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Li LM, Carson A, Dams-O'Connor K. Psychiatric sequelae of traumatic brain injury - future directions in research. Nat Rev Neurol 2023; 19:556-571. [PMID: 37591931 DOI: 10.1038/s41582-023-00853-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2023] [Indexed: 08/19/2023]
Abstract
Despite growing appreciation that traumatic brain injury (TBI) is an important public health burden, our understanding of the psychiatric and behavioural consequences of TBI remains limited. These changes are particularly detrimental to a person's sense of self, their relationships and their participation in the wider community, and they continue to have devastating individual and cumulative effects long after TBI. This Review relates specifically to TBIs that confer objective clinical or biomarker evidence of structural brain injury; symptomatic head injuries without such evidence are outside the scope of this article. Common psychiatric, affective and behavioural sequelae of TBI and their proposed underlying mechanisms are outlined, along with a brief overview of current treatments. Suggestions for how scientists and clinicians can work together in the future to address the chasms in clinical care and knowledge are discussed in depth.
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Affiliation(s)
- Lucia M Li
- Department of Brain Sciences, Imperial College London, London, UK.
| | - Alan Carson
- Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Kristen Dams-O'Connor
- Brain Injury Research Center, Department of Rehabilitation and Human Performance, Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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2
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Merrill RM, Ashton MK. Rates of injury according to a single or comorbid mental illness identified in a large employee database. J Occup Health 2023; 65:e12387. [PMID: 36718664 PMCID: PMC9887468 DOI: 10.1002/1348-9585.12387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE To identify associations between specific types of mental illness (occurring alone or in combination with other mental illness) and (specific and all types) of injury. METHODS Analyses involve 21 027 employees aged 18-64 insured by Deseret Mutual Benefit Administrator (DMBA), 2020. Nine classifications of mental illness and 12 classifications of injury are considered. Rate ratios are adjusted for age, sex, and marital status. RESULTS The rate of injuries is 13.6%. A positive association exists between any mental illness and injury (rate ratio [RR] = 1.74, 95% CI 1.62-1.87). The positive association is consistent across all types of injury, except burns. While having a mental illness tends to positively associate with having an injury (vs. none), it more strongly associates with having two or more types of injury (vs. none). Injury rates are significantly greater when comorbid mental illness is involved (vs. one type of mental illness), more so for multiple types of injuries. Specifically, there is a positive association between having a mental illness (vs. none) and a single type of injury (vs. none) (RR = 1.58, 95% CI 1.42-1.75) or two or more types of injuries (vs. none) (RR = 1.94, 95% CI 1.70-2.23). Corresponding estimates where comorbid mental illnesses exist (vs. none) are (RR = 2.07, 95% CI 1.70-2.51) and (RR = 3.32, 95% CI 2.64-4.17), respectively. The most common combinations of mental illness that positively associate with injury tend to involve comorbid mental illness. CONCLUSIONS Several types of mental illness positively associate with injury and are more strongly associated when there is comorbid mental illness.
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Affiliation(s)
- Ray M. Merrill
- Department of Public HealthCollege of Life Sciences, Brigham Young UniversityProvoUtahUSA
| | - McKay K. Ashton
- Department of Public HealthCollege of Life Sciences, Brigham Young UniversityProvoUtahUSA
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3
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Abstract
Obsessive-compulsive disorder (OCD) is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for OCD are exposure and response prevention, and serotonin reuptake inhibitor medications (SRIs). However, a subset of patients fails to respond to either modality, and few experience complete remission. Beyond SRI monotherapy, antipsychotic augmentation is the only medication approach for OCD with substantial empirical support. Our incomplete understanding of the neurobiology of OCD has hampered efforts to develop new treatments or enhance extant interventions. This review focuses on several promising areas of research that may help elucidate the pathophysiology of OCD and advance treatment. Multiple studies support a significant genetic contribution to OCD, but pinpointing the specific genetic determinants requires additional investigation. The preferential efficacy of SRIs in OCD has neither led to discovery of serotonergic abnormalities in OCD nor to development of new serotonergic medications for OCD. Several lines of preclinical and clinical evidence suggest dysfunction of the glutamatergic system in OCD, prompting testing of several promising glutamate modulating agents. Functional imaging studies in OCD show consistent evidence for increased activity in brain regions that form a cortico-striato-thalamo-cortical (CSTC) loop. Neuromodulation treatments with either noninvasive devices (e.g., transcranial magnetic stimulation) or invasive procedures (e.g., deep brain stimulation) provide further support for the CSTC model of OCD. A common substrate for various interventions (whether drug, behavioral, or device) may be modulation (at different nodes or connections) of the CSTC circuit that mediates the symptoms of OCD.
