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Smárason O, Selles RR, Højgaard DRMA, Best JR, Melin K, Ivarsson T, Thomsen PH, Weidle B, McBride NM, Storch EA, Geller D, Wilhelm S, Farrell LJ, Waters AM, Mathieu S, Soreni N, Stewart SE, Skarphedinsson G. Exploring latent clusters in pediatric OCD based on symptoms, severity, age, gender, and comorbidity. Eur Child Adolesc Psychiatry 2024:10.1007/s00787-024-02431-9. [PMID: 38634862 DOI: 10.1007/s00787-024-02431-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 03/25/2024] [Indexed: 04/19/2024]
Abstract
Given diverse symptom expression and high rates of comorbid conditions, the present study explored underlying commonalities among OCD-affected children and adolescents to better conceptualize disorder presentation and associated features. Data from 830 OCD-affected participants presenting to OCD specialty centers was aggregated. Dependent mixture modeling was used to examine latent clusters based on their age- and gender adjusted symptom severity (as measured by the Children's Yale-Brown Obsessive-Compulsive Scale; CY-BOCS), symptom type (as measured by factor scores calculated from the CY-BOCS symptom checklist), and comorbid diagnoses (as assessed via diagnostic interviews). Fit statistics favored a four-cluster model with groups distinguished primarily by symptom expression and comorbidity type. Fit indices for 3-7 cluster models were only marginally different and characteristics of the clusters remained largely stable between solutions with small clusters of distinct presentations added in more complex models. Rather than identifying a single classification system, the findings support the utility of integrating dimensional, developmental, and transdiagnostic information in the conceptualization of OCD-affected children and adolescents. Identified clusters point to the centrality of contamination concerns to OCD, relationships between broader symptom expression and higher levels of comorbidity, and the potential for complex/neurodevelopmental presentations.
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Affiliation(s)
- Orri Smárason
- Faculty of Psychology, University of Iceland, Reykjavik, Iceland.
- Department of Child and Adolescent Psychiatry, Landspitali-The National University Hospital of Iceland, Reykjavik, Iceland.
| | - Robert R Selles
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - John R Best
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Child and Adolescent Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Bernhard Weidle
- Regional Center for Child Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway
- St. Olavs University Hospital, Trondheim, Norway
| | - Nicole Michelle McBride
- Embedded Preventive Behavioral Health Capability, III MEF, United States Marine Corps, Okinawa, Japan
| | | | - Daniel Geller
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | - Sabine Wilhelm
- Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, Boston, MA, USA
| | | | | | | | - Noam Soreni
- St. Joseph's Hospital, Hamilton, ON, Canada
- McMaster University, Hamilton, ON, Canada
| | - S Evelyn Stewart
- University of British Columbia, Vancouver, BC, Canada
- BC Children's Hospital, Vancouver, BC, Canada
- BC Mental Health and Substance Use Services, Burnaby, BC, Canada
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Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr 2020; 9:S76-S93. [PMID: 32206586 PMCID: PMC7082239 DOI: 10.21037/tp.2019.10.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.
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Affiliation(s)
- Ahsan Nazeer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Sidra Medicine, Doha, Qatar
| | - Finza Latif
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Aisha Mondal
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | | | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Boysan M, Yıldırım A, Beşiroğlu L, Kefeli MC, Kağan M. Development and Preliminary Psychometric Properties of an Instrument for the Measurement of Obsessional Dissociative Experiences: The Van Obsessional Dissociation Questionnaire (VOD-Q). Psychiatr Q 2018; 89:549-568. [PMID: 29302772 DOI: 10.1007/s11126-017-9555-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
A growing body of research evidence documents the substantial associations between obsessive-compulsive disorder (OCD) and dissociation. This article describes the development and preliminary psychometric properties of the Van Obsessional Dissociation Questionnaire (VOD-Q). Obsessional dissociation is defined as a tendency to dissociate in reaction to distressing, unwanted and intrusive thoughts, images and impulses. The screening tool is conceptualized to tap obsessional dissociation across three dimensions: obsessional absorption, obsessional depersonalization/ derealization and obsessional amnesia. The VOD-Q, the Padua Inventory-Revised (PI-R), the Dissociative Experiences Scale (DES), and the Obsessive Belief Questionnaire (OBQ-44) were administered in this study. The results showed that the VOD-Q had excellent test-retest reliability (ranging from 0.73 to 0.90) and internal consistency (ranging from 0.90 to 0.97). The VOD-Q total and subscale scores were significantly associated with measures of obsessive-compulsive symptoms and dissociative experiences. OCD patients scored significantly higher on the VOD-Q than community participants. Based on the present findings, the VOD-Q appears to be a reliable and valid instrument for the measurement of obsessional dissociative experiences.
