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de Filippis R, Aguglia A, Costanza A, Benatti B, Placenti V, Vai E, Bruno E, De Berardis D, Dell’Osso B, Albert U, De Fazio P, Amore M, Serafini G, Ghaemi NS, Amerio A. Obsessive-Compulsive Disorder as an Epiphenomenon of Comorbid Bipolar Disorder? An Updated Systematic Review. J Clin Med 2024; 13:1230. [PMID: 38592113 PMCID: PMC10931838 DOI: 10.3390/jcm13051230] [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: 12/24/2023] [Revised: 02/06/2024] [Accepted: 02/13/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Bipolar disorder (BD) and obsessive-compulsive disorder (OCD) comorbidity is an emerging condition in psychiatry, with relevant nosological, clinical, and therapeutic implications. METHODS We updated our previous systematic review on epidemiology and standard diagnostic validators (including phenomenology, course of illness, heredity, biological markers, and treatment response) of BD-OCD. Relevant papers published until (and including) 15 October 2023 were identified by searching the electronic databases MEDLINE, Embase, PsychINFO, and Cochrane Library, according to the PRISMA statement (PROSPERO registration number, CRD42021267685). RESULTS We identified 38 new articles, which added to the previous 64 and raised the total to 102. The lifetime comorbidity prevalence ranged from 0.26 to 27.8% for BD and from 0.3 to 53.3% for OCD. The onset of the two disorders appears to be often overlapping, although the appearance of the primary disorder may influence the outcome. Compared to a single diagnosis, BD-OCD exhibited a distinct pattern of OC symptoms typically following an episodic course, occurring in up to 75% of cases (vs. 3%). Notably, these OC symptoms tended to worsen during depressive episodes (78%) and improve during manic or hypomanic episodes (64%). Similarly, a BD course appears to be chronic in individuals with BD-OCD in comparison to patients without. Additionally, individuals with BD-OCD comorbidity experienced more depressive episodes (mean of 8.9 ± 4.2) compared to those without comorbidity (mean of 4.1 ± 2.7). CONCLUSIONS We found a greater likelihood of antidepressant-induced manic/hypomanic episodes (60% vs. 4.1%), and mood stabilizers with antipsychotic add-ons emerging as a preferred treatment. In line with our previous work, BD-OCD comorbidity encompasses a condition of greater nosological and clinical complexity than individual disorders.
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Affiliation(s)
- Renato de Filippis
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Andrea Aguglia
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Alessandra Costanza
- Department of Psychiatry, Faculty of Medicine, University of Geneva (UNIGE), 1205 Geneva, Switzerland
- Department of Psychiatry, Faculty of Biomedical Sciences, University of Italian Switzerland (USI) Lugano, 6900 Lugano, Switzerland
| | - Beatrice Benatti
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
| | - Valeria Placenti
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Eleonora Vai
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Edoardo Bruno
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Domenico De Berardis
- NHS, Department of Mental Health, Psychiatric Service for Diagnosis and Treatment, Hospital “G. Mazzini”, 64100 Teramo, Italy
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, Luigi Sacco Hospital, University of Milan, 20157 Milan, Italy
- “Aldo Ravelli” Center for Nanotechnology and Neurostimulation, University of Milan, 20122 Milan, Italy
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA 94305, USA
| | - Umberto Albert
- Department of Medicine, Surgery and Health Sciences, University of Trieste and Department of Mental Health, Azienda Sanitaria Universitaria Giuliano Isontina—ASUGI, 34128 Trieste, Italy
| | - Pasquale De Fazio
- Psychiatry Unit, Department of Health Sciences, University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
| | - Nassir S. Ghaemi
- Department of Psychiatry, Tufts University School of Medicine, Boston, MA 02111, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), University of Genoa, 16132 Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, 16132 Genoa, Italy
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Chang YJ, Tseng JC, Leong PY, Wang YH, Wei JCC. Increased Risk of Sjögren's Syndrome in Patients with Obsessive-Compulsive Disorder: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115936. [PMID: 34205846 PMCID: PMC8199316 DOI: 10.3390/ijerph18115936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 12/02/2022]
Abstract
Obsessive-compulsive disorder (OCD) includes a wide range of symptoms and is often associated with comorbidities. Although psychiatric involvement may be an early manifestation of Sjögren’s syndrome (SS), only a few studies have demonstrated the relationship between OCD and SS. This is a nationwide cohort study identifying the risk of SS in OCD patients. We studied a longitudinal health insurance database for the period from 1999 to 2013. The study group was OCD patients with at least three outpatient visits or one hospitalization. The comparison cohort was matched by age and sex, as well as comorbidities. We calculated the risk of Sjögren’s syndrome using Cox proportional hazard regression models. We performed a propensity score match for confounders and effect modifiers between the two groups. The propensity score probability was estimated through logistic regression. Primary outcome was the incidental SS. A total of 1678 patients with OCD (49% women, mean age: 35.6 years) and 3356 controls were followed up, resulting in 13,077 and 25,856 person-years, respectively. The hazard ratio for developing SS was 3.31 (95% C.I.: 1.74–6.28) in patients with OCD, compared to those without OCD after adjusting for age, sex, and comorbidities. Furthermore, the risk of SS significantly increased over the 2-year follow-up period after OCD diagnosis. We concluded that risk of SS is significantly increased in patients with OCD compared to those without OCD. Clinically, Sjögren’s symptoms in OCD patients should be regularly assessed.