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Affiliation(s)
- Wayne K. Goodman
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Eric A. Storch
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
| | - Sameer A. Sheth
- Menninger Department of Psychiatry and Behavioral Sciences (all authors) and Department of Neurosurgery (Sheth), Baylor College of Medicine, Houston
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4
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Hicks AJ, Clay FJ, Hopwood M, James AC, Perry LA, Jayaram M, Batty R, Ponsford JL. Efficacy and Harms of Pharmacological Interventions for Anxiety after Traumatic Brain Injury: Systematic Review. J Neurotrauma 2020; 38:519-528. [PMID: 33045912 DOI: 10.1089/neu.2020.7277] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
After a traumatic brain injury (TBI), many persons experience significant and debilitating problems with anxiety. The aim of this systematic review was to critically evaluate the evidence regarding efficacy of pharmacological interventions for anxiety after TBI. We reviewed studies published in English before July 2020 and included original research on pharmacological interventions for anxiety after TBI in adults ≥16 years of age. MEDLINE, PubMed, CINAHL, EMBASE, PsycINFO, and CENTRAL databases were searched, with additional searching of key journals, clinical trials registries, and international drug regulators. The primary outcomes of interest were reduction in symptoms of anxiety and occurrence of harms. The secondary outcomes of interest were changes in depression, cognition, quality of life, and participation. Data were summarized in a narrative synthesis, and evidence quality was assessed using the Cochrane Risk of Bias tool. Only a single non-peer-reviewed, randomized controlled trial of 19 male military service members with mild TBI met inclusion criteria. This study found no significant effect of citalopram on anxiety symptoms over a 12-week intervention. The trial was stopped early because of poor recruitment, and much of the study detail was not included in the report. The methodological quality of the study was difficult to assess because of the lack of detail. No recommendations could be drawn from this review. There is a critical need for adequately powered and controlled studies of pharmacological interventions for anxiety after TBI across all severities that examine side-effect profiles and consider issues of comorbidity and effects of long-term pharmacotherapy.
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Affiliation(s)
- Amelia J Hicks
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Fiona J Clay
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Malcolm Hopwood
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia.,Professorial Psychiatry Unit, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Amelia C James
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
| | - Luke A Perry
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Mahesh Jayaram
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Rachel Batty
- Department of Psychiatry, Albert Road Clinic, University of Melbourne, Melbourne, Victoria, Australia
| | - Jennie L Ponsford
- Monash-Epworth Rehabilitation Research Centre, Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Melbourne, Victoria, Australia
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5
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Fernandez TV, Leckman JF, Pittenger C. Genetic susceptibility in obsessive-compulsive disorder. HANDBOOK OF CLINICAL NEUROLOGY 2018; 148:767-781. [PMID: 29478613 DOI: 10.1016/b978-0-444-64076-5.00049-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obsessive-compulsive disorder (OCD) is present in 1.5-2.5% of the population and can result in substantial lifelong disability. It is characterized by intrusive thoughts, sensations, and urges and by repetitive behaviors that are difficult to control despite, in most cases, preserved insight as to their excessive or irrational nature. The causes and underlying pathophysiology of OCD are not well understood, which has limited the development of new treatments and interventions. Despite evidence for a substantial genetic contribution to disease risk, identification and replication of genetic variants associated with OCD have been challenging. Decades of candidate gene association studies have provided little insight. They are now being supplanted by modern genomewide approaches to discover both common and rare sequence and structural variants. Studies to date suggest potential novel therapeutic avenues such as modulators of glutamatergic and immune pathways; however, individual genetic findings are not yet statistically robust or replicated. Further efforts are clearly needed to identify specific risk variants and to confirm vulnerable pathways by studying much larger cohorts of patients with comprehensive variant discovery approaches. Mouse knockout models have already made notable inroads into our understanding of OCD pathology; their utility will only increase as specific risk alleles are identified.