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Affiliation(s)
- Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Lütfullah Beşiroğlu
- Department of Psychiatry, Kâtip Çelebi University School of Medicine, İzmir, Turkey
| | - Mehmet Celal Kefeli
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey
| | - Mücahit Kağan
- Department of Psychological Counseling, Erzincan University Faculty of Education, Erzincan, Turkey
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Tapancı Z, Yıldırım A, Boysan M. Neurological soft signs, dissociation and alexithymia in patients with obsessive-compulsive disorder (OCD) and healthy subjects. Psychiatry Res 2018; 260:90-97. [PMID: 29175504 DOI: 10.1016/j.psychres.2017.11.058] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 11/09/2017] [Accepted: 11/18/2017] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Zafer Tapancı
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Abdullah Yıldırım
- Department of Psychiatry, Yüzüncü Yıl University School of Medicine, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Yüzüncü Yıl University Faculty of Social Sciences, Van, Turkey.
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Boysan M, Kadak MT, Tarakcioglu MC, Sertdurak ZS, Demirel OF. Psychometric Properties of Turkish versions of the Leyton Obsessional Inventory-Child Version (LOI-CV) and Obsessive Beliefs Questionnaire-Child Version (OBQ-CV). ACTA ACUST UNITED AC 2017. [DOI: 10.5455/bcp.20151203125902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Murat Boysan
- Yuzuncu Yil University, Faculty of Arts, Department of Psychology, Van - Turkey
| | - Muhammed Tayyib Kadak
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Mahmut Cem Tarakcioglu
- Dr. Sadi Konuk Education and Research Hospital, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Zeynep Seda Sertdurak
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
| | - Omer Faruk Demirel
- Istanbul University, Cerrahpasa School of Medicine, Department of Child and Adolescent Psychiatry, Istanbul - Turkey
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Knapton O. Experiences of Obsessive-Compulsive Disorder: Activity, State, and Object Episodes. QUALITATIVE HEALTH RESEARCH 2016; 26:2009-2023. [PMID: 26329423 DOI: 10.1177/1049732315601666] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Obsessive-compulsive disorder (OCD) is a mental health problem characterized by persistent obsessions and compulsions. This article provides insights into experiences of OCD through a qualitative, thematic analysis performed on a set of interviews with people with OCD. Four themes were found as central in the participants' descriptions of OCD episodes: (a) space, (b) the body, (c) objects, and (d) interactions. The findings also show that episodes of OCD can be grouped into three broad categories: (a) activity episodes, which revolve around everyday tasks; (b) state episodes, which are concerned with the self and identity; and (c) object episodes, which are concerned with the effects of objects on the self. The relationship of this three-way classification of OCD episodes to existing cognitive models of OCD is discussed. The study also demonstrates the value of categorizing episodes, rather than people, into subtypes of OCD so that intra-participant variation can be highlighted.
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Cappi C, Diniz JB, Requena GL, Lourenço T, Lisboa BCG, Batistuzzo MC, Marques AH, Hoexter MQ, Pereira CA, Miguel EC, Brentani H. Epigenetic evidence for involvement of the oxytocin receptor gene in obsessive-compulsive disorder. BMC Neurosci 2016; 17:79. [PMID: 27903255 PMCID: PMC5131547 DOI: 10.1186/s12868-016-0313-4] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 11/24/2016] [Indexed: 12/22/2022] Open
Abstract
Background
Obsessive–compulsive disorder (OCD) is a chronic neurodevelopmental disorder that affects up to 3% of the general population. Although epigenetic mechanisms play a role in neurodevelopment disorders, epigenetic pathways associated with OCD have rarely been investigated. Oxytocin is a neuropeptide involved in neurobehavioral functions. Oxytocin has been shown to be associated with the regulation of complex socio-cognitive processes such as attachment, social exploration, and social recognition, as well as anxiety and other stress-related behaviors. Oxytocin has also been linked to the pathophysiology of OCD, albeit inconsistently. The aim of this study was to investigate methylation in two targets sequences located in the exon III of the oxytocin receptor gene (OXTR), in OCD patients and healthy controls. We used bisulfite sequencing to quantify DNA methylation in peripheral blood samples collected from 42 OCD patients and 31 healthy controls.
Results We found that the level of methylation of the cytosine-phosphate-guanine sites in two targets sequences analyzed was greater in the OCD patients than in the controls. The higher methylation in the OCD patients correlated with OCD severity. We measured DNA methylation in the peripheral blood, which prevented us from drawing any conclusions about processes in the central nervous system. Conclusion To our knowledge, this is the first study investigating DNA methylation of the OXTR in OCD. Further studies are needed to evaluate the roles that DNA methylation and oxytocin play in OCD.