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Affiliation(s)
- Yi-Jung Chang
- Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan 33305, Taiwan;
- College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Jui-Cheng Tseng
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81362, Taiwan; or
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Department of Medicine, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Institute of Medicine, Chung Shan Medical University, Taichung 40201, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung 40201, Taiwan;
- Graduate Institute of Integrated Medicine, China Medical University, Taichung 404333, Taiwan
- Correspondence:
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Dalsgaard S, Thorsteinsson E, Trabjerg BB, Schullehner J, Plana-Ripoll O, Brikell I, Wimberley T, Thygesen M, Madsen KB, Timmerman A, Schendel D, McGrath JJ, Mortensen PB, Pedersen CB. Incidence Rates and Cumulative Incidences of the Full Spectrum of Diagnosed Mental Disorders in Childhood and Adolescence. JAMA Psychiatry 2020; 77:155-164. [PMID: 31746968 PMCID: PMC6902162 DOI: 10.1001/jamapsychiatry.2019.3523] [Citation(s) in RCA: 209] [Impact Index Per Article: 52.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE Knowledge about the epidemiology of mental disorders in children and adolescents is essential for research and planning of health services. Surveys can provide prevalence rates, whereas population-based registers are instrumental to obtain precise estimates of incidence rates and risks. OBJECTIVE To estimate age- and sex-specific incidence rates and risks of being diagnosed with any mental disorder during childhood and adolescence. DESIGN This cohort study included all individuals born in Denmark from January 1, 1995, through December 31, 2016 (1.3 million), and followed up from birth until December 31, 2016, or the date of death, emigration, disappearance, or diagnosis of 1 of the mental disorders examined (14.4 million person-years of follow-up). Data were analyzed from September 14, 2018, through June 11, 2019. EXPOSURES Age and sex. MAIN OUTCOMES AND MEASURES Incidence rates and cumulative incidences of all mental disorders according to the ICD-10 Classification of Mental and Behavioral Disorders: Diagnostic Criteria for Research, diagnosed before 18 years of age during the study period. RESULTS A total of 99 926 individuals (15.01%; 95% CI, 14.98%-15.17%), including 41 350 girls (14.63%; 95% CI, 14.48%-14.77%) and 58 576 boys (15.51%; 95% CI, 15.18%-15.84%), were diagnosed with a mental disorder before 18 years of age. Anxiety disorder was the most common diagnosis in girls (7.85%; 95% CI, 7.74%-7.97%); attention-deficit/hyperactivity disorder (ADHD) was the most common in boys (5.90%; 95% CI, 5.76%-6.03%). Girls had a higher risk than boys of schizophrenia (0.76% [95% CI, 0.72%-0.80%] vs 0.48% [95% CI, 0.39%-0.59%]), obsessive-compulsive disorder (0.96% [95% CI, 0.92%-1.00%] vs 0.63% [95% CI, 0.56%-0.72%]), and mood disorders (2.54% [95% CI, 2.47%-2.61%] vs 1.10% [95% CI, 0.84%-1.21%]). Incidence peaked earlier in boys than girls in ADHD (8 vs 17 years of age), intellectual disability (5 vs 14 years of age), and other developmental disorders (5 vs 16 years of age). The overall risk of being diagnosed with a mental disorder before 6 years of age was 2.13% (95% CI, 2.11%-2.16%) and was higher in boys (2.78% [95% CI, 2.44%-3.15%]) than in girls (1.45% [95% CI, 1.42%-1.49%]). CONCLUSIONS AND RELEVANCE This nationwide population-based cohort study provides a first comprehensive assessment of the incidence and risks of mental disorders in childhood and adolescence. By 18 years of age, 15.01% of children and adolescents in this study were diagnosed with a mental disorder. The incidence of several neurodevelopmental disorders peaked in late adolescence in girls, suggesting possible delayed detection. The distinct signatures of the different mental disorders with respect to sex and age may have important implications for service planning and etiological research.