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Affiliation(s)
- Thomas V Fernandez
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States.
| | - James F Leckman
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University School of Medicine, New Haven, CT, United States
| | - Christopher Pittenger
- Child Study Center, Yale University School of Medicine, New Haven, CT, United States; Department of Psychiatry, Yale University School of Medicine, New Haven, CT, United States; Department of Psychology, Yale University School of Medicine, New Haven, CT, United States; Integrated Neuroscience Research Program, Yale University School of Medicine, New Haven, CT, United States
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6
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Rydon-Grange M, Coetzer R. Association between cognitive impairments and obsessive-compulsive spectrum presentations following traumatic brain injury. Neuropsychol Rehabil 2017; 29:214-231. [PMID: 28043199 DOI: 10.1080/09602011.2016.1272469] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
This study examined the association between self-reported obsessive-compulsive spectrum symptomatology and cognitive performance in a sample of patients with traumatic brain injury (TBI). Twenty-four adults with a moderate-severe TBI accessing a community brain injury rehabilitation service were recruited. Age ranged between 19 and 69 years. Participants completed a battery of neuropsychological tasks assessing memory, executive functioning, and speed of information processing. Self-report questionnaires assessing obsessive-compulsive (OC) symptoms and obsessive-compulsive personality disorder (OCPD) traits were also completed. Correlational analyses revealed that deficits in cognitive flexibility were associated with greater self-reported OC symptomatology and severity. Greater OC symptom severity was significantly related to poorer performance on a visual memory task. Verbal memory and speed of information processing impairments were unrelated to OC symptoms. Performance on tasks of memory, executive functioning, and speed of information processing were not associated with OCPD traits. Overall, results indicate that greater OC symptomatology and severity were associated with specific neuropsychological functions (i.e., cognitive flexibility, visual memory). OCPD personality traits were unrelated to cognitive performance. Further research is needed to examine the potential causal relationship and longer-term interactions between cognitive sequelae and obsessive-compulsive spectrum presentations post-TBI.
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Affiliation(s)
| | - Rudi Coetzer
- b North Wales Brain Injury Service , Betsi Cadwaladr University Health Board NHS Wales , Colwyn Bay , UK.,c School of Psychology , Bangor University , Wales , UK
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7
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Abstract
Mitochondrial diseases are a clinically heterogeneous group of disorders that ultimately result from dysfunction of the mitochondrial respiratory chain. There is some evidence to suggest that mitochondrial dysfunction plays a role in neuropsychiatric illness; however, the data are inconclusive. This article summarizes the available literature published in the area of neuropsychiatric manifestations in both children and adults with primary mitochondrial disease, with a focus on autism spectrum disorder in children and mood disorders and schizophrenia in adults.
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Affiliation(s)
- Samantha E Marin
- Department of Neurosciences, University of California, San Diego (UCSD), 9500 Gilman Drive #0935, La Jolla, CA 92093-0935, USA
| | - Russell P Saneto
- Department of Neurology, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA; Department of Pediatrics, Seattle Children's Hospital, University of Washington, 4800 Sand Point Way Northeast, Seattle, WA 98105, USA.
