A qualititative study of neurological soft signs in obsessive compulsive disorder and effect of comorbid psychotic spectrum disorders and familiality on its expression in Indian population

White matter abnormalities in paediatric obsessive-compulsive disorder: a systematic review of diffusion tensor imaging studies

Microstructural alterations in white matter are evident in obsessive-compulsive disorder (OCD) both in adult and paediatric populations. Paediatric patients go through the process of maturation and thus may undergo different pathophysiology than adult OCD. Findings from studies in paediatric obsessive-compulsive disorder have been inconsistent, possibly due to their small sample size or heterogeneous populations. The aim of this review is to provide a comprehensive overview of white matter structures in paediatric obsessive-compulsive disorder and their correlation with clinical features. Based on PRISMA guidelines, we performed a systematic search on diffusion tensor imaging studies that reported fractional anisotropy, mean diffusivity, radial diffusivity, or axial diffusivity alterations between paediatric patients with obsessive-compulsive disorder and healthy controls using voxel-based analysis, or tract-based spatial statistics. We identified fifteen relevant studies. Most studies reported changes predominantly in the corpus callosum, cingulum, arcuate fasciculus, uncinate fasciculus, inferior longitudinal fasciculus, superior longitudinal fasciculus, inferior fronto-occipital fasciculus, corticospinal tract, forceps minor and major, and the cerebellum in paediatric obsessive-compulsive disorder. These alterations included increased and decreased fractional anisotropy and radial diffusivity, and increased mean and axial diffusivity in different white matter tracts. These changes were associated with obsessive-compulsive disorder symptoms. Moreover, specific genetic polymorphisms were linked with cerebellar white matter changes in paediatric obsessive-compulsive disorder. White matter changes are widespread in paediatric OCD patients. These changes are often associated with symptoms however there are controversies in the direction of changes in some tracts.

Prevalence and clinical correlations of obsessive-compulsive symptoms in schizophrenia

INTRODUCTION

Obsessive compulsive symptoms are often present in persons with schizophrenia. Adequately powered studies to evaluate the effect of such symptoms in the course of the disorder, are few.

AIM

We aimed to estimate the prevalence and type of obsessive-compulsive symptoms in persons with schizophrenia.

METHODS

We evaluated 200 outpatients with schizophrenia (DSM-V) on the Positive and Negative Symptom Scale (PANSS) and the Yale Brown Obsessive Compulsive Scale (YBOCS). Participants with or without obsessive compulsive symptoms were matched on age, gender and age of onset of schizophrenia. Appropriate analysis by comparisons and correlations were performed.

RESULTS

Prevalence of obsessive-compulsive symptoms was 18.5% (n = 37/200). Most common obsession was contamination and compulsion was cleaning/washing with a prevalence of 51.35% and 63.33% respectively. There were no significant differences between the two groups on age, gender, marital status, residence, age of onset or total duration of illness of schizophrenia. The OC symptoms group had significantly higher general psychopathology and PANSS total scores. There was significant positive correlation between YBOCS total obsession scores (To) and total PANSS scores (r = 0.358) (p = 0.030), as well as PANSS general psychopathology subscale scores (Gt) (r = 0.395) (p = 0.016) and finally between total YBOCS scores (To + Tc) and PANSS positive subscale scores (Pt)(r = 0.344) (p = 0.037).

CONCLUSION

There was a significant subgroup of schizophrenia patients (almost one fifth) who complained of obsessive-compulsive symptoms. This group reported significantly higher general psychopathology and could thus be said to be more seriously ill, in an adequately powered cross sectional study.

Motor dysfunction as research domain across bipolar, obsessive-compulsive and neurodevelopmental disorders

Although genuine motor abnormalities (GMA) are frequently found in schizophrenia, they are also considered as an intrinsic feature of bipolar, obsessive-compulsive, and neurodevelopmental disorders with early onset such as autism, ADHD, and Tourette syndrome. Such transnosological observations strongly suggest a common neural pathophysiology. This systematic review highlights the evidence on GMA and their neuroanatomical substrates in bipolar, obsessive-compulsive, and neurodevelopmental disorders. The data lends support for a common pattern contributing to GMA expression in these diseases that seems to be related to cerebello-thalamo-cortical, fronto-parietal, and cortico-subcortical motor circuit dysfunction. The identified studies provide first evidence for a motor network dysfunction as a correlate of early neurodevelopmental deviance prior to clinical symptom expression. There are also first hints for a developmental risk factor model of these mental disorders. An in-depth analysis of motor networks and related patho-(physiological) mechanisms will not only help promoting Research Domain Criteria (RDoC) Motor System construct, but also facilitate the development of novel psychopharmacological models, as well as the identification of neurobiologically plausible target sites for non-invasive brain stimulation.

Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects

A body of evidence has supported that patients with obsessive-compulsive disorder (OCD) have increased rates of various neurological soft signs (NSS) compared to controls. Various lines of research has documented robust relationships between OCD and dissociative symptomatology. The study aimed to examine the associations between obsessive-compulsive symptoms, dissociative experiences alexithymia, and NSS. The study included thirty OCD patients and thirty healthy controls, matched for age, marital status, education, and income. The Neurological Evaluation Scale (NES), Padua Inventory-Revised (PI-R), Dissociative Experiences Scale (DES) and Toronto Alexithymia Scale (TAS-20) were administered. In comparison to healthy controls, patients with OCD had difficulty sequencing for complex motor acts and greater absorption/ imaginative involvement. Using latent class analysis, the study sample was classified into two homogenous subsets as mild NSS (n = 45) and severe NSS (n = 15). Majority of the participants who were grouped into severe NSS latent class were OCD patient (n = 14, 93.3%). Furthermore, those with severe NSS reported greater levels of alexithymia and more severe obsessive-compulsive symptoms, particularly precision. We concluded that relationships between OCD severity and NSS appear to be of crucial importance. Our data along with accumulated evidence suggest that OCD associated with pronounced NSS may represent a specific subtype of the disorder.