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Affiliation(s)
- Carolina Cappi
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil.
| | - Juliana Belo Diniz
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Guaraci L Requena
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Tiaya Lourenço
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Bianca Cristina Garcia Lisboa
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Camargo Batistuzzo
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Andrea H Marques
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Marcelo Q Hoexter
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Carlos A Pereira
- Institute of Mathematics and Statistics, University of São Paulo, São Paulo, Brazil
| | - Euripedes Constantino Miguel
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
| | - Helena Brentani
- Department of Psychiatry, School of Medicine, University of São Paulo, R. Dr. Ovídio Pires de Campos, 785, 3º andar, sala 9, São Paulo, SP, 05403-010, Brazil
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Boysan M, Çam Z. An investigation into the role of attachment insecurities in obsessive-compulsive symptoms. BRITISH JOURNAL OF GUIDANCE & COUNSELLING 2016. [DOI: 10.1080/03069885.2016.1262533] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Murat Boysan
- Department of Psychology, Faculty of Social Sciences, Yüzüncü Yıl University, Van, Turkey
| | - Zekeriya Çam
- Department of Educational Sciences, Faculty of Education, Muş Alparslan University, Muş, Turkey
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Olatunji BO, Ebesutani C, Abramowitz JS. Examination of a Bifactor Model of Obsessive-Compulsive Symptom Dimensions. Assessment 2016; 24:45-59. [DOI: 10.1177/1073191115601207] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Although obsessive-compulsive (OC) symptoms are observed along four dimensions (contamination, responsibility for harm, order/symmetry, and unacceptable thoughts), the structure of the dimensions remains unclear. The current study evaluated a bifactor model of OC symptoms among those with and without obsessive-compulsive disorder (OCD). The goals were (a) to evaluate if OC symptoms should be conceptualized as unidimensional or whether distinct dimensions should be interpreted and (b) to use structural equation modeling to examine the convergence of the OC dimensions above and beyond a general dimension with related criteria. Results revealed that a bifactor model fit the data well and that OC symptoms were influenced by a general dimension and by four dimensions. Measurement invariance of the bifactor model was also supported among those with and without OCD. However, the general OC dimension accounted for only half of the variability in OC symptoms, with the remaining variability accounted for by distinct dimensions. Despite evidence of multidimensionality, the dimensions were unreliable after covarying for the general OC dimension. However, the four dimensions did significantly converge with a latent OC spectrum factor above and beyond the general OC dimension. The implications of these findings for conceptualizing the structure of OCD are discussed.
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Özdemir O, Boysan M, Özdemir PG, Coşkun S, Özcan H, Yılmaz E, Atilla E. Family patterns of psychopathology in psychiatric disorders. Compr Psychiatry 2015; 56:161-74. [PMID: 25308406 DOI: 10.1016/j.comppsych.2014.09.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Revised: 09/10/2014] [Accepted: 09/16/2014] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Familial loading and crucial outcomes of family history of psychopathology in psychiatric disorders have long been recognized. There has been ample literature providing convincing evidence for the importance of family psychopathology in development of emotional disturbances in children as well as worse outcomes in the course of psychiatric disorders. More often, maternal psychopathology seems to have been an issue of interest rather than paternal psychopathology while effects of second-degree familiality have received almost no attention. In this study, we addressed the relations between affected first- and second-degree relatives of probands and categories of psychiatric disorders. METHOD Subjects were 350 hospitalized psychiatric inpatients, consecutively admitted to psychiatry clinics in Van, Turkey. Mean age was 34.16 (SD±12) and 51.4% of the sample consisted of male patients. Assessment of psychopathology in psychiatric probands was conducted based on DSM-IV TR. Familial loading of psychiatric disorders amongst first- and second-degree relatives of patients were initially noted primarily relying on patients' retrospective reports, and confirmed by both phone call and following official health records via the Medical Knowledge System. We analyzed the data using latent class analysis approach. RESULTS We found four patterns of familial psychopathology. Latent homogeneous subsets of patients due to familial characteristics were as paternal kinship psychopathology with schizophrenia, paternal kinship psychopathology with mood disorders, maternal kinship psychopathology and core family psychopathology. CONCLUSION Family patterns were critical to exerting variation in psychiatric disorders of probands and affected relatives. Probands with a core family pattern of psychopathology exhibited the most colorful clinical presentations in terms of variation in psychopathology. We observed a specificity of intergenerational transmission of psychiatric disorders when family patterns of psychopathology were taken into consideration, even second-degree relatives of psychiatric probands.
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Affiliation(s)
- Osman Özdemir
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
| | - Murat Boysan
- Department of Psychology, Faculty of Art, Yuzuncu Yil University, Van, Turkey.
| | | | - Salih Coşkun
- Department of Medical Genetics, Dicle University, Diyarbakır, Turkey.
| | - Halil Özcan
- Department of Psychiatry, Atatürk University, Erzurum, Turkey.
| | - Ekrem Yılmaz
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
| | - Ercan Atilla
- Department of Psychiatry, Yuzuncu Yil University, Van, Turkey.
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