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8
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Abstract
In addition to the well-known cognitive impairment following traumatic brain injury (TBI), neuropsychiatric sequelae are often reported as well. Although not the most common neuropsychiatric consequence of TBI, obsessive-compulsive disorder (OCD) has been associated with TBI. However, diagnosing new onset OCD secondary to TBI is complicated by the potential for cognitive impairment secondary to TBI masquerading as OCD. In particular, memory difficulties and executive dysfunction may be confused as representing obsessions and compulsions. Research in this area, which could guide clinical practice, remains limited. In addition to using Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria, neuropsychological testing and collateral interviews may help clinicians when considering differential diagnoses in this complex area of neuropsychiatry.
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Mallya S, Sutherland J, Pongracic S, Mainland B, Ornstein TJ. The manifestation of anxiety disorders after traumatic brain injury: a review. J Neurotrauma 2015; 32:411-21. [PMID: 25227240 DOI: 10.1089/neu.2014.3504] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The development of anxiety disorders after a traumatic brain injury (TBI) is a strong predictor of social, personal, and work dysfunction; nevertheless, the emergence of anxiety has been largely unexplored and poorly understood in the context of TBI. This article provides an overview of the limited published research to date on anxiety disorders that are known to develop after TBI, including post-traumatic stress disorder, generalized anxiety disorder, obsessive-compulsive disorder, panic disorder, specific phobia, and social anxiety disorder. This review also examines diagnostic criteria, the epidemiology of each disorder, and the factors that influence the expression of these conditions, including injury-related and psychosocial variables. Putative neural correlates will be reviewed where known. A discussion of current treatment options and avenues for further research are explored.
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Hofer H, Frigerio S, Frischknecht E, Gassmann D, Gutbrod K, Müri RM. Diagnosis and treatment of an obsessive-compulsive disorder following traumatic brain injury: a single case and review of the literature. Neurocase 2013; 19:390-400. [PMID: 22784309 DOI: 10.1080/13554794.2012.690423] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
A 27-year-old patient with traumatic brain injury and neuropsychiatric symptoms fitting the obsessive-compulsive disorder was investigated. Brain CT-scan revealed left temporal and bilateral fronto-basal parenchymal contusions. Main Outcome Measure was the Yale-Brown Obsessive Compulsive Scale at pre- and post-treatment and at 6 months follow-up. The combination of pharmacotherapy and psychotherapy resulted in lower intensity and frequency of symptoms. Our case illustrates the importance of a detailed diagnostic procedure in order to provide appropriate therapeutic interventions. Further studies are needed to guide the clinician in determining which patients are likely to benefit from a psychotherapeutic intervention in combination with pharmacotherapy.
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Affiliation(s)
- Helene Hofer
- Department of Neurology, University Hospital, Bern, Switzerland.
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11
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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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12
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Abramovitch A, Mittelman A, Henin A, Geller D. Neuroimaging and neuropsychological findings in pediatric obsessive–compulsive disorder: a review and developmental considerations. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/npy.12.40] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Murphy DL, Timpano KR, Wheaton MG, Greenberg BD, Miguel EC. Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts. DIALOGUES IN CLINICAL NEUROSCIENCE 2010. [PMID: 20623919 PMCID: PMC3181955 DOI: 10.31887/dcns.2010.12.2/dmurphy] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are
excessive, anxiety-evoking thoughts and compulsive behaviors that are generally
recognized as unreasonable, but which cause significant distress and impairment.
When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD
may also occur in the context of other neuropsychiatric disorders, most commonly
other anxiety and mood disorders. The question remains as to whether these
combinations of disorders should be regarded as independent, cooccurring
disorders or as different manifestations of an incompletely understood
constellation of OCD spectrum disorders with a common etiology. Additional
considerations are given here to two potential etiology-based subgroups: (i) an
environmentally based group in which OCD occurs following apparent causal events
such as streptococcal infections, brain injury, or atypical neuroleptic
treatment; and (ii) a genomically based group in which OCD is related to
chromosomal anomalies or specific genes. Considering the status of current
research, the concept of OCD and OCD-related spectrum conditions seems fluid in
2010, and in need of ongoing reappraisal.
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Affiliation(s)
- Dennis L Murphy
- Laboratory of Clinical Science, NIMH Intramural Research Program, Bethesda, Maryland 20892, USA.
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Yoldascan E, Ozenli Y, Kutlu O, Topal K, Bozkurt AI. Prevalence of obsessive-compulsive disorder in Turkish university students and assessment of associated factors. BMC Psychiatry 2009; 9:40. [PMID: 19580658 PMCID: PMC2719627 DOI: 10.1186/1471-244x-9-40] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Accepted: 07/06/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many students who begin university at risky periods for OCD development cannot meet the new challenges successfully. They often seek help and apply to the university health center for psychiatric distress. We aimed to determine the prevalence and associated factors of Obsessive Compulsive Disorder (OCD) at students of the Cukurova University in this cross sectional study. METHODS This study was performed in the Cukurova University Faculty of Education with a population of 5500 students; the representative sample size for detecting the OCD prevalence was calculated to be 800. After collecting sociodemographic data, we questioned the students for associated factors of OCD. The General Health Questionnaire-12 (GHQ-12) and Composite International Diagnostic Interview (CIDI, Section K) were used for psychiatric evaluation. Logistic regression analysis was performed to evaluate the linkage between OCD and associated factors. RESULTS A total of 804 university students were included in this study. The GHQ-12-positive students (241 students, 29.9%) were interviewed using Section K of the CIDI (222 students, 27.6%). OCD was diagnosed in 33 (4.2%) students. The Logistic regression analysis of the data showed significant associations between OCD and male gender (p:0.036), living on government dormitory (p: 0.003), living on students' house/parental house (p:0.006), having private room in the parental house (p:0.055) and verbal abuse in the family (p:0.006). CONCLUSION This study demonstrates a higher prevalence of OCD among a group of university students compared to other prevalence studies of OCD in Turkish society. Furthermore, our findings also suggest relationships between OCD and sociodemographic factors, as well as other environmental stress factors.
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Affiliation(s)
- Elcin Yoldascan
- Department of Public Health, Faculty of Medicine, Cukurova University, Adana, Turkey.
| | - Yarkin Ozenli
- Department of Psychiatry, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oguz Kutlu
- Department of Computer and Teaching Technology Education, Faculty of Education, Cukurova University, Adana, Turkey
| | - Kenan Topal
- Department of Family Medicine, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Ali Ihsan Bozkurt
- Department of Public Health, Faculty of Medicine, Pamukkale University, Denizli, Turkey
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Chavira DA, Garrido H, Bagnarello M, Azzam A, Reus VI, Mathews CA. A comparative study of obsessive-compulsive disorder in Costa Rica and the United States. Depress Anxiety 2008; 25:609-19. [PMID: 17823962 DOI: 10.1002/da.20357] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
This study compares the presentation and expression of obsessive-compulsive symptoms between a Latin-American and North American sample. In Costa Rica (CR) and the United States (US), respectively, 26 and 52 affected individuals with early-onset obsessive-compulsive disorder (OCD) were recruited. The Yale Brown Obsessive Compulsive Scale (YBOCS), a semi-structured psychiatric interview, and self-report questionnaires were administered. Age of onset and the distribution of OCD across men and women were similar across groups. Both CR and US participants reported obsessions and compulsions, with similar frequencies of symptoms, and contamination, symmetry, and hoarding as the most common symptom subtypes. The US sample had higher YBOCS total severity scores than the Costa Rican group. Similarly, there were significant ethnicity effects for YBOCS compulsion [F(1, 70)=17.88, P<.001] and obsession severity [F(1, 70)=8.78, P<.001], with Caucasians having higher scores than Costa Ricans on both subscales. Comorbidity rates were higher for US Caucasians than Costa Ricans for all disorders; differences were significant for mood disorders [64.7% versus 34.6%], alcohol use [21.3% versus 3.8%], cannabis use disorders [19.1% versus 0%], and other substance use disorders [39.4% versus 0%]. Regression analyses revealed that ethnicity, trait anxiety, and proband status were the only significant predictors of total YBOCS severity. Findings suggest that the core phenotype of OCD is the same in both CR and the US, and perhaps biologically driven. However some features of OCD, such as impairment, may be culturally influenced, leading to differences in prevalence rates and treatment utilization.
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Affiliation(s)
- Denise A Chavira
- Department of Psychiatry, University of California San Diego, San Diego, California 92037, USA.
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Schwarzbold M, Diaz A, Martins ET, Rufino A, Amante LN, Thais ME, Quevedo J, Hohl A, Linhares MN, Walz R. Psychiatric disorders and traumatic brain injury. Neuropsychiatr Dis Treat 2008; 4:797-816. [PMID: 19043523 PMCID: PMC2536546 DOI: 10.2147/ndt.s2653] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.5] [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
Psychiatric disorders after traumatic brain injury (TBI) are frequent. Researches in this area are important for the patients' care and they may provide hints for the comprehension of primary psychiatric disorders. Here we approach epidemiology, diagnosis, associated factors and treatment of the main psychiatric disorders after TBI. Finally, the present situation of the knowledge in this field is discussed.
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Affiliation(s)
- Marcelo Schwarzbold
- Núcleo de Pesquisas em Neurologia Clínica e Experimental (NUPNEC), Departamento de Clínica Médica, Hospital Universitário, UFSC Florianópolis, SC, Brazil.
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Abstract
BACKGROUND SERT I425V, an uncommon missense single nucleotide polymorphism producing a gain-of-function of the serotonin transporter (SERT), was originally found to segregate with a primarily obsessive-compulsive disorder (OCD) but complexly comorbid phenotype in two unrelated families. OBJECTIVE As two individuals with SERT I425V and OCD also had Asperger syndrome (AS), an autism spectrum disorder, and as other rare SERT variants have recently shown significant associations with autism, we set out to extend our original OCD study by genotyping additional autism/AS and OCD samples. METHODS Case-control association study of SERT I425V in 210 AS/autism probands and 215 controls, plus 335 OCD probands and their family members. RESULTS SERT I425V was not found in any of the individuals with AS/autism, OCD alone or OCD comorbid with AS and other disorders, or in controls. This results in new estimates of SERT I425V having a 1.5% prevalence in 530 individuals with OCD from five unrelated families genotyped by us and by one other group and a 0.23% frequency in four control populations totaling 1300 individuals, yielding a continuing significant OCD-control difference (Fisher's exact test corrected for family coefficient of identity P=0.004, odds ratio=6.54). CONCLUSION As several other uncommon, less well quantitated genetic variations occur with an OCD phenotype, including chromosomal anomalies and some other rare gene variants (SGCE, GCH1 and SLITRK1), a tentative conclusion is that OCD resembles other complex disorders in being etiologically heterogeneous and in having both highly penetrant familial subtypes associated with rare alleles or chromosomal anomalies, as well as having a more common, polygenetic form that may involve polymorphisms in such genes as BDNF, COMT, GRIN2beta, TPH2, HTR2A and SLC1A1.
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Ettelt S, Ruhrmann S, Barnow S, Buthz F, Hochrein A, Meyer K, Kraft S, Reck C, Pukrop R, Klosterkötter J, Falkai P, Maier W, Wagner M, Freyberger HJ, Grabe HJ. Impulsiveness in obsessive-compulsive disorder: results from a family study. Acta Psychiatr Scand 2007; 115:41-7. [PMID: 17201865 DOI: 10.1111/j.1600-0447.2006.00835.x] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although obsessive-compulsive disorder (OCD) is usually conceptualized as an anxiety disorder some studies suggested it to be a deficit of impulse control. The purpose of this study was to assess impulsiveness in OCD families and compare it to control families. METHOD Seventy cases and their 139 relatives were compared with 70 controls and their 134 relatives from a German family study on OCD (German Epidemiologic Network for OCD Studies). All subjects were interviewed and diagnosed according DSM-IV criteria and were administered the Barratt Impulsiveness Scale (BIS) and PADUA-Inventory to assess obsessive-compulsive symptoms. RESULTS OCD subjects had significantly higher scores of cognitive impulsiveness. However, first-degree relatives of OCD cases and of controls had comparable BIS-11 scores. Significant associations of aggressive obsessions and checking with cognitive impulsiveness were found. CONCLUSION OCD is a severe mental disorder that is characterized by a lack of cognitive inhibition. However, impulsiveness does not represent a familial trait in families of OCD subjects.
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Affiliation(s)
- S Ettelt
- Department of Psychiatry and Psychotherapy, University of Greifswald, Stralsund, Germany.
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Samuels JF, Riddle MA, Greenberg BD, Fyer AJ, McCracken JT, Rauch SL, Murphy DL, Grados MA, Pinto A, Knowles JA, Piacentini J, Cannistraro PA, Cullen B, Bienvenu OJ, Rasmussen SA, Pauls DL, Willour VL, Shugart YY, Liang KY, Hoehn-Saric R, Nestadt G. The OCD collaborative genetics study: methods and sample description. Am J Med Genet B Neuropsychiatr Genet 2006; 141B:201-7. [PMID: 16511842 PMCID: PMC2555990 DOI: 10.1002/ajmg.b.30224] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Results from twin and family studies suggest that obsessive-compulsive disorder (OCD) may be transmitted in families but, to date, genes for the disorder have not been identified. The OCD Collaborative Genetics Study (OCGS) is a six-site collaborative genetic linkage study of OCD. Specimens and blinded clinical data will be made available through the National Institute of Mental Health (NIMH) cell repository. In this initial report, we describe the methods of the study and present clinical characteristics of affected individuals for researchers interested in this valuable resource for genetic studies of OCD. The project clinically evaluated and collected blood specimens from 238 families containing 299 OCD-affected sibling pairs and their parents, and additional affected relative pairs, for a genome-wide linkage study. Of the 999 individuals interviewed to date, 624 were diagnosed with "definite" OCD. The mean age of subjects was 36 years (range 7-95). The majority of affected individuals (66%) were female. The mean age at onset of obsessive-compulsive symptoms was 9.5 years. Specific mood disorders, anxiety disorders, eating disorders, and skin picking were more prevalent in female cases, whereas tics, Tourette disorder, and alcohol dependence were more prevalent in male cases. Compared to "definite" cases of OCD, "probable" cases (n = 82) had, on average, later age at onset of obsessive-compulsive symptoms, lower severity score, and fewer numbers of different categories of obsessions and compulsions, and they were less likely to have received treatment for their symptoms.
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Affiliation(s)
- Jack F Samuels
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287-7228, USA
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Abstract
OBJECTIVE This article reviews obsessive-compulsive disorder (OCD) following acquired brain injury. OCD type symptomatology without any other cognitive, behavioral, or emotional problems following a brain injury appears to be rare. However, the first onset of obsessions and compulsions following a brain injury has been described, but cognitive impairments can potentially color the presentation. METHOD This article reviews obsessive-compulsive disorder (OCD) after brain injury, including traumatic brain injury, cerebrovascular accidents, brain tumors and brain infections. Overlapping symtomatology between OCD and brain injury is discussed. RESULTS Findings regarding the neuro-imaging of OCD after brain injury are reviewed and integrated with neuropsychological data from studies with idiopathic OCD. CONCLUSION There appears to be some convergance between findings from studies of the neuropsychology of idiopathic OCD and neuro-imaging of OCD following brain injury.
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Affiliation(s)
- Bernardus R Coetzer
- North Wales Brain Injury Service, Conwy & Denbighshire NHS Trust, Colwyn Bay Hospital, United Kingdom.
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