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Affiliation(s)
- Søren Dalsgaard
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Erla Thorsteinsson
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Betina B. Trabjerg
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Jörg Schullehner
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Geological Survey of Denmark and Greenland, Aarhus, Denmark
| | - Oleguer Plana-Ripoll
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Isabell Brikell
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Theresa Wimberley
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Malene Thygesen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Kathrine Bang Madsen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark
| | - Allan Timmerman
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Diana Schendel
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - John J. McGrath
- National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Queensland Centre for Mental Health Research, The Park Centre for Mental Health, Wacol, Australia,Queensland Brain Institute, University of Queensland, Brisbane, Australia
| | - Preben Bo Mortensen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
| | - Carsten B. Pedersen
- The Lundbeck Foundation Initiative for Integrative Psychiatric Research (iPSYCH), Aarhus, Denmark,National Centre for Register-Based Research, Department of Economics and Business Economics, Aarhus University, Aarhus, Denmark,Centre for Integrated Register-based Research, Aarhus University, Aarhus, Denmark
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Rapinesi C, Kotzalidis GD, Ferracuti S, Sani G, Girardi P, Del Casale A. Brain Stimulation in Obsessive-Compulsive Disorder (OCD): A Systematic Review. Curr Neuropharmacol 2020; 17:787-807. [PMID: 30963971 PMCID: PMC7059162 DOI: 10.2174/1570159x17666190409142555] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 02/06/2023] Open
Abstract
Background Obsessive-compulsive disorder (OCD) is a highly prevalent, severe, and chronic disease. There is a need for alternative strategies for treatment-resistant OCD. Objective This review aims to assess the effect of brain stimulation techniques in OCD. Method We included papers published in peer-reviewed journals dealing with brain stimulation techniques in OCD. We conducted treatment-specific searches for OCD (Technique AND ((randomized OR randomised) AND control* AND trial) AND (magnetic AND stimulation OR (rTMS OR dTMS)) AND (obsess* OR compuls* OR OCD)) on six databases, i.e., PubMed, Cochrane, Scopus, CINAHL, PsycINFO, and Web of Science to identify randomised controlled trials and ClinicalTrials.gov for possible additional results. Results Different add-on stimulation techniques could be effective for severely ill OCD patients unresponsive to drugs and/or behavioural therapy. Most evidence regarded deep brain stimulation (DBS) and transcranial magnetic stimulation (TMS), while there is less evidence regarding transcranial direct current stimulation (tDCS), electroconvulsive therapy, and vagus nerve stimulation (for these last two there are no sham-controlled studies). Low-frequency TMS may be more effective over the supplementary motor area or the orbitofrontal cortex. DBS showed best results when targeting the crossroad between the nucleus accumbens and the ventral capsule or the subthalamic nucleus. Cathodal tDCS may be better than anodal in treating OCD. Limitations. We had to include methodologically inconsistent underpowered studies. Conclusion Different brain stimulation techniques are promising as an add-on treatment of
refractory OCD, although studies frequently reported inconsistent results. TMS, DBS, and tDCS could possibly find some use with adequate testing, but their standard methodology still needs to be established.
