Juvenile-onset OCD: clinical features in children, adolescents and adults

Anxiety disorder symptoms in children and adolescents: differences by age and gender in a community sample

INTRODUCTION

Anxiety symptoms in childhood and adolescence are an important risk factor for developing anxiety disorders in subsequent development stages. This study examines the frequency and characteristics of the symptoms of the principal anxiety disorders in children and adoloscents using a self-report questionnaire based on the diagnostic categories of the American Psychiatric Association (APA) manual.

MATERIAL AND METHODS

A cross-sectional, non-interventional study was conducted on 2522 children and adolescents form 8 to 17 years (49% males), enrolled from different schools in the Province of Alicante who completed the Spence Children's Anxiety Scale.

RESULTS

The mean score obtained on the scale (range: 0-114) was 25.15 (standard deviation (SD)=13.54). More than one in four (26.41%) of the children and adolescents showed high scores in any anxiety disorder. The anxiety symptoms due to separation were the most frequent in the sample (5.5%), followed by physical fears (5.1%). Girls scored significantly higher in all disorders (P<.001), except in obsessive-compulsive disorder. Differences were found as regards age in all disorders, except physical fears, but the effect sizes were only in anxiety due to separation, which decreased with age, and generalised anxiety, which was higher in adolescents than in children.

CONCLUSIONS

From the mental health perspective, it is important to be able to detect anxiety symptoms in children from 8 years onwards, in order to intervene early and prevent the development of anxiety disorders in later life.

A review of obsessive-compulsive disorder in children and adolescents

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

Cross-sectional comparison of the clinical characteristics of adults with early-onset and late-onset obsessive compulsive disorder

BACKGROUND

Age at onset (AAO) in obsessive compulsive disorder (OCD) may differentiate genetically and clinically heterogeneous subtypes. The current cross-sectional study compared the characteristics of early-onset OCD (onset age≤18 years) and late-onset OCD (onset age>18 years). The AAO cut-off was based on the onset distribution observed in our systematically recruited patients with OCD.

METHODS

Six hundred and two (including 339 men and 263 women) outpatients meeting DSM-IV criteria of OCD were recruited from the Shanghai Mental Health Center and were screened by a battery of instruments: Yale-Brown Obsessive Compulsive Scale (YBOCS) attached Y-BOCS Symptom Checklist, Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA), and State-Trait Anxiety Inventory (STAI). The demographic and clinical characteristics of the 275 early-onset patients were compared to those of the 327 late-onset patients.

RESULTS

Compared to patients with late-onset OCD, early-onset patients with OCD were significantly more likely to be male (66.9% vs. 47.4%, X2=23.1, p<0.001), to have a positive family history of mental illnesses (26.5% vs. 19.0%, X2=4.9, p=0.026), and to have a longer duration of illness [80.0 (SD=80.7) vs. 65.5 (SD=78.3) months, t600=3.17, p=0.002]. Early-onset patients also had significantly higher scores on the HAMA, HAMD, STAI2, and obsessive in Y-BOCS. The sexual and symmetry/exactness obsessions and the washing/cleaning compulsions were significantly more prevalent in the early-onset group.

CONCLUSIONS

The study of a large sample from mainland China confirms the findings from previous studies and supports the hypothesis that early-onset OCD is a demographically and clinically distinct subtype of OCD.

Provoked arrangement symptoms in obsessive-compulsive disorder using a virtual environment: A preliminary report

The current study aims to explore the effectiveness of virtual environment (VE) in producing anxiety variations to arrangement in order to treat obsessive-compulsive disorder. Twenty-four participants completed and performed the virtual arrangement tasks three times with three-day intervals. The results showed that the levels of participants' anxiety decreased significantly from the first to the last day, but the levels of decrement were different depending on the type of tasks: the time limit task was most effective among the three tasks in evoking arrangement anxiety. Also, only the Symmetry, Ordering, and Arrangement Questionnaire (SOAQ) revealed significant positive correlations with anxieties. These VE profiles can serve as an adjunct for better diagnosis and treatment for people with arranging compulsion symptoms.

Age at onset in Canadian OCD patients: mixture analysis and systematic comparison with other studies

OBJECTIVE

This study aimed to determine the distributions of the age at onset (AAO) using mixture analysis and better develop the understanding of AAO as a clinical feature of obsessive-compulsive disorder.

METHOD

Mixture analysis was used to identify sub-groups characterized by differences in AAO. Clinical features were analyzed for differences in AAO sub-groups using mixture analysis. Comparisons were made with AAO cut-offs used in previous studies using the 2-Sample Kolmogorov-Smirnov Test.

RESULTS

Mixture analysis of our sample (n=196) yielded a combination of 2 normal theoretical distributions with means (SD) of 9.66 (3.12) for the early-onset sub-group and 21.1 (8.36) years for the late-onset sub-group. The sub-groups were divided by a cut-off of 15 years. As expected, a negative correlation was found between AAO and duration of illness. The early-onset subjects had significantly lower age at the time of the assessment and they tended to have more often panic attacks but were treated less often with benzodiazepines and other anti-anxiety medications. The comparison analysis showed significant difference in the AAO distribution between our sample and four other study samples.

CONCLUSIONS

Our findings support the notion that different AAO sub-groups correspond with differences in clinical presentations of obsessive-compulsive disorder.

Objective sleep patterns and severity of symptoms in pediatric obsessive compulsive disorder: a pilot investigation

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.

