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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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Sharma E, Tripathi A, Grover S, Avasthi A, Dan A, Srivastava C, Goyal N, Manohari SM, Reddy J. Clinical profile of obsessive-compulsive disorder in children and adolescents: A multicentric study from India. Indian J Psychiatry 2019; 61:564-571. [PMID: 31896861 PMCID: PMC6862976 DOI: 10.4103/psychiatry.indianjpsychiatry_128_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Data from the Western countries suggest that obsessive-compulsive disorder (OCD) in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents. AIMS To study the demographic and clinical characteristics of children and adolescents (age ≤18 years) with OCD. SETTING AND DESIGN This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India. MATERIALS AND METHODS Participants were assessed using a semi-structured pro forma for sociodemographic information, clinical characteristics, the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS), Structured Clinical Interview for Diagnostic and Statistical Manual, 5th Edition Research Version, Children's Depression Rating Scale, and Family Interview for Genetic Studies. RESULTS The sample was largely male with a moderate illness severity. Nearly 75% of the sample had illness onset before the age of 14 years. Aggressive, contamination-related obsessions and washing, checking, and repeating compulsions were the most common symptoms. CYBOCS assessment revealed that >2/3rd of children and adolescents endorsed avoidance, pathological doubting, overvalued sense of responsibility, pervasive slowness, and indecisiveness. Family history and comorbidity rates were low. OC-related disorders were present in about 10% of the sample. CONCLUSIONS This study suggests that the clinical characteristics of OCD in children and adolescents in developing countries differ on certain aspects as reported from developed countries.
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Affiliation(s)
- Eesha Sharma
- Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences Hospital, Bengaluru, Karnataka, India
| | - Adarsh Tripathi
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College, Bardhaman, West Bengal, India
| | - Chhitij Srivastava
- Department of Psychiatry, Motilal Nehru Medical College, Allahabad and Institute of Psychiatry, King's College London, London, UK.,Centre of Behavioral and Cognitive Sciences, University of Allahabad, Allahabad, Uttar Pradesh, India
| | - Nishant Goyal
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkahnd, India
| | - S M Manohari
- Department of Psychiatry, St. John's Medical College Hospital, Bengaluru, Karnataka, India
| | - Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences Hospital, Bengaluru, Karnataka, India
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Ching TH, Williams MT. The role of ethnic identity in OC symptom dimensions among Asian Americans. J Obsessive Compuls Relat Disord 2019; 21:112-120. [PMID: 32377506 PMCID: PMC7201378 DOI: 10.1016/j.jocrd.2019.03.005] [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] [Indexed: 10/27/2022]
Abstract
Little is known about obsessive-compulsive (OC) symptoms in Asian Americans. Past research has shown elevations in certain symptom dimensions when compared with White Americans, but there have not been any studies on cultural mechanisms for these differences. In this study, we examined whether ethnic identity mediated differences in severity of various OC symptom dimensions between Asian and White Americans. A total of 453 participants (79 Asian American, 374 non-Hispanic White) completed measures of ethnic identity and OC symptoms. Separate boostrapped mediation analyses were conducted to determine the indirect (i.e., mediation) effect of ethnoracial group membership on different OC symptom dimensions, via ethnic identity. There was significant evidence of mediation across the majority of OC subscales examined. Asian Americans reported stronger ethnic identity than their White counterparts, which in turn predicted more severe contamination obsessions and washing compulsions, harm-related intrusions, checking, neutralizing, as well as symmetry/ordering symptoms. This study is the first to demonstrate an exacerbating function of ethnic identity for OC symptoms among Asian Americans, contrary to some previous evidence of its protective role for overall mental health among ethnoracial minorities. More research is needed to test and validate hypotheses about why ethnic identity mediated group differences in OC symptoms.
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Affiliation(s)
- Terence H.W. Ching
- Corresponding author. University of Connecticut, Department of Psychological Sciences, 406 Babbidge Road, Unit 1020, Storrs, CT, 06269, USA. (T.H.W. Ching)
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Deepthi K, Sagar Kommu JV, Smitha M, Reddy YCJ. Clinical profile and outcome in a large sample of children and adolescents with obsessive-compulsive disorder: A chart review from a tertiary care center in India. Indian J Psychiatry 2018; 60:205-212. [PMID: 30166677 PMCID: PMC6102964 DOI: 10.4103/psychiatry.indianjpsychiatry_342_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Till date, the sample sizes in the Indian studies have been relatively small. METHODOLOGY The present study is a retrospective chart review of a large sample of children and adolescents diagnosed with OCD in a tertiary care center. OBJECTIVES The objectives of this study were to characterize the clinical profile and to evaluate outcome of OCD in children and adolescents. RESULTS Fear of contamination and washing/cleaning compulsions were the most common presenting symptoms. Most of the patients were male with two-thirds having a comorbid disorder. Major depressive disorder was the most common comorbid disorder. The rates of attention deficit hyperactivity disorder, disruptive behavioral disorders, and tic disorders were low when compared to Western studies. One-third of the patients received adequate trial of serotonin reuptake inhibitors and 36% received cognitive behavior therapy. Fifty-four percent of patients had a poor outcome with hospitalization, longer duration of illness, earlier onset of OC symptoms, and family history of OCD being the predictors of poor outcome. CONCLUSION The present study of a large sample of patients with juvenile OCD highlights the low rate of comorbid disruptive behavior disorders as reported in the earlier Indian studies and a favorable short-term outcome in approximately 56% of the patients.