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Affiliation(s)
- Chiara Rapinesi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
| | - Georgios D Kotzalidis
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
| | - Stefano Ferracuti
- Department of Human Neuroscience, Sapienza University; Risk Management Unit, "Sant'Andrea" University Hospital, Rome, Italy
| | - Gabriele Sani
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy.,"Lucio Bini" Center, "Aretaeus Onlus", Rome, Italy
| | - Paolo Girardi
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy.,"Lucio Bini" Center, "Aretaeus Onlus", Rome, Italy
| | - Antonio Del Casale
- Neurosciences, Mental Health, and Sensory Organs (NESMOS) Department, Faculty of Medicine and Psychology, Sapienza University; "Sant'Andrea" University Hospital, Rome, Italy
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Wang LY, Chen SF, Chiang JH, Hsu CY, Shen YC. Systemic autoimmune diseases are associated with an increased risk of obsessive-compulsive disorder: a nationwide population-based cohort study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:507-516. [PMID: 30406283 DOI: 10.1007/s00127-018-1622-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Accepted: 10/30/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE Studies suggested autoimmunity plays a role in the etiology of obsessive-compulsive disorder (OCD). The purpose of this study was to determine if a history of systemic autoimmune diseases (SADs) is associated with an increased risk of subsequent onset of OCD. METHODS Patients with or without SADs were identified in the Taiwan National Health Insurance Program. The SADs cohort consisted of 63,165, while the comparison cohort consisted of 315,825 patients. The incidence rates of OCD with a maximum follow-up period of 10 years between patients with and without SADs were compared using a Cox proportional hazard model to estimate the hazard ratio (HR) and 95% confidence interval (95% CI). RESULTS The major finding was the discovery of a higher incidence of subsequent OCD among patients with SADs (HR: 1.85; 95% CI 1.41-2.43) after adjusted for other demographic characteristics. Specifically, the risk of OCD was observed to be significant increase in systemic lupus erythematosus (1.65, 1.07-2.54) dermatomyositis (3.25, 1.04-10.17), and Sjögren's syndrome (2.38, 1.53-3.72). Also, this study revealed some potential risk factors for developing OCD, including younger age (less than or equal to 50-year-old) and some comorbidities (alcohol use disorder, liver cirrhosis, and malignancies). Conversely, this study found that steroid use was a potential protective factor for the development of OCD. CONCLUSIONS This study confirms that SADs are associated with higher incidence of OCD, suggesting that abnormal autoimmune process is associated with increased expression of psychiatric disturbances.
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Affiliation(s)
- Ling-Yi Wang
- Epidemiology and Biostatistics Consulting Center, Departments of Medical Research and Pharmacy, Tzu Chi General Hospital, Hualien, Taiwan
| | - Shih-Fen Chen
- Center of Medical Genetics, Tzu Chi General Hospital, Hualien, Taiwan
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
| | - Chung-Y Hsu
- Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan
| | - Yu-Chih Shen
- Department of Psychiatry, Tzu Chi General Hospital, 707, Sec. 3, Chung Yang Rd, Hualien, 970, Taiwan. .,School of Medicine, Tzu Chi University, Hualien, Taiwan.
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Özyurt G, Beşiroğlu L. Autism Spectrum Symptoms in Children and Adolescents with Obsessive Compulsive Disorder and Their Mothers. NORO PSIKIYATRI ARSIVI 2018; 55:40-48. [PMID: 30042640 DOI: 10.29399/npa.18138] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 10/26/2016] [Indexed: 12/27/2022]
Abstract
Introduction Obsessive-compulsive disorder (OCD) affects 1-3% of children and adolescents. Although a close relation between OCD and autism spectrum disorder (ASD) has been pointed out, the relation between maternal ASD symptoms and subclinical ASD symptoms in OCD have not been evaluated adequately. In this study, children and adolescents with OCD diagnosis, and OSB indications in their mothers were investigated. The relationship between the clinical severity of these indications in children and adolescents with OCD, and maternal OSB indications will be examined. Method The study group consisted of 38 cases (8-18 years old) diagnosed with OCD. The control group (n=39) comprised patients of other clinics at hospital, and was matched for gender and age to the OCD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL) was used to diagnose OCD and accompanying comorbidities. Social Communication Questionnaire (SCQ) was used to evaluate children's ASD symptoms while Autism Spectrum Quotient (ASQ) was used to evaluate maternal broad autism phenotype. OCD symptoms in children were evaluated with Children Yale-Brown Obsessive Compulsive Scale-(C-Y-BOCS), and OCD symptoms in mothers were evaluated with Yale-Brown Obsessive Compulsive Scale-(Y-BOCS). Results There was no significant difference between sociodemographic data of two groups. When cases and controls were compared with SCQ; all subscales' scores and total score of SCQ were statistically significant higher in OCD group and also mothers of OCD group had statistically significant higher scores in total score of ASQ and subscales except "imagination". Also in comparing the groups with Y-BOCS and C-Y-BOCS; OCD group had statistically significant higher scores in these scales. Conclusion ASD symptoms are prevalent in cases diagnosed with OCD and ASD symptoms increases with OCD severity. Further studies are needed to examine genetic and environmental common risk factors between OCD and ASD.