Comorbid major depression in obsessive-compulsive disorder patients

Although major depressive disorder (MDD) has been consistently considered the most frequent complication of obsessive-compulsive disorder (OCD), little is known about the clinical characteristics of patients with both disorders. This study assessed 815 Brazilian OCD patients using a comprehensive psychiatric evaluation. Clinical and demographic variables, including OCD symptom dimensions, were compared among OCD patients with and without MDD. Our findings showed that prevalence rates of current MDD (32%) and lifetime MDD (67.5%) were similar for both sexes in this study. In addition, patients with comorbid MDD had higher severity scores of OCD symptoms. There was no preferential association of MDD with any particular OCD symptom dimension. This study supports the notion that depressed OCD patients present more severe general psychopathology.

Can obsessions drive you mad? Longitudinal evidence that obsessive-compulsive symptoms worsen the outcome of early psychotic experiences

OBJECTIVE

Although there is substantial comorbidity between psychotic disorder and obsessive-compulsive disorder (OCD), little is known about how these clinical phenotypes, and their subclinical extended phenotypes, covary and impact on each other over time. This study examined cross-sectional and longitudinal associations between both (extended) phenotypes in the general population.

METHOD

Data were obtained from the three waves of the NEMESIS-study. A representative population sample of 7076 participants were assessed using the composite international diagnostic interview (CIDI) at baseline (T(0)), 1 year later at T(1) and again 2 years later at T(2).

RESULTS

At T(0), a lifetime diagnosis of psychotic disorder was present in 1.5% of the entire sample, in 11.5% of the people with any OC symptom and in 23.0% of individuals diagnosed with OCD. OC symptoms at T(0) predicted incident psychotic symptoms at T(2). Similarly, T(0) psychotic symptoms predicted T(2) OC symptoms. The likelihood of persistence of psychotic symptoms or transition to psychotic disorder was higher if early psychosis was accompanied by co-occurring OC symptoms, but not the other way around.

CONCLUSION

OCD and the psychosis phenotype cluster together and predict each other at (sub)clinical level. The co-occurrence of subclinical OC and psychosis may facilitate the formation of a more 'toxic' form of persistent psychosis.

A review of obsessive-compulsive disorder in children and adolescents

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

A novel, multiple symptom model of obsessive-compulsive-like behaviors in animals

BACKGROUND

Current animal models of obsessive-compulsive disorder (OCD) typically involve acute, drug-induced symptom provocation or a genetic association with stereotypies or anxiety. None of these current models demonstrate multiple OCD-like behaviors.

METHODS

Neonatal rats were treated with the tricyclic antidepressant clomipramine or vehicle between days 9 and 16 twice daily and behaviorally tested in adulthood.

RESULTS

Clomipramine exposure in immature rats produced significant behavioral and biochemical changes that include enhanced anxiety (elevated plus maze and marble burying), behavioral inflexibility (perseveration in the spontaneous alternation task and impaired reversal learning), working memory impairment (e.g., win-shift paradigm), hoarding, and corticostriatal dysfunction. Dopamine D2 receptors were elevated in the striatum, whereas serotonin 2C, but not serotonin 1A, receptors were elevated in the orbital frontal cortex.

CONCLUSIONS

This is the first demonstration of multiple symptoms consistent with an OCD-like profile in animals. Moreover, these behaviors are accompanied by biochemical changes in brain regions previously identified as relevant to OCD. This novel model of OCD demonstrates that drug exposure during a sensitive period can program disease-like systems permanently, which could have implications for current and future therapeutic strategies for this and other psychiatric disorders.

Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V

BACKGROUND

Since the publication of the DSM-IV in 1994, research on obsessive-compulsive disorder (OCD) has continued to expand. It is timely to reconsider the nosology of this disorder, assessing whether changes to diagnostic criteria as well as subtypes and specifiers may improve diagnostic validity and clinical utility.

METHODS

The existing criteria were evaluated. Key issues were identified. Electronic databases of PubMed, ScienceDirect, and PsycINFO were searched for relevant studies.

RESULTS

This review presents a number of options and preliminary recommendations to be considered for DSM-V. These include: (1) clarifying and simplifying the definition of obsessions and compulsions (criterion A); (2) possibly deleting the requirement that people recognize that their obsessions or compulsions are excessive or unreasonable (criterion B); (3) rethinking the clinical significance criterion (criterion C) and, in the interim, possibly adjusting what is considered "time-consuming" for OCD; (4) listing additional disorders to help with the differential diagnosis (criterion D); (5) rethinking the medical exclusion criterion (criterion E) and clarifying what is meant by a "general medical condition"; (6) revising the specifiers (i.e., clarifying that OCD can involve a range of insight, in addition to "poor insight," and adding "tic-related OCD"); and (7) highlighting in the DSM-V text important clinical features of OCD that are not currently mentioned in the criteria (e.g., the major symptom dimensions).

CONCLUSIONS

A number of changes to the existing diagnostic criteria for OCD are proposed. These proposed criteria may change as the DSM-V process progresses.

Children with obsessive-compulsive disorder: are they just "little adults"?

Childhood-onset obsessive-compulsive disorder (OCD) affects 1%-2% of children and adolescents. It is characterized by recurrent obsessions and compulsions that create distress and interfere with daily life. The symptoms reported by children are similar to those seen among individuals who develop OCD in adulthood, and the two groups of patients are treated with similar symptom-relieving behavior therapies and medications. However, there are differences in sex ratios, patterns of comorbidity, and the results of neuroimaging studies that might be important. Here we review the diagnosis and treatment of childhood-onset OCD in light of pediatric and adult studies. We also discuss current knowledge of the pathophysiology of the disorder. Despite advances in this area, further research is needed to understand better the etiopathogenesis of the disorder and to develop new, more effective therapeutic options.