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Affiliation(s)
- K Deepthi
- Department of Psychiatry, NIMHANS, Bengaluru, Karnataka, India
| | | | - M Smitha
- Department of Psychiatry, ESI Hospital, Bengaluru, Karnataka, India
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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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Agarwal V, Yaduvanshi R, Arya A, Gupta PK, Sitholey P. A study of phenomenology, psychiatric co-morbidities, social and adaptive functioning in children and adolescents with OCD. Asian J Psychiatr 2016; 22:69-73. [PMID: 27520897 DOI: 10.1016/j.ajp.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 04/16/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To study the phenomenology, social, adaptive and global functioning of children and adolescents with OCD. BACKGROUND Studies have shown varying prevalence of paediatric OCD ranging from 1% to 4%. Childhood-onset OCD have some important differences in sex distribution, presentation, co-morbidities and insight. MATERIALS AND METHODS 25 subjects (6 to ≤18 years) with a DSM-IV-TR diagnosis of OCD were included in this study. Subjects were evaluated using K-SADS-PL, Children's Y-BOCS, HoNOSCA, C-GAS and VABS-II. RESULTS The mean age of the sample was 14.9±2.2 years. Obsession of contamination was commonest (68%) followed by aggressive obsession (60%); commonest compulsions were washing and cleaning (72%) followed by checking (56%). Most distressing obsessions were obsession of doubt about their decision (28%), having horrible thoughts about their family being hurt (20%) and thought that something terrible is going to happen and it will be their fault (16%). Most subjects rate spending far too much time in washing hands (60%) as most distressing compulsion, followed by rewriting and checking compulsions (both 12%). 76% subjects have co-morbid psychiatric diagnosis. Anxiety disorders (24%), depression (16%), and dissociative disorder (16%) were common co-morbidities. Mean C-GAS score of the sample was 53.2±9.9. 44% of subjects had below average adaptive functioning. CONCLUSIONS The study shows that, most frequent obsessions and compulsions may be different from most distressing ones and this finding might have clinical implication. Most of the children and adolescent with OCD have co-morbidities. Children also had problems in adaptive functioning.
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Affiliation(s)
- Vivek Agarwal
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Rakesh Yaduvanshi
- Department of Psychiatry, Rohilkhand Medical College and Hospitals, Bareilly, Uttar Pradesh, India
| | - Amit Arya
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India.
| | - Pawan Kumar Gupta
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Prabhat Sitholey
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
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Amerio A, Stubbs B, Odone A, Tonna M, Marchesi C, Ghaemi SN. The prevalence and predictors of comorbid bipolar disorder and obsessive-compulsive disorder: A systematic review and meta-analysis. J Affect Disord 2015; 186:99-109. [PMID: 26233320 DOI: 10.1016/j.jad.2015.06.005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although some authors have recently investigated the co-occurrence of anxiety and bipolar disorders, the topic remains insufficiently studied. Defining the prevalence and predictors of BD-OCD comorbidity has important nosological, clinical and therapeutic implications. METHODS A systematic review and meta-analysis was conducted on the prevalence and predictors of comorbid BD-OCD. Relevant papers published through March 30th, 2015 were identified searching the electronic databases MEDLINE, Embase, PsycINFO and the Cochrane Library. RESULTS 46 articles met inclusion criteria. The pooled prevalence of OCD in BD was 17.0% (95% CI 12.7-22.4%), which was comparable to the results reported by the pooled prevalence of BD in OCD (18.35%, 95% CI 13.2-24.8%). With regard to OCD-BD predictors, a higher mean age predicted a lower prevalence of OCD in BD patients. Sub group meta-analyses reported higher OCD prevalence rates in BD children and adolescents (24.2%, compared to 13.5% in adults), in BD-I patients (24.6%, compared to 13.6% in mixed BD patients), and among population-based studies (22.2%, compared to 13.2% in hospital-based studies). LIMITATIONS Most studies use retrospective assessment scales with low sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations that may bias results towards an overestimation of obsessive symptom prevalence. CONCLUSIONS This first systematic review and meta-analysis of the prevalence and predictors of comorbid BD-OCD confirms that BD-OCD comorbidity is a common condition in psychiatry with children and adolescents and BD-I patients as the most affected subgroups.
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Affiliation(s)
- A Amerio
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA.
| | - B Stubbs
- School of Health and Social Care, University of Greenwich, London, UK.
| | - A Odone
- School of Medicine-Public Health Unit, University of Parma, Parma, Italy; Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA.
| | - M Tonna
- Department of Mental Health, Local Health Service, Parma, Italy.
| | - C Marchesi
- Department of Neuroscience, Section of Psychiatry, University of Parma, Parma, Italy; Department of Mental Health, Local Health Service, Parma, Italy.
| | - S N Ghaemi
- Mood Disorders Program, Tufts Medical Center, Boston, MA, USA; Tufts University Medical School, Department of Psychiatry and Pharmacology, Boston, MA, USA.
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