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Affiliation(s)
- Gonca Özyurt
- Department of Child Psychiatry, Nevşehir State Hospital, Nevşehir, Turkey
| | - Lütfullah Beşiroğlu
- Department of Psychiatry, Katip Çelebi University Medical Faculty, İzmir, Turkey
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Peris TS, Rozenman M, Bergman RL, Chang S, O'Neill J, Piacentini J. Developmental and clinical predictors of comorbidity for youth with obsessive compulsive disorder. J Psychiatr Res 2017; 93:72-78. [PMID: 28601668 DOI: 10.1016/j.jpsychires.2017.05.002] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Revised: 04/03/2017] [Accepted: 05/04/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To date, few studies of childhood obsessive compulsive disorder (OCD) have been adequately powered to examine patterns and predictors of comorbidity, despite the frequency with which it occurs. We address this gap, drawing on a large sample of youth with OCD who were systematically assessed through research and clinical programs in a university-based specialty program for children and adolescents with OCD. We examine patterns of comorbidity across different epochs of development and predict specific classes of OCD (comorbidity internalizing/externalizing/both) from key demographic and clinical variables that may be useful in guiding individualized treatment. METHOD A total of 322 youths (mean age = 12.28, 53% male) were assessed using the Anxiety Disorders Interview Schedule (ADIS; Silverman and Albano, 1996), the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997) and other standardized measures. RESULTS Consistent with prior research, 50% of youth met criteria for a co-occurring anxiety or depressive disorder. Rates of externalizing disorders were lower (16%). Developmental differences emerged such that older youth met criteria for a higher number of co-occurring disorders. As expected, adolescents in particular were more likely to have a co-occurring internalizing disorder compared to early or pre-adolescent peers. Surprisingly, they were also more likely to have a comorbid externalizing disorder. Developmental trends were particularly striking with respect to depression, with adolescents with OCD demonstrating a six-fold greater likelihood of co-occurring depressive disorder compared to younger counterparts. DISCUSSION Clinical implications are discussed with eye toward tailoring interventions, particularly during the transition to adolescence when youth are at heightened risk for depression.
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Affiliation(s)
- Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, USA.
| | | | | | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, USA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, USA
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Rintala H, Chudal R, Leppämäki S, Leivonen S, Hinkka-Yli-Salomäki S, Sourander A. Register-based study of the incidence, comorbidities and demographics of obsessive-compulsive disorder in specialist healthcare. BMC Psychiatry 2017; 17:64. [PMID: 28183286 PMCID: PMC5301466 DOI: 10.1186/s12888-017-1224-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 02/02/2017] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Incidence of obsessive-compulsive disorder (OCD) has been suspected to increase but nationwide epidemiological studies are limited. This study aims to examine sex-specific incidence time trends and characterize psychiatric and neurodevelopmental comorbidities and sociodemographic risk factors of OCD in specialist healthcare in Finland. METHODS A nationwide register-based study using data from four Finnish registers identified 3372 OCD cases and 13,372 matched controls (1:4). Cumulative incidence in subjects born between 1987 and 2001 was estimated at ages of 10, 15, 20 and 23 years. Conditional logistic regression was used to examine the sociodemographic factors. RESULTS The cumulative incidence of OCD was 0.4% by age 23. Incidence by age 15 among three cohorts increased from 12.4 to 23.7 /10000 live born males and 8.5 to 28.0 /10000 live born females. 73% of the sample had a comorbid condition. Males were significantly more comorbid with psychotic and developmental disorders; females were more comorbid with depressive and anxiety disorders (p <0.001). Higher maternal SES was associated with an increased risk of OCD (OR 1.4; 95% CI 1.1-1.6). CONCLUSIONS These findings suggest that incidence of treated OCD in specialist healthcare has increased. The reason may be increased awareness and rate of referrals but a true increase cannot be ruled out. Further research on risk factors of OCD is warranted.
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Affiliation(s)
- Hanna Rintala
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd floor), 20014 Turku, Finland
| | - Roshan Chudal
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd floor), 20014 Turku, Finland
| | - Sami Leppämäki
- Department of Psychiatry, Helsinki University Central Hospital, Helsinki, Finland
| | - Susanna Leivonen
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Neurology, Helsinki University Central Hospital, Helsinki, Finland
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd floor), 20014 Turku, Finland
| | - Susanna Hinkka-Yli-Salomäki
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, University of Turku and Turku University Central Hospital, Turku, Finland
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd floor), 20014 Turku, Finland
| | - Andre Sourander
- Department of Child Psychiatry, University of Turku, Turku, Finland
- Department of Child Psychiatry, University of Turku and Turku University Central Hospital, Turku, Finland
- Research Centre for Child Psychiatry, Institute of Clinical Medicine, Faculty of Medicine, University of Turku, Lemminkäisenkatu 3 / Teutori (3rd floor), 20014 Turku, Finland
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Arildskov TW, Højgaard DRMA, Skarphedinsson G, Thomsen PH, Ivarsson T, Weidle B, Melin KH, Hybel KA. Subclinical autism spectrum symptoms in pediatric obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 2016; 25:711-23. [PMID: 26518580 DOI: 10.1007/s00787-015-0782-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/05/2015] [Indexed: 12/23/2022]
Abstract
The literature on subclinical autism spectrum (ASD) symptoms in pediatric obsessive-compulsive disorder (OCD) is scarce, and it remains unclear whether ASD symptoms are related to OCD severity. The aims of the present study were to assess the prevalence of ASD symptoms and age and sex differences in children and adolescents with OCD, and to explore the relation between ASD symptoms and OCD severity. This is the largest study of ASD symptoms in an OCD population to date, and the first directly aimed at elucidating sex and age differences in this matter. The study used baseline data from the Nordic Long-term OCD Treatment Study in which parents of 257 children and adolescents with OCD aged 7-17 completed the Autism Spectrum Screening Questionnaire. OCD severity was assessed with the Children's Yale-Brown Obsessive Compulsive Scale. Pediatric OCD patients were found to exhibit elevated rates of ASD symptoms compared to a norm group of school-age children. ASD symptoms were concentrated in a subgroup with a prevalence of 10-17 %. This subgroup was characterized by a male preponderance with a sex ratio of approximately 2.6:1, while children versus adolescents with OCD exhibited similar rates. Autism-specific social and communication difficulties were not related to OCD severity, while restricted repetitive behavior was positively related to OCD severity. The results indicate that clinicians need to be aware of ASD symptoms in children and adolescents with OCD since one out of ten exhibits such symptoms at a clinical sub-threshold.
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Affiliation(s)
- Trine Wigh Arildskov
- Research Department, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entry 81, 8240, Risskov, Denmark.
| | - David R M A Højgaard
- Research Department, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entry 81, 8240, Risskov, Denmark
| | - Gudmundur Skarphedinsson
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484, Oslo, Norway
| | - Per Hove Thomsen
- Research Department, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entry 81, 8240, Risskov, Denmark
| | - Tord Ivarsson
- Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484, Oslo, Norway
| | - Bernhard Weidle
- Department of Child and Adolescent Psychiatry, St. Olavs University Hospital and Regional Center for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Klostergate 46, 7491, Trondheim, Norway
| | - Karin Holmgren Melin
- Department of Child and Adolescent Psychiatry, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Katja A Hybel
- Research Department, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Skovagervej 2, entry 81, 8240, Risskov, Denmark
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