reliable improvements on parent-reported OCD symptoms/impairment from pre- to post-treatment, and from pre-treatment to 1-month follow-up. Crucially, the intervention was acceptable to parents. CONCLUSIONS Brief therapist-guided, parent-led CBT has the potential to be an effective, acceptable and accessible first-line treatment for pre-adolescent children with OCD, subject to the findings of further evaluations.
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Affiliation(s)
- Chloe Chessell
- School of Psychological and Clinical Language Sciences, University of Reading, UK
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Brynjar Halldorsson
- Department of Psychology, Reykjavik University, Iceland
- Landspitali, The National University Hospital of Iceland, Iceland
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
| | - Sasha Walters
- National Specialist CAMHS OCD, BDD, and Related Disorders Team, London, UK
- Oxford Psychological Intervention Centre, Oxford, UK
| | - Alice Farrington
- CAMHS Anxiety and Depression Pathway, Berkshire Healthcare NHS Foundation Trust, Reading, UK
| | - Kate Harvey
- School of Psychological and Clinical Language Sciences, University of Reading, UK
| | - Cathy Creswell
- Department of Experimental Psychology, University of Oxford, UK
- Department of Psychiatry, University of Oxford, UK
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Lima MO, Saraiva LC, Ramos VR, Oliveira MC, Costa DLC, Fernandez TV, Crowley JJ, Storch EA, Shavitt RG, Miguel EC, Cappi C. Clinical characteristics of probands with obsessive-compulsive disorder from simplex and multiplex families. Psychiatry Res 2024; 331:115627. [PMID: 38113811 PMCID: PMC11129832 DOI: 10.1016/j.psychres.2023.115627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 11/14/2023] [Accepted: 11/24/2023] [Indexed: 12/21/2023]
Abstract
Genetic and non-genetic factors contribute to obsessive-compulsive disorder (OCD), with strong evidence of familial clustering. Genomic studies in psychiatry have used the concepts of families that are "simplex" (one affected) versus "multiplex" (multiple affected). Our study compares demographic and clinical data from OCD probands in simplex and multiplex families to uncover potential differences. We analyzed 994 OCD probands (501 multiplex, 493 simplex) from the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (C-TOC). Clinicians administered the Structured Clinical Interview for DSM-IV (SCID-IV) to diagnose, Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) to assess severity, and Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) to assess symptom dimensionality. Demographics, clinical history, and family data were collected. Compared to simplex probands, multiplex probands had earlier onset, higher sexual/religious and hoarding dimensions severity, increased comorbidity with other obsessive-compulsive-related disorders (OCRD), and higher family history of psychiatric disorders. These comparisons provide the first insights into demographic and clinical differences between Latin American simplex and multiplex families with OCD. Distinct clinical patterns may suggest diverse genetic and environmental influences. Further research is needed to clarify these differences, which have implications for symptom monitoring and management.
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Affiliation(s)
- Monicke O Lima
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Leonardo C Saraiva
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Vanessa R Ramos
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Melaine C Oliveira
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Daniel L C Costa
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Thomas V Fernandez
- Child Study Center and Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
| | - James J Crowley
- Departments of Genetics and Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Roseli G Shavitt
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Euripedes C Miguel
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil
| | - Carolina Cappi
- Department & Institute of Psychiatry, Faculdade de Medicina, Hospital das Clinicas HCFMUSP, Universidade de Sao Paulo, Sao Paulo (SP), Brazil; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy, New York, NY, USA.
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Very early-onset Obsessive-Compulsive Disorder in pre-schoolers: A prospective case series. Asian J Psychiatr 2021; 65:102857. [PMID: 34560565 DOI: 10.1016/j.ajp.2021.102857] [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: 07/05/2021] [Revised: 09/02/2021] [Accepted: 09/05/2021] [Indexed: 11/22/2022]
Abstract
Normative Obsessive-compulsive (OC) like behaviors can be common in early childhood. Very young children rarely can present with significantly impairing OC phenomenon associated with severe accommodative behaviors, which may warrant interventions. We describe three pre-schoolers with an onset of impairing OC symptoms at 28-, 21-, and 36-months of ages. An eclectic psychosocial approach based on Behaviorism, Attachment, Sensitive Parenting, Developmental, and Family systems was used. The children were followed-up for one to three years. The cases highlight the pattern of Obsessive-Compulsive Disorders (OCD) in very young children and emphasize the utility of non-pharmacological intervention in this age group.
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Mitra S, Bult-Ito A. Bidirectional Behavioral Selection in Mice: A Novel Pre-clinical Approach to Examining Compulsivity. Front Psychiatry 2021; 12:716619. [PMID: 34566718 PMCID: PMC8458042 DOI: 10.3389/fpsyt.2021.716619] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/16/2021] [Indexed: 11/17/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) and related disorders (OCRD) is one of the most prevalent neuropsychiatric disorders with no definitive etiology. The pathophysiological attributes of OCD are driven by a multitude of factors that involve polygenic mechanisms, gender, neurochemistry, physiological status, environmental exposures and complex interactions among these factors. Such complex intertwining of contributing factors imparts clinical heterogeneity to the disorder making it challenging for therapeutic intervention. Mouse strains selected for excessive levels of nest- building behavior exhibit a spontaneous, stable and predictable compulsive-like behavioral phenotype. These compulsive-like mice exhibit heterogeneity in expression of compulsive-like and other adjunct behaviors that might serve as a valuable animal equivalent for examining the interactions of genetics, sex and environmental factors in influencing the pathophysiology of OCD. The current review summarizes the existing findings on the compulsive-like mice that bolster their face, construct and predictive validity for studying various dimensions of compulsive and associated behaviors often reported in clinical OCD and OCRD.
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Affiliation(s)
- Swarup Mitra
- Department of Pharmacology and Toxicology, State University of New York at Buffalo, Buffalo, NY, United States
| | - Abel Bult-Ito
- Department of Biology and Wildlife, University of Alaska Fairbanks, Fairbanks, AK, United States
- OCRD Biomed LLC, Fairbanks, AK, United States
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La Buissonniere-Ariza V, Fitzgerald K, Meoded A, Williams LL, Liu G, Goodman WK, Storch EA. Neural correlates of cognitive behavioral therapy response in youth with negative valence disorders: A systematic review of the literature. J Affect Disord 2021; 282:1288-1307. [PMID: 33601708 DOI: 10.1016/j.jad.2020.12.182] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 11/25/2020] [Accepted: 12/24/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) is the gold-standard psychotherapeutic treatment for pediatric negative valence disorders. However, some youths do not respond optimally to treatment, which may be due to variations in neural functioning. METHODS We systematically reviewed functional magnetic resonance imaging studies in youths with negative valence disorders to identify pre- and post-treatment neural correlates of CBT response. RESULTS A total of 21 studies were identified, of overall weak to moderate quality. The most consistent findings across negative valence disorders consisted of associations of treatment response with pre- and post-treatment task-based activation and/or functional connectivity within and between the prefrontal cortex, the medial temporal lobe, and other limbic regions. Associations of CBT response with baseline and/or post-treatment activity in the striatum, precentral and postcentral gyri, medial and posterior cingulate cortices, and parietal cortex, connectivity within and between the default-mode, cognitive control, salience, and frontoparietal networks, and metrics of large-scale brain network organization, were also reported, although less consistently. LIMITATIONS The poor quality and limited number of studies and the important heterogeneity of study designs and results considerably limit the conclusions that can be drawn from this literature. CONCLUSIONS Despite these limitations, these findings provide preliminary evidence suggesting youths presenting certain patterns of brain function may respond better to CBT, whereas others may benefit from alternative or augmented forms of treatment.
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Affiliation(s)
- Valerie La Buissonniere-Ariza
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA.
| | - Kate Fitzgerald
- Department of Psychiatry, University of Michigan, Rachel Upjohn Building, 4250 Plymouth Road, Ann Arbor, MI, 48109, USA
| | - Avner Meoded
- Edward B. Singleton Department of Radiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA
| | - Laurel L Williams
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Gary Liu
- Department of Neuroscience, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX, 77030, USA
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Del Casale A, Sorice S, Padovano A, Simmaco M, Ferracuti S, Lamis DA, Rapinesi C, Sani G, Girardi P, Kotzalidis GD, Pompili M. Psychopharmacological Treatment of Obsessive-Compulsive Disorder (OCD). Curr Neuropharmacol 2020; 17:710-736. [PMID: 30101713 PMCID: PMC7059159 DOI: 10.2174/1570159x16666180813155017] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/06/2018] [Accepted: 08/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) is associated with affective and cognitive symptoms causing personal distress and reduced global functioning. These have considerable societal costs due to healthcare service utilization. Objective: Our aim was to assess the efficacy of pharmacological interventions in OCD and clinical guidelines, providing a comprehensive overview of this field. Methods: We searched the PubMed database for papers dealing with drug treatment of OCD, with a specific focus on clinical guidelines, treatments with antidepressants, antipsychotics, mood stabilizers, off-label medications, and pharmacogenomics. Results: Prolonged administration of selective serotonin reuptake inhibitors (SSRIs) is most effective. Better results can be obtained with a SSRI combined with cognitive behavioral therapy (CBT) or the similarly oriented exposure and response prevention (ERP). Refractory OCD could be treated with different strategies, including a switch to another SSRI or clomipramine, or augmentation with an atypical antipsychotic. The addition of medications other than antipsychotics or intravenous antidepressant administration needs further investigation, as the evidence is inconsistent. Pharmacogenomics and personalization of therapy could reduce treatment resistance. Conclusions: SSRI/clomipramine in combination with CBT/ERP is associated with the optimal response compared to each treatment alone or to other treatments. New strategies for refractory OCD are needed. The role of pharmacogenomics could become preponderant in the coming years.
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Affiliation(s)
- Antonio Del Casale
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Serena Sorice
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Alessio Padovano
- Residency School in Psychiatry, Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Simmaco
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | | | - Dorian A Lamis
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, United States
| | - Chiara Rapinesi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Gabriele Sani
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Paolo Girardi
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
| | - Maurizio Pompili
- Department of Neuroscience, Mental Health, and Sensory Organs (NESMOS), Faculty of Medicine and Psychology, Sapienza University, Unit of Psychiatry, Sant'Andrea University Hospital, Rome, Italy
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Early intervention for obsessive compulsive disorder: An expert consensus statement. Eur Neuropsychopharmacol 2019; 29:549-565. [PMID: 30773387 DOI: 10.1016/j.euroneuro.2019.02.002] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 01/04/2019] [Accepted: 02/02/2019] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is common, emerges early in life and tends to run a chronic, impairing course. Despite the availability of effective treatments, the duration of untreated illness (DUI) is high (up to around 10 years in adults) and is associated with considerable suffering for the individual and their families. This consensus statement represents the views of an international group of expert clinicians, including child and adult psychiatrists, psychologists and neuroscientists, working both in high and low and middle income countries, as well as those with the experience of living with OCD. The statement draws together evidence from epidemiological, clinical, health economic and brain imaging studies documenting the negative impact associated with treatment delay on clinical outcomes, and supporting the importance of early clinical intervention. It draws parallels between OCD and other disorders for which early intervention is recognized as beneficial, such as psychotic disorders and impulsive-compulsive disorders associated with problematic usage of the Internet, for which early intervention may prevent the development of later addictive disorders. It also generates new heuristics for exploring the brain-based mechanisms moderating the 'toxic' effect of an extended DUI in OCD. The statement concludes that there is a global unmet need for early intervention services for OC related disorders to reduce the unnecessary suffering and costly disability associated with under-treatment. New clinical staging models for OCD that may be used to facilitate primary, secondary and tertiary prevention within this context are proposed.
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Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.
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Jaspers-Fayer F, Han SHJ, Chan E, McKenney K, Simpson A, Boyle A, Ellwyn R, Stewart SE. Prevalence of Acute-Onset Subtypes in Pediatric Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2017; 27:332-341. [PMID: 28121463 DOI: 10.1089/cap.2016.0031] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Pediatric obsessive-compulsive disorder (OCD) is a common, debilitating illness. When childhood OCD symptom onset is described as acute and severe, diagnostic criteria for pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) and pediatric acute-onset neuropsychiatric syndrome (PANS) should be considered. However, the frequency and differentiating features of these putative syndromes within pediatric OCD remain poorly understood. OBJECTIVES To determine the prevalence and characteristics of those meeting PANDAS and/or PANS criteria within pediatric OCD, as determined by parent report and clinician interview. METHODS Consecutive youth presenting to a subspecialty pediatric OCD clinic were rigorously assessed through the Anxiety Disorders Interview Schedule for DSM-IV, the Children's Yale-Brown Obsessive-Compulsive Scale, and through self- and parent-report measures, including a medical questionnaire. Strict diagnostic criteria for PANDAS and PANS were applied to determine prevalence rates, and comparative analyses were performed between subgroups. RESULTS Among 136 youth with a lifetime OCD diagnosis, 5% (n = 7; 95% adjusted Wald interval: 1%-10%) met proposed criteria for PANDAS and/or PANS, of whom two met PANDAS criteria, four met PANS criteria, and one met criteria for both. Those in the PANDAS/PANS subgroup were more likely to have autoimmune illness, less likely to report symmetry factor symptoms, and had greater OCD-related family impairment during their worst OCD episode. CONCLUSION A small yet significant percentage of pediatric OCD outpatients met criteria for PANDAS and/or PANS, justifying routine screening and attention to related characteristics during assessment and management. Longitudinal studies of these putative subtypes are warranted.
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Affiliation(s)
- Fern Jaspers-Fayer
- 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .,2 Department of Psychiatry, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | | | - Elaine Chan
- 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada
| | - Katherine McKenney
- 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada
| | - Annie Simpson
- 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada
| | - Andrea Boyle
- 4 Department of Psychology, BC Children's Hospital , Vancouver, British Columbia, Canada
| | - Rhonda Ellwyn
- 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada
| | - S Evelyn Stewart
- 1 BC Children's Hospital Research Institute , Vancouver, British Columbia, Canada .,2 Department of Psychiatry, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada .,5 Massachusetts General Hospital , Boston, Massachusetts.,6 Harvard Medical School , Boston, Massachusetts.,7 Department of Psychiatry, BC Children's Hospital , Vancouver, British Columbia, Canada
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Abstract
Obsessive-compulsive disorder (OCD) in children and adolescents is a prevalent condition with a number of adverse correlates and implications. The cognitive-behavioral treatment of an 11-year-old girl with prolonged tooth brushing is described in this case study. The frequency of the compulsive behavior was measured over the course of the treatment and standard assessment devices were used to determine the nature and severity of the OCD symptoms. Results of the intervention were suggestive of substantial improvements in OCD symptoms and a reduction in the associated impairments. The implications of these data were reviewed and recommendations for clinicians who intend on treating OCD in children and adolescents were provided
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Armstrong CC, Moody TD, Feusner JD, McCracken JT, Chang S, Levitt JG, Piacentini JC, O'Neill J. Graph-theoretical analysis of resting-state fMRI in pediatric obsessive-compulsive disorder. J Affect Disord 2016; 193:175-84. [PMID: 26773910 PMCID: PMC5767329 DOI: 10.1016/j.jad.2015.12.071] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 12/06/2015] [Accepted: 12/26/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND fMRI graph theory reveals resting-state brain networks, but has never been used in pediatric OCD. METHODS Whole-brain resting-state fMRI was acquired at 3T from 21 children with OCD and 20 age-matched healthy controls. BOLD connectivity was analyzed yielding global and local graph-theory metrics across 100 child-based functional nodes. We also compared local metrics between groups in frontopolar, supplementary motor, and sensorimotor cortices, regions implicated in recent neuroimaging and/or brain stimulation treatment studies in OCD. RESULTS As in adults, the global metric small-worldness was significantly (P<0.05) lower in patients than controls, by 13.5% (%mean difference=100%X(OCD mean - control mean)/control mean). This suggests less efficient information transfer in patients. In addition, modularity was lower in OCD (15.1%, P<0.01), suggesting less granular - or differently organized - functional brain parcellation. Higher clustering coefficients (23.9-32.4%, P<0.05) were observed in patients in frontopolar, supplementary motor, sensorimotor, and cortices with lower betweenness centrality (-63.6%, P<0.01) at one frontopolar site. These findings are consistent with more locally intensive connectivity or less interaction with other brain regions at these sites. LIMITATIONS Relatively large node size; relatively small sample size, comorbidities in some patients. CONCLUSIONS Pediatric OCD patients demonstrate aberrant global and local resting-state network connectivity topologies compared to healthy children. Local results accord with recent views of OCD as a disorder with sensorimotor component.
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Affiliation(s)
- Casey C. Armstrong
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - Teena D. Moody
- Division of Adult Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - Jamie D. Feusner
- Division of Adult Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - James T. McCracken
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - Susanna Chang
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - Jennifer G. Levitt
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - John C. Piacentini
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute For Neurosciences, Los Angeles, CA, United States
| | - Joseph O'Neill
- Division of Child & Adolescent Psychiatry, UCLA Semel Institute for Neurosciences, 760 Westwood Plaza, Los Angeles, CA 90024-1759, United States.
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Personalizing the Treatment of Pediatric Obsessive-Compulsive Disorder: Evidence for Predictors and Moderators of Treatment Outcomes. Curr Behav Neurosci Rep 2016. [DOI: 10.1007/s40473-016-0066-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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15
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Nissen JB, Hansen CS, Starnawska A, Mattheisen M, Børglum AD, Buttenschøn HN, Hollegaard M. DNA Methylation at the Neonatal State and at the Time of Diagnosis: Preliminary Support for an Association with the Estrogen Receptor 1, Gamma-Aminobutyric Acid B Receptor 1, and Myelin Oligodendrocyte Glycoprotein in Female Adolescent Patients with OCD. Front Psychiatry 2016; 7:35. [PMID: 27047397 PMCID: PMC4796012 DOI: 10.3389/fpsyt.2016.00035] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Accepted: 02/26/2016] [Indexed: 12/26/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder. Non-genetic factors and their interaction with genes have attracted increasing attention. Epigenetics is regarded an important interface between environmental signals and activation/repression of genomic responses. Epigenetic mechanisms have not previously been examined in OCD in children and adolescents. The aim of the present study was to examine the DNA methylation profile of selected genes in blood spots from neonates later diagnosed with OCD and in the same children/adolescents at the time of diagnosis compared with age- and sex-matched controls. Furthermore, we wanted to characterize the association of the differential methylation profiles with the severity of OCD and treatment outcome. Dried and new blood spot samples were obtained from 21 female children/adolescents with verified OCD and 12 female controls. The differential methylation was analyzed using a linear model and the correlation with the severity of OCD and treatment outcome was analyzed using the Pearson correlation. We evaluated selected Illumina Infinium HumanMethylation450 BeadChip probes within and up to 100,000 bp up- and downstream of 14 genes previously associated with OCD (SLC1A1, SLC25A12, GABBR1, GAD1, DLGAP1, MOG, BDNF, OLIG2, NTRK2 and 3, ESR1, SL6A4, TPH2, and COMT). The study found no significantly differential methylation. However, preliminary support for a difference was found for the gamma-aminobutyric acid (GABA) B receptor 1 (cg10234998, cg17099072) in blood samples at birth and for the estrogen receptor 1 (ESR1) (cg10939667), the myelin oligodendrocyte glycoprotein (MOG) (cg16650906), and the brain-derived neurotrophic factor (BDNF) (cg14080521) in blood samples at the time of diagnosis. Preliminary support for an association was observed between the methylation profiles of GABBR1 and MOG and baseline severity, treatment effect, and responder status; and between the methylation profile of ESR1 and baseline severity. To our knowledge, this is the first study to examine the DNA methylation profiles in OCD. The study points towards possible differences in the methylation profiles and suggests a correlation with the severity of OCD. However, the results warrant further studies in larger sample sets.
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Affiliation(s)
- Judith Becker Nissen
- Center of Child and Adolescent Psychiatry (BUC), Aarhus University Hospital , Risskov , Denmark
| | - Christine Søholm Hansen
- Department of Congenital Diseases, Neonatal Genetics, Statens Serum Institut , Copenhagen , Denmark
| | - Anna Starnawska
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Centre for Integrative Sequencing (iSEQ), Aarhus, Denmark
| | - Manuel Mattheisen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Centre for Integrative Sequencing (iSEQ), Aarhus, Denmark
| | - Anders Dupont Børglum
- Department of Biomedicine, Aarhus University, Aarhus, Denmark; The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark; Centre for Integrative Sequencing (iSEQ), Aarhus, Denmark
| | | | - Mads Hollegaard
- Department of Congenital Diseases, Neonatal Genetics, Statens Serum Institut , Copenhagen , Denmark
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Olatunji BO, Rosenfield D, Monzani B, Krebs G, Heyman I, Turner C, Isomura K, Mataix-Cols D. EFFECTS OF HOMEWORK COMPLIANCE ON COGNITIVE-BEHAVIORAL THERAPY WITH D-CYCLOSERINE AUGMENTATION FOR CHILDREN WITH OBSESSIVE COMPULSIVE DISORDER. Depress Anxiety 2015; 32:935-43. [PMID: 26372401 DOI: 10.1002/da.22423] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Revised: 08/04/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The present study examined the effects of homework compliance on outcome from cognitive behavioral therapy (CBT) for children with obsessive-compulsive disorder (OCD) and the extent to which these effects differ as a function of augmentation of CBT with D-cycloserine (DCS). METHODS Twenty-seven youth with OCD were randomized to either 50 mg DCS or placebo (PBO) administered immediately after each of 10 CBT sessions, primarily consisting of exposure and ritual prevention (ERP). Independent evaluators assessed OCD severity using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at the start of each session. Compliance with between-session ERP assignments was also assessed at the start of each session using the Patient ERP Adherence Scale (PEAS). RESULTS Greater homework compliance between the previous session and the current session was related to lower CY-BOCS at the current session. However, the relation between homework compliance and CY-BOCS varied by treatment condition. Higher homework compliance was related to lower CY-BOCS for participants in the DCS condition, but not for participants in the PBO condition. Furthermore, participants receiving DCS were estimated to have significantly lower CY-BOCS than those given PBO among those with the highest levels of homework compliance. CONCLUSIONS DCS may more effectively facilitate the effects of CBT for youth with OCD when patients are compliant with prescribed homework. Theoretical and clinical implications are discussed.
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Affiliation(s)
- Bunmi O Olatunji
- Department of Psychology, Vanderbilt University, Nashville, Tennessee
| | - David Rosenfield
- Department of Psychology, Southern Methodist University, Dallas, Texas
| | - Benedetta Monzani
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Georgina Krebs
- Institute of Psychiatry, Psychology & Neuroscience, King's College, London, UK
| | - Isobel Heyman
- Dept of Neurosciences & Mental Health, Institute of Child Health, London, UK
| | - Cynthia Turner
- School of Psychology, University of Queensland, Australia
| | - Kayoko Isomura
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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17
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Abstract
OBJECTIVE Significant differences in clinical profile and comorbidity patterns have been observed between "juvenile-onset" and "adult-onset" obsessive-compulsive disorder (OCD). There is little systematic research on onset of OCD after the fourth decade. The current study aims to compare the demographic, clinical, and comorbidity patterns of patients with "juvenile-onset" (<18 years), "adult-onset" (18-39 years), and "late-onset" (≥40 years) OCD. METHOD Eight hundred two consecutive patients who consulted a specialty OCD clinic at a tertiary care hospital in India were evaluated with the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive-Compulsive Scale, and the Clinical Global Impression scale. RESULTS 37.4%, 57.4%, and 5.2% of patients had juvenile-, adult-, and late-onset OCD, respectively. Late-onset OCD was associated with female gender (χ2=42, p<0.001); negative family history of OCD in first-degree relatives (χ2=20.4, p<0.001); and less aggressive obsessions (χ2=18.16, p<0.001), sexual obsessions (χ2=26.68, p<0.001), pathological doubts (χ2=19.41; p<0.001), and repeating rituals (χ2=44.28; p<0.001). On multinomial logistic regression, late-onset OCD was significantly associated with female gender, collecting compulsions, and less aggressive obsessions, in comparison with adult-onset OCD. In comparison with juvenile-onset, late-onset OCD was significantly associated with female gender, presence of precipitating factors, and less aggressive obsessions, sexual obsessions, and repeating compulsions. CONCLUSION Late-onset OCD is characterized by female gender, lesser familial loading for OCD, and presence of precipitating factors, suggesting that it may have a distinct pathophysiology compared to juvenile- and adult-onset OCD. Systematic research is required to understand the family-genetic, neuropsychological, and neurobiological correlates of late-onset OCD.
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18
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Murray K, Jassi A, Mataix-Cols D, Barrow F, Krebs G. Outcomes of cognitive behaviour therapy for obsessive-compulsive disorder in young people with and without autism spectrum disorders: A case controlled study. Psychiatry Res 2015; 228:8-13. [PMID: 25935374 DOI: 10.1016/j.psychres.2015.03.012] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2014] [Revised: 12/02/2014] [Accepted: 03/11/2015] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) and autism spectrum disorders (ASD) are highly co-morbid. It is suggested that youth with ASD will respond less well to cognitive behaviour therapy (CBT), as compared to their typically developing counterparts. To date there is no empirical evidence to support this view. The current study sought to compare CBT for OCD outcomes among youth with and without ASD. 22 young people with ICD-10 diagnoses of OCD and ASD (OCD+ASD) were matched with 22 youth with OCD, but no ASD (OCD+NoASD) according to base line OCD symptom severity, age, and gender. Outcomes were assessed for the two groups following a course of individually tailored, but protocol-driven CBT for OCD. While both groups responded to treatment the OCD+ASD group's outcomes were inferior to the OCD+NoASD group, as indicated by a significantly smaller decrease in symptoms over treatment (38.31% vs. 48.20%) and lower remission rates at post-treatment (9% vs. 46%). Overall, young people experiencing OCD in the context of ASD benefitted from CBT, but to a lesser extent than typically developing children. Recent efforts to modifying standard CBT protocols for OCD in ASD should continue in order to optimise outcomes among youth with this particular dual psychopathology.
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Affiliation(s)
- Kim Murray
- Institute of Psychiatry, King׳s College London, London, UK.
| | - Amita Jassi
- OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King׳s College London, London, UK
| | - David Mataix-Cols
- Institute of Psychiatry, King׳s College London, London, UK; Karolinska Institutet, Stockholm, Sweden
| | - Faye Barrow
- OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Georgina Krebs
- OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK; MRC Social, Genetic & Developmental Psychiatry Centre, Institute of Psychiatry, King׳s College London, London, UK
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19
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Privitera AP, Distefano R, Wefer HA, Ferro A, Pulvirenti A, Giugno R. OCDB: a database collecting genes, miRNAs and drugs for obsessive-compulsive disorder. Database (Oxford) 2015; 2015:bav069. [PMID: 26228432 PMCID: PMC4519680 DOI: 10.1093/database/bav069] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Revised: 04/30/2015] [Accepted: 06/23/2015] [Indexed: 12/20/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by intrusive and unwilling thoughts (obsessions) giving rise to anxiety. The patients feel obliged to perform a behavior (compulsions) induced by the obsessions. The World Health Organization ranks OCD as one of the 10 most disabling medical conditions. In the class of Anxiety Disorders, OCD is a pathology that shows an hereditary component. Consequently, an online resource collecting and integrating scientific discoveries and genetic evidence about OCD would be helpful to improve the current knowledge on this disorder. We have developed a manually curated database, OCD Database (OCDB), collecting the relations between candidate genes in OCD, microRNAs (miRNAs) involved in the pathophysiology of OCD and drugs used in its treatments. We have screened articles from PubMed and MEDLINE. For each gene, the bibliographic references with a brief description of the gene and the experimental conditions are shown. The database also lists the polymorphisms within genes and its chromosomal regions. OCDB data is enriched with both validated and predicted miRNA-target and drug-target information. The transcription factors regulations, which are also included, are taken from David and TransmiR. Moreover, a scoring function ranks the relevance of data in the OCDB context. The database is also integrated with the main online resources (PubMed, Entrez-gene, HGNC, dbSNP, DrugBank, miRBase, PubChem, Kegg, Disease-ontology and ChEBI). The web interface has been developed using phpMyAdmin and Bootstrap software. This allows (i) to browse data by category and (ii) to navigate in the database by searching genes, miRNAs, drugs, SNPs, regions, drug targets and articles. The data can be exported in textual format as well as the whole database in.sql or tabular format. OCDB is an essential resource to support genome-wide analysis, genetic and pharmacological studies. It also facilitates the evaluation of genetic data in OCD and the detection of alternative treatments.
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Affiliation(s)
- Anna P Privitera
- Department of Clinical and Experimental Medicine, University of Catania, Viale A. Doria 6, Catania, Italy, Istituto di Scienze Neurologiche, CNR, Via Paolo Gaifami, 18, 95125 Catania, Italy
| | - Rosario Distefano
- Department of Computer Science, University of Verona, Strada le Grazie 15, Verona, Italy and
| | - Hugo A Wefer
- KarolinskaInstitutet, Department of Microbiology, Tumor and Cell Biology, Science for Life Laboratory, Stockholm, Sweden
| | - Alfredo Ferro
- Department of Clinical and Experimental Medicine, University of Catania, Viale A. Doria 6, Catania, Italy
| | - Alfredo Pulvirenti
- Department of Clinical and Experimental Medicine, University of Catania, Viale A. Doria 6, Catania, Italy
| | - Rosalba Giugno
- Department of Clinical and Experimental Medicine, University of Catania, Viale A. Doria 6, Catania, Italy,
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20
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Torp NC, Dahl K, Skarphedinsson G, Thomsen PH, Valderhaug R, Weidle B, Melin KH, Hybel K, Nissen JB, Lenhard F, Wentzel-Larsen T, Franklin ME, Ivarsson T. Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS). Behav Res Ther 2015; 64:15-23. [DOI: 10.1016/j.brat.2014.11.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2014] [Revised: 11/05/2014] [Accepted: 11/14/2014] [Indexed: 11/16/2022]
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21
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Tamini BK, Rahdar Z, Kahrazei F. The Relationship between Obsessive-Compulsive Symptoms and Body Image in Boy and Girl High School Students. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/psych.2015.610129] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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22
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Grünblatt E, Hauser TU, Walitza S. Imaging genetics in obsessive-compulsive disorder: linking genetic variations to alterations in neuroimaging. Prog Neurobiol 2014; 121:114-24. [PMID: 25046835 DOI: 10.1016/j.pneurobio.2014.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/10/2014] [Accepted: 07/10/2014] [Indexed: 12/11/2022]
Abstract
Obsessive-compulsive disorder (OCD) occurs in ∼1-3% of the general population, and its often rather early onset causes major disabilities in the everyday lives of patients. Although the heritability of OCD is between 35 and 65%, many linkage, association, and genome-wide association studies have failed to identify single genes that exhibit high effect sizes. Several neuroimaging studies have revealed structural and functional alterations mainly in cortico-striato-thalamic loops. However, there is also marked heterogeneity across studies. These inconsistencies in genetic and neuroimaging studies may be due to the heterogeneous and complex phenotypes of OCD. Under the consideration that genetic variants may also influence neuroimaging in OCD, researchers have started to combine both domains in the field of imaging genetics. Here, we conducted a systematic search of PubMed and Google Scholar literature for articles that address genetic imaging in OCD and related disorders (published through March 2014). We selected 8 publications that describe the combination of imaging genetics with OCD, and extended it with 43 publications of comorbid psychiatric disorders. The most promising findings of this systematic review point to the involvement of variants in genes involved in the serotonergic (5-HTTLPR, HTR2A), dopaminergic (COMT, DAT), and glutamatergic (SLC1A1, SAPAP) systems. However, the field of imaging genetics must be further explored, best through investigations that combine multimodal imaging techniques with genetic profiling, particularly profiling techniques that employ polygenetic approaches, with much larger sample sizes than have been used up to now.
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Affiliation(s)
- Edna Grünblatt
- University Clinics for Child and Adolescent Psychiatry (UCCAP), University of Zurich, Neumuensterallee 9, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland.
| | - Tobias U Hauser
- University Clinics for Child and Adolescent Psychiatry (UCCAP), University of Zurich, Neumuensterallee 9, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland; Wellcome Trust Centre for Neuroimaging, University College London, United Kingdom
| | - Susanne Walitza
- University Clinics for Child and Adolescent Psychiatry (UCCAP), University of Zurich, Neumuensterallee 9, 8032 Zurich, Switzerland; Neuroscience Center Zurich, University of Zurich and ETH Zurich, Switzerland; Zurich Center for Integrative Human Physiology, University of Zurich, Switzerland
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23
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Park JM, Small BJ, Geller DA, Murphy TK, Lewin AB, Storch EA. Does d-Cycloserine Augmentation of CBT Improve Therapeutic Homework Compliance for Pediatric Obsessive-Compulsive Disorder? JOURNAL OF CHILD AND FAMILY STUDIES 2014; 23:863-871. [PMID: 24999301 PMCID: PMC4078886 DOI: 10.1007/s10826-013-9742-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
Clinical studies in adults and children with obsessive-compulsive disorder (OCD) have shown that d-cycloserine (DCS) can improve treatment response by enhancing fear extinction learning during exposure-based psychotherapy. Some have hypothesized that improved treatment response is a function of increased compliance and engagement in therapeutic homework tasks, a core component of behavioral treatment. The present study examined the relationship between DCS augmented cognitive-behavioral therapy (CBT) and homework compliance in a double-blind, placebo controlled trial with 30 youth with OCD. All children received 10 CBT sessions, the last seven of which included exposure and response prevention paired with DCS or placebo dosed 1 h before the session started. Results suggested that DCS augmented CBT did not predict improved homework compliance over the course of treatment, relative to the placebo augmented CBT group. However, when groups were collapsed, homework compliance was directly associated with treatment outcome. These findings suggest that while DCS may not increase homework compliance over time, more generally, homework compliance is an integral part of pediatric OCD treatment outcome.
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Affiliation(s)
- Jennifer M Park
- Department of Psychology, University of South Florida, 4202 E Fowler Ave, PCD 4118G, Tampa, FL 33611, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, USA
| | - Daniel A Geller
- Department of Pediatric Psychopharmacology, Massachusetts General Hospital, Boston, MA, USA
| | - Tanya K Murphy
- Departments of Pediatrics and Psychiatry, University of South Florida, St Petersburg, FL, USA
| | - Adam B Lewin
- Departments of Pediatrics and Psychiatry, University of South Florida, St Petersburg, FL, USA
| | - Eric A Storch
- Departments of Pediatrics and Psychiatry, University of South Florida, St Petersburg, FL, USA
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24
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Walitza S. [Obsessive-compulsive disorders in DSM-5 – what is new?]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 42:121-6; quiz 126-7. [PMID: 24571818 DOI: 10.1024/1422-4917/a000279] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Obsessive-compulsive disorders are a frequent and debilitating condition also in children and adolescents. The present paper summarizes the changes in the DSM diagnostic criteria between the IV-TR edition and the DSM-5 edition, and evaluates them critically. A central feature is the revision of the category to which these disorders belong: Obsessive-Compulsive Disorders are no longer considered to be anxiety disorders, but rather now comprise an independent category encompassing a broader spectrum of obsessive-compulsive and related disorders. Minor changes have been made to the description of the criteria, and there is a new emphasis on the clinical assessment of the patient's insight level (good, poor, absent). Obsessive-compulsive disorders associated with tic disorders are classified as a separate subtype. The present paper discusses these changes on the basis of the available studies and literature, and then looks ahead to the implementation of the new criteria in the everyday clinical setting and in research.
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Affiliation(s)
- Susanne Walitza
- Universitätsklinik für Kinder- und Jugendpsychiatrie, Zürich
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25
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Abstract
Zwangsstörungen zählen mit einer Prävalenz von 1 bis 2 % zu den häufigeren Störungen im Kindes- und Jugendalter. Komorbide Störungen sind regelhaft vorhanden und die psychosozialen Beeinträchtigungen sind oftmals gravierend. Trotz guter Behandelbarkeit der Zwangsstörung gestaltet sich der Langzeitverlauf bei einem bedeutsamen Teil der Betroffenen insgesamt ungünstig. Der vorliegende Beitrag gibt eine selektive Übersicht zu Definition und Klassifikation, Epidemiologie, Symptomatik, Komorbidität, Diagnostik und Verlauf der Zwangsstörung im Jugendalter.
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Affiliation(s)
- Thomas Jans
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie
| | - Andreas Reichert
- Diakonisches Werk Würzburg, Tagesklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie
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26
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The influence of age at onset and duration of illness on long-term outcome in patients with obsessive-compulsive disorder: a report from the International College of Obsessive Compulsive Spectrum Disorders (ICOCS). Eur Neuropsychopharmacol 2013; 23:865-71. [PMID: 23791074 DOI: 10.1016/j.euroneuro.2013.05.004] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2013] [Revised: 04/30/2013] [Accepted: 05/15/2013] [Indexed: 01/02/2023]
Abstract
Several studies reported a negative effect of early onset and long duration of illness on long-term outcome in psychiatric disorders, including Obsessive-Compulsive Disorder (OCD). OCD is a prevalent, comorbid and disabling condition, associated with reduced quality of life and overall well-being for affected patients and related caregivers. The present multicenter naturalistic study sought to assess the influence of early onset and duration of illness on long-term outcome in a sample of 376 OCD out-patients worldwide, as part of the "International College of Obsessive-Compulsive Spectrum Disorders" (ICOCS) network. Binary logistic regressions were performed with age at the onset and duration of illness, as continuous independent variables, on a series of different outcome dependent variables, including lifetime number of hospitalizations and suicide attempts, poly-therapy and psychiatric comorbidity. Correlations in terms of disability (SDS) were analyzed as well. Results showed that a longer duration of illness (but not earlier age of onset) was associated with hospitalization (odds ratio=1.03, p=0.01), earlier age at onset with CBT (odds ratio=0.94, p<0.001) and both a later age at onset (odds ratio=1.05, p=0.02) and a shorter duration of illness (odds ratio=0.93, p=0.02) with panic disorder comorbidity. In addition, earlier age at onset inversely correlated with higher social disability (r=-0.12, p=0.048) and longer duration of illness directly correlated with higher disability in work, social and family life (r=0.14, p=0.017; r=0.13, p=0.035; r=0.14, p=0.02). The findings from the present large, multicenter study indicate early onset and long duration of illness as overall negative predictors of long-term outcome in OCD.
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27
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Murphy DL, Moya PR, Fox MA, Rubenstein LM, Wendland JR, Timpano KR. Anxiety and affective disorder comorbidity related to serotonin and other neurotransmitter systems: obsessive-compulsive disorder as an example of overlapping clinical and genetic heterogeneity. Philos Trans R Soc Lond B Biol Sci 2013; 368:20120435. [PMID: 23440468 DOI: 10.1098/rstb.2012.0435] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Individuals with obsessive-compulsive disorder (OCD) have also been shown to have comorbid lifetime diagnoses of major depressive disorder (MDD; rates greater than 70%), bipolar disorder (rates greater than 10%) and other anxiety disorders (e.g. panic disorder, post-traumatic stress disorder (PTSD)). In addition, overlap exists in some common genetic variants (e.g. the serotonin transporter gene (SLC6A4), the brain-derived neurotrophic factor (BDNF) gene), and rare variants in genes/chromosomal abnormalities (e.g. the 22q11 microdeletion syndrome) found across the affective/anxiety disorder spectrums. OCD has been proposed as a possible independent entity for DSM-5, but by others thought best retained as an anxiety disorder subtype (its current designation in DSM-IV), and yet by others considered best in the affective disorder spectrum. This review focuses on OCD, a well-studied but still puzzling heterogeneous disorder, regarding alterations in serotonergic, dopaminergic and glutamatergic neurotransmission in addition to other systems involved, and how related genes may be involved in the comorbidity of anxiety and affective disorders. OCD resembles disorders such as depression, in which gene × gene interactions, gene × environment interactions and stress elements coalesce to yield OC symptoms and, in some individuals, full-blown OCD with multiple comorbid disorders.
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Affiliation(s)
- Dennis L Murphy
- Laboratory of Clinical Science, National Institute of Mental Health, National Institutes of Health, Bethesda, MD 20892, USA
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28
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Coskun M, Zoroglu S, Ozturk M. Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive-compulsive disorder. Child Adolesc Psychiatry Ment Health 2012; 6:36. [PMID: 23173690 PMCID: PMC3556131 DOI: 10.1186/1753-2000-6-36] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aimed to investigate phenomenology, psychiatric comorbidity, and family history of obsessive-compulsive disorder (OCD) in a clinical sample of normally developing preschool children with OCD. METHOD Subjects in this study were recruited from a clinical sample of preschool children (under 72 months of age) who were referred to a university clinic. Subjects with a normal developmental history and significant impairment related to OCD symptoms were included in the study. Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms. Each subject was assessed for comorbid DSM-IV psychiatric disorders using a semi-structured interview. Parents were evaluated for lifetime history of OCD in individual sessions. RESULTS Fifteen boys and ten girls (age range: 28 to 69 months; 54.12±9.08 months) were included. Mean age of onset of OCD was 35.64±13.42 months. All subjects received at least one comorbid diagnosis. The most frequent comorbid disorders were non-OCD anxiety disorders (n=17; 68.0%), attention-deficit hyperactivity disorder (ADHD) (n=15; 60.0%), oppositional defiant disorder (ODD) (n=12; 48.0%), and tic disorders (n=6; 24.0%). Mean number of comorbid disorders was 3.65 and 2.35 for boys and girls, respectively. At least one parent received lifetime OCD diagnosis in 68 percent of the subjects. CONCLUSIONS The results indicated that OCD in referred preschool children is more common in males, highly comorbid with other psychiatric disorders, and associated with high rates of family history of OCD. Given the high rates of comorbidity and family history, OCD should be considered in referred preschool children with disruptive behavior disorders and/or with family history of OCD.
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Affiliation(s)
- Murat Coskun
- Istanbul University, Istanbul Medical Faculty, Child and Adolescent Psychiatry Department, Istanbul, Turkey.
| | - Salih Zoroglu
- Istanbul University, Istanbul Medical Faculty, Child and Adolescent Psychiatry Department, Istanbul, Turkey
| | - Mucahit Ozturk
- Center for Psychiatric Research, Training and Consultation (PEDAM), Istanbul, Turkey
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Johnson M, Ostlund S, Fransson G, Landgren M, Nasic S, Kadesjö B, Gillberg C, Fernell E. Attention-deficit/hyperactivity disorder with oppositional defiant disorder in Swedish children - an open study of collaborative problem solving. Acta Paediatr 2012; 101:624-30. [PMID: 22375727 DOI: 10.1111/j.1651-2227.2012.02646.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To evaluate collaborative problem solving (CPS) in Swedish 6-13-year-old children with attention-deficit/hyperactivity disorder and oppositional defiant disorder (ODD). METHODS Seventeen families completed 6-10 sessions of CPS training. Primary outcome measures were SNAP-IV [attention-deficit/hyperactivity disorder (ADHD) and ODD scores] and Clinical Global Impression-Improvement (CGI-I) scores at baseline, post-intervention and 6 months later. Secondary outcome measures were the Conners' 10-item scale and the Family Burden of Illness Module (FBIM). RESULTS All 17 participants completed the intervention. The whole group had significant reductions in SNAP-IV ODD, ADHD, total Conners' and FBIM scores, both at post-intervention and at 6-month follow-up. Eight of the children, although significantly improved on ODD scores and the Conners' emotional lability subscale at post-intervention, had almost no improvement in hyperactivity/impulsivity. Post-intervention, this group received stimulant medication for their ADHD. CGI-I scores of much improved or very much improved were reached by 53% (9/17) of all at post-intervention, and by 81% (13/16) at 6-month follow-up. CONCLUSION Collaborative problem solving significantly reduced ODD, ADHD and emotional lability symptoms. A subgroup improved in their ADHD symptoms only after adding stimulant medication.
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Affiliation(s)
- Mats Johnson
- The Gillberg Neuropsychiatry Centre at the Sahlgrenska Academy, University of Gothenburg, Sweden
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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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Stewart SE, Hezel D, Stachon AC. Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder. Drugs 2012; 72:881-93. [DOI: 10.2165/11632860-000000000-00000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
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Abdellaoui A, Bartels M, Hudziak JJ, Rizzu P, van Beijsterveldt TCEM, Boomsma DI. Genetic Influences on Thought Problems in 7-Year-Olds: A Twin-Study of Genetic, Environmental and Rater Effects. Twin Res Hum Genet 2012; 11:571-8. [DOI: 10.1375/twin.11.6.571] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe Thought–Problem scale (TP) of the CBCL assesses symptoms such as hallucinations and strange thoughts/behaviors and has been associated with other behavioral disorders. This study uses parental reports to examine the etiology of variation in TP, about which relatively little is known, in 7-year-old twins. Parental ratings on TP were collected in 8,962 7-year-old twin pairs. Because the distribution of TP scores was highly skewed scores were categorized into 3 classes. The data were analyzed under a threshold liability model with genetic structural equation modeling. Ratings from both parents were simultaneously analyzed to determine the rater agreement phenotype (or common phenotype [TPc]) and the rater specific phenotype [TPs] that represents rater disagreement caused by rater bias, measurement error and/or a unique view of the parents on the child's behavior. Scores on the TP-scale varied as a function of rater (fathers rated fewer problems), sex (boys scored higher) and zygosity (DZ twins scored higher). The TPc explained 67% of the total variance in the parental ratings. Variation in TPc was influenced mainly by the children's genotype (76%). Variance in TPs also showed a contribution of genetic factors (maternal reports: 61%, paternal reports: 65%), indicating that TPs does not only represent rater bias. Shared environmental influences were only found in the TPs. No sex differences in genetic architecture were observed. These results indicate an important contribution of genetic factors to thought problems in children as young as 7 years.
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O'Neill J, Piacentini JC, Chang S, Levitt JG, Rozenman M, Bergman L, Salamon N, Alger JR, McCracken JT. MRSI correlates of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2012; 36:161-8. [PMID: 21983143 PMCID: PMC4344316 DOI: 10.1016/j.pnpbp.2011.09.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 09/02/2011] [Accepted: 09/08/2011] [Indexed: 01/01/2023]
Abstract
BACKGROUND The brain mechanisms of cognitive-behavioral therapy (CBT), a highly effective treatment for pediatric obsessive-compulsive disorder (OCD), are unknown. Neuroimaging in adult OCD indicates that CBT is associated with metabolic changes in striatum, thalamus, and anterior cingulate cortex. We therefore probed putative metabolic effects of CBT on these brain structures in pediatric OCD using proton magnetic resonance spectroscopic imaging (1H MRSI). METHOD Five unmedicated OCD patients (4 ♀, 13.5±2.8) and 9 healthy controls (7 ♀, 13.0±2.5) underwent MRSI (1.5 T, repetition-time/echo-time=1500/30 ms) of bilateral putamen, thalamus and pregenual anterior cingulate cortex (pACC). Patients were rescanned after 12 weeks of exposure-based CBT. The Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) of OCD symptoms was administered before and after CBT. RESULTS Four of 5 patients responded to CBT (mean 32.8% CY-BOCS reduction). Multiple metabolite effects emerged. Pre-CBT, N-acetyl-aspartate+N-acetyl-aspartyl-glutamate (tNAA) in left pregenual anterior cingulate cortex (pACC) was 55.5% higher in patients than controls. Post-CBT, tNAA (15.0%) and Cr (23.9%) in left pACC decreased and choline compounds (Cho) in right thalamus increased (10.6%) in all 5 patients. In left thalamus, lower pre-CBT tNAA, glutamate+glutamine (Glx), and myo-inositol (mI) predicted greater post-CBT drop in CY-BOCS (r=0.98) and CY-BOCS decrease correlated with increased Cho. CONCLUSIONS Interpretations are offered in terms of the Glutamatergic Hypothesis of Pediatric OCD. Similar to 18FDG-PET in adults, objectively measurable regional MRSI metabolites may indicate pediatric OCD and predict its response to CBT.
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Affiliation(s)
- Joseph O'Neill
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, CA 90024-1759, United States.
| | - John C. Piacentini
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
| | - Susanna Chang
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
| | - Jennifer G. Levitt
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
| | - Michelle Rozenman
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
| | - Lindsey Bergman
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
| | - Noriko Salamon
- Department of Radiological Sciences, UCLA School of Medicine, Los Angeles, California
| | - Jeffry R. Alger
- Department of Neurology, UCLA School of Medicine, Los Angeles, California
| | - James T. McCracken
- Division of Child & Adolescent Psychiatry, Semel Institute for Neurosciences, UCLA School of Medicine, Los Angeles, California
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Del Casale A, Kotzalidis GD, Rapinesi C, Serata D, Ambrosi E, Simonetti A, Pompili M, Ferracuti S, Tatarelli R, Girardi P. Functional neuroimaging in obsessive-compulsive disorder. Neuropsychobiology 2011; 64:61-85. [PMID: 21701225 DOI: 10.1159/000325223] [Citation(s) in RCA: 132] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2010] [Accepted: 01/23/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND AND AIM Obsessive-compulsive disorder (OCD) is a severe, highly prevalent and chronically disabling psychiatric disorder that usually emerges during childhood or adolescence. This paper aims to review the literature on functional neuroimaging in OCD, analysing the reported dysfunctional connectivity in the corticostriatothalamocortical circuitry. METHOD This study included papers published in peer-reviewed journals dealing with functional imaging in OCD. RESULTS Striatal dysfunction, mainly of the caudate nucleus, leads to inefficient thalamic gating, resulting in hyperactivity within the orbitofrontal cortex (intrusive thoughts) and the anterior cingulate cortex (non-specific anxiety). Compulsions consist of ritualistic behaviours performed to recruit the inefficient striatum and neutralise unwanted thoughts and anxiety. Functional neuroimaging findings are discussed against the background of specific cognitive impairments, mainly regarding visuospatial processing, executive functioning and motor speed. Cognitive deficits are partial and specific, matching imaging data. CONCLUSIONS Several studies have targeted brain regions hypothesised to be involved in the pathogenesis of OCD, showing the existence of dysfunctional connectivity in the corticostriatothalamocortical circuitry. Improvements in spatial resolution of neuroimaging techniques may contribute to a better understanding of the neurocircuitry of OCD and other anxiety disorders.
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Affiliation(s)
- A Del Casale
- NESMOS (Neurosciences, Mental Health, and Sensory Organs) Department, School of Medicine and Psychology, Sapienza University and Sant'Andrea Hospital, Rome, Italy.
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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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Objective sleep patterns and severity of symptoms in pediatric obsessive compulsive disorder: a pilot investigation. J Anxiety Disord 2011; 25:835-9. [PMID: 21570250 PMCID: PMC3109106 DOI: 10.1016/j.janxdis.2011.04.004] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Accepted: 04/10/2011] [Indexed: 10/18/2022]
Abstract
Sleep disturbances are common among youth with anxiety disorders, yet objective assessments of sleep in children with obsessive compulsive disorder (OCD) have been the focus of scant research. We therefore compared a small group of non-medicated, non-depressed children with primary OCD (ages 7-11 years) to matched healthy controls using home-based actigraphy during a 7-day prospective assessment. Validated parent and child sleep measures also were collected, and associations among objective sleep variables and severity of obsessions and compulsions were examined. We found significantly fragmented sleep patterns in the OCD group compared to controls including reduced total sleep time (TST) and longer wake periods after sleep onset. Severity of compulsions showed a significant negative correlation with TST. These preliminary findings indicate the presence of sleep abnormalities in pre-pubescent OCD patients with potential implications for future examinations of early developmental processes and features of the disorder.
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Walitza S, Melfsen S, Jans T, Zellmann H, Wewetzer C, Warnke A. Obsessive-compulsive disorder in children and adolescents. DEUTSCHES ARZTEBLATT INTERNATIONAL 2011; 108:173-9. [PMID: 21475565 DOI: 10.3238/arztebl.2011.0173] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2009] [Accepted: 06/16/2010] [Indexed: 11/27/2022]
Abstract
BACKGROUND Early-onset obsessive-compulsive disorder (OCD) is one of the more common mental illnesses of children and adolescents, with prevalence of 1% to 3%. Its manifestations often lead to severe impairment and to conflict in the family. In this review, we summarize the manifestations, comorbidity, pathophysiology, and course of this disease as well as current modes of diagnosis and treatment. METHODS We selectively review the relevant literature and the German-language guidelines for the diagnosis and treatment of mental illnesses in children and adolescents. RESULTS Obsessive-compulsive manifestations are of many types and cause severe impairment. Comorbid mental disturbances are present in as many as 70% of patients. The disease takes a chronic course in more than 40% of patients. Cognitive behavioral therapy is the treatment of first choice, followed by combination pharmacotherapy including selective serotonin reuptake inhibitors (SSRI) and then by SSRI alone. CONCLUSION OCD often begins in childhood or adolescence. There are empirically based neurobiological and cognitive-behavioral models of its pathophysiology. Multiaxial diagnostic evaluation permits early diagnosis. Behavioral therapy and medications are highly effective treatments, but the disorder nonetheless takes a chronic course in a large percentage of patients.
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Affiliation(s)
- Susanne Walitza
- Zentrum für Kinder- und Jugendpsychiatrie, Universität Zürich, Germany.
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Rooney M, Alfano CA, Walsh KS, Parr AF. Differential Diagnosis and Treatment of Obsessive-Compulsive, Inattentive, and Sleep Symptoms in a 7-Year-Old With PDD-NOS. Clin Case Stud 2011. [DOI: 10.1177/1534650111398123] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The overlap in symptoms among autism spectrum disorders (ASDs), anxiety disorders, and attention-deficit/hyperactivity disorder (ADHD) in youth can present diagnostic challenges for clinicians and researchers. Accurate diagnosis and comprehensive treatment can be facilitated by ongoing assessment and close collaboration among members of a multidisciplinary team. Specific treatment guidelines for reducing anxiety and/or inattentive behaviors in children with a primary ASD diagnosis are currently lacking. This case provides an example of how an empirically supported treatment for anxiety, exposure with response prevention (E/RP), in conjunction with pharmacotherapy, can be effective in reducing anxiety and ritualistic/compulsive behaviors in ASDs. This case also exemplifies how attention to and treatment of sleep problems can improve inattentive symptoms and overall functioning.
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Affiliation(s)
- Mary Rooney
- University of Maryland, College Park, , Children's National Medical Center, Washington, D.C
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Derisley J, Libby S, Clark S, Reynolds S. Mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder and with anxiety disorders. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2011; 44:439-44. [PMID: 16238888 DOI: 10.1348/014466505x29152] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To compare mental health, coping and family-functioning in parents of young people with obsessive-compulsive disorder (OCD), anxiety disorders, and no known mental health problems. METHOD Parents of young people with OCD (N = 28), other anxiety disorders (N = 28), and no known mental health problems (N = 62) completed the Brief Symptom Inventory (Derogatis, 1993), the Coping Responses Inventory (Moos, 1990), and the McMaster family assessment device (Epstein, Baldwin, & Bishop, 1983). RESULTS Parents of children with OCD and anxiety disorders had poorer mental health and used more avoidant coping than parents of non-clinical children. There were no group differences in family-functioning. CONCLUSION The similarities across the parents of clinically referred children suggest that there is a case for encouraging active parental involvement in the treatment of OCD in young people.
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Affiliation(s)
- Jo Derisley
- Norfolk Mental Health Care Trust, Bethel Child and Family Centre, UK
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Rauch SL, Britton JC. Developmental neuroimaging studies of OCD: the maturation of a field. J Am Acad Child Adolesc Psychiatry 2010; 49:1186-8. [PMID: 21093768 DOI: 10.1016/j.jaac.2010.08.016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2010] [Accepted: 08/30/2010] [Indexed: 11/30/2022]
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Mancuso E, Faro A, Joshi G, Geller DA. Treatment of pediatric obsessive-compulsive disorder: a review. J Child Adolesc Psychopharmacol 2010; 20:299-308. [PMID: 20807068 DOI: 10.1089/cap.2010.0040] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Recently, research in pediatric obsessive-compulsive disorder (OCD) has expanded to include large family genetic studies, elaboration of phenotypic dimensions, description of co-morbid disorders and their moderating effects on treatment response and outcome, research on immune-based neuropsychiatric causes, randomized controlled trials of selective serotonin reuptake inhibitors (SSRIs), randomized controlled trials of cognitive behavioral therapy (CBT), comparative treatment trials; new approaches in behavior therapy, and increased awareness of newer approaches to treatment. The purpose of this article is to review assessment and treatment strategies to include current advances in research.
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Affiliation(s)
- Elizabeth Mancuso
- Clinical and Research Program in Pediatric Psychopharmacology, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02138, USA
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Abstract
OCD is a psychiatric disorder with a lifetime prevalence of 1-3% and is a significant cause of disability worldwide. Family studies indicate that OCD has a significant hereditable component, with relatives of OCD cases being 4 times more likely to develop the disorder than the general population. Linkage studies in OCD have generally been underpowered and have failed to reach the statistical threshold for genome-wide significance, but they have nevertheless been useful for revealing potential regions of interest for future candidate gene studies. Candidate gene studies in OCD have thus far focused on genes involved in the serotonergic, dopaminergic, and glutamatergic pathways. These studies have been for the most part inconclusive, and failures to replicate have been the norm until very recently. The only genetic association replicated by multiple groups was with a glutamate transporter gene (SLC1A1). Genome-wide association studies in OCD are in progress, but final results have not yet been reported. As with the study of many other psychiatric disorders, an improved understanding of OCD will only be achieved (1) with larger collaborative efforts involving more probands, (2) the use of probands and controls drawn from epidemiologically-based populations rather than clinical samples, (3) developing a more precise phenotypic description of OCD and (4) measuring important environmental influences that affect OCD pathogenesis and severity.
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Affiliation(s)
- Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, Connecticut ; Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut
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Steinhausen HC, Peloso M, Metzke CW. Performance of the adolescent obsessive-compulsive scale in a community survey. J Anxiety Disord 2009; 23:218-22. [PMID: 18723315 DOI: 10.1016/j.janxdis.2008.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Obsessive-compulsive behavior was studied in a cohort of N=570 subjects who had been assessed at three times between adolescence and young adulthood. Based on the Youth Self-Report (YSR) and the Young Adult Self-Report (YASR), the adolescent obsessive-compulsive scale (AOCS) was defined. At each of the three assessments, subjects scoring above the cut-off score of the 90th percentile of the AOCS were identified and compared to the rest of the sample serving as control group. The risk group was clearly more abnormal in both domains of internalizing and externalizing across time. Various psychiatric disorders in young adulthood were predicted by the AOCS. However, concomitant general psychopathology also contributed strongly to the prediction. Parent and youth agreement on group membership was rather low. Stability of group assignment across time was significantly increased. The AOCS is a promising instrument both for epidemiological and clinical studies. Its content and predictive validity deserves further studies.
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Abstract
Functional imaging studies have reported with remarkable consistency hyperactivity in the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), and caudate nucleus of patients with obsessive-compulsive disorder (OCD). These findings have often been interpreted as evidence that abnormalities in cortico-basal ganglia-thalamo-cortical loops involving the OFC and ACC are causally related to OCD. This interpretation remains controversial, however, because such hyperactivity may represent either a cause or a consequence of the symptoms. This article analyzes the evidence for a causal role of these loops in producing OCD in children and adults. The article first reviews the strong evidence for anatomical abnormalities in these loops in patients with OCD. These findings are not sufficient to establish causality, however, because anatomical alterations may themselves be a consequence rather than a cause of the symptoms. The article then reviews three lines of evidence that, despite their own limitations, permit stronger causal inferences: the development of OCD following brain injury, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and neurosurgical lesions that attenuate OCD. Converging evidence from these various lines of research supports a causal role for the cortico-basal ganglia-thalamo-cortical loops that involve the OFC and ACC in the pathogenesis of OCD in children and adults.
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Hemmings SMJ, Kinnear CJ, Van der Merwe L, Lochner C, Corfield VA, Moolman-Smook JC, Stein DJ. Investigating the role of the brain-derived neurotrophic factor (BDNF) val66met variant in obsessive-compulsive disorder (OCD). World J Biol Psychiatry 2008; 9:126-34. [PMID: 17853300 DOI: 10.1080/15622970701245003] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Although evidence from family studies suggest that genetic factors play an important role in mediating obsessive-compulsive disorder (OCD), results from genetic case-control association analyses have been inconsistent. Discrepant findings may be attributed to the lack of phenotypic resolution, and population stratification. The aim of the present study was to investigate the role that the val66met variant within the gene encoding brain-derived neurotrophic factor (BDNF) may play in mediating the development of selected OCD subtypes accounting for the aforementioned confounding factors. One hundred and twelve OCD subjects and 140 controls were selected from the South African Afrikaner population. A significant association was observed in the male subgroup, with the met66 allele implicated as the risk allele in the development of OCD. This allele was also found to be associated with an earlier age at onset of OCD in males. On the other hand, the val66val genotype was associated with more severe OCD in the female population. No evidence of population stratification was observed in Afrikaner control subjects. These preliminary results point towards genetically distinct characteristics of OCD mediated by dysfunctions in BDNF. The present investigation forms part of ongoing research to elucidate the genetic components involved in the aetiology of OCD and OCD-related characteristics.
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Affiliation(s)
- Sîan M J Hemmings
- MRC/US Centre for Molecular and Cellular Biology, University of Stellenbosch, Tygerberg, South Africa.
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Grisham JR, Anderson TM, Sachdev PS. Genetic and environmental influences on obsessive-compulsive disorder. Eur Arch Psychiatry Clin Neurosci 2008; 258:107-16. [PMID: 18297419 DOI: 10.1007/s00406-007-0789-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
It is important to understand how genetic and environmental factors interact in the development of obsessive-compulsive disorder (OCD) in order to provide a cohesive model of the underlying pathogenic mechanisms. In this article, we provide an overview of the current knowledge of possible genetic and environmental contributions to the development of OCD. We consider the significant challenges for identifying risk factors for OCD as well as promising avenues for overcoming these obstacles in future research. In particular, we discuss the value of focusing on certain phenotypes, applying a dimensional approach, and investigating possible endophenotypes. We also describe innovative study designs that may be used in future research to explore the interaction between genetic vulnerability and environmental risk factors for OCD.
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Affiliation(s)
- Jessica R Grisham
- School of Psychology, University of New South Wales, Sydney, NSW, Australia.
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O'Kearney RT, Anstey KJ, von Sanden C. Cochrane review: Behavioural and cognitive behavioural therapy for obsessive compulsive disorder in children and adolescents. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/ebch.207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Morer A, Lázaro L, Sabater L, Massana J, Castro J, Graus F. Antineuronal antibodies in a group of children with obsessive-compulsive disorder and Tourette syndrome. J Psychiatr Res 2008; 42:64-8. [PMID: 17113107 DOI: 10.1016/j.jpsychires.2006.09.010] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2006] [Revised: 09/22/2006] [Accepted: 09/25/2006] [Indexed: 11/17/2022]
Abstract
An autoimmune hypothesis has been suggested for early onset obsessive-compulsive disorder and Tourette syndrome. The term: Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) has been proposed as an aetiological subtype of OCD and TS, related to a Group A beta haemolytic streptococcal (GABHS) infection that triggers an autoimmune response. Antineural antibodies have been studied and found in the sera of some patients with these disorders, and they are thought to cross-react with streptococcal and basal ganglia antigens. The present study included 32 prepubertal-onset OCD patients, 21 with TS diagnosis (some of them meeting criteria for PANDAS) and 19 normal children, all aged between 9 and 17 years. Antibodies were assayed by immunohistochemistry and immunoblot. Special attention was paid to the methodology and a high serum dilution was used to minimize non-specific binding. No anti-basal ganglia antibodies were detected by immunohistochemistry in any of the samples. Two proteins, with approximate molecular weights of 86 kDa and 55 kDa, were found in sera from 7 patients. Though the study supports the hypothesis of an autoimmune process underlying OCD or TS in some patients, further research is needed.
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Affiliation(s)
- Astrid Morer
- Department of Child and Adolescent Psychiatry and Psychology, Institut Clinic de Neurociències, Hospital Clínic Universitari, Carrer Villarroel 170, Barcelona 08036, Spain.
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Nissen JB, Thomsen PH. Clinicians' views on clinical examination and treatment of children and adolescents with obsessive-compulsive disorder (OCD). A Danish national survey study. Nord J Psychiatry 2008; 62:309-14. [PMID: 18763190 DOI: 10.1080/08039480801984065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a frequently encountered disorder in children and adolescents. Several characteristics make the disorder a challenge to diagnostic methods and treatment procedures including the diversity of symptoms, the delay of referral and the occurrence of comorbidity. The aim of the present study was to examine how recent progress in assessment and treatment has influenced the Danish clinicians in their work with children and adolescents with OCD. The study was conducted as a national survey addressing a total of 14 outpatient children and adolescent departments, and 25 medical specialists in private practice. The clinicians received a questionnaire including general and specific questions on assessment scales and treatment methods towards OCD and their view on treatment efficacy and prognosis. A total of 71.8% responded to the questionnaire. Most clinicians reported the use of a general medical and social history combined with the use of OCD-specific checklists. Treatment procedures included medication, cognitive therapy or cognitive-behavioural therapy and a family approach depending on the age of the patient. Eighty-one per cent of the clinicians reported a good or very good effect of treatment. Clinical Global Improvement ratings of the last treated patient indicated a treatment response of 68.8% and a response on general improvement of 59.4%. In conclusion, the present study shows that treatment methods employed towards children and adolescents with OCD are close to the clinical recommendations and comparable with those employed in other countries. Furthermore, the general opinion of clinicians towards OCD is comparable with that described in the literature. However, a discussion of the choice of recommended assessment methods including the use of both specific and general checklists is warranted.
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Affiliation(s)
- Judith Becker Nissen
- Psychiatric Hospital for Children and Adolescent Psychiatry, Aarhus University Hospital, Aarhus University, Risskov, DK-8240, Denmark.
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Van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Genetic and environmental influences on obsessive-compulsive symptoms in adults: a population-based twin-family study. Psychol Med 2007; 37:1635-1644. [PMID: 17592667 DOI: 10.1017/s0033291707000980] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND The contribution of genetic factors to obsessive-compulsive (OC) symptoms has not been examined using a large population-based sample of adults. Furthermore, the extent to which there are qualitative and quantitative differences in genetic architecture between men and women with OC symptoms has not been elucidated. METHOD We obtained the Young Adult Self Report Obsessive-Compulsive Scale (YASR-OCS) from a group of 5893 monozygotic (MZ) and dizygotic (DZ) twins, and 1304 additional siblings from the population-based Netherlands Twin Register. Structural equation modelling was used to decompose the variation in OC behaviour into genetic and environmental components and analyse quantitative and qualitative sex differences. RESULTS Familial resemblance was the same for DZ twins and non-twin siblings, which means that there was no evidence for a special twin environment. The same genetic risk factors for OC behaviour were expressed in men and women. Depending on the choice of fit index, we found small (39% for men and 50% for women) or no sex differences (47% for both men and women) in heritability. The remaining variance in liability was due to individual-specific environment. CONCLUSIONS OC behaviour showed a moderate heritability. At most, small quantitative sex differences were found in the genetic architecture of OC behaviour, and no qualitative sex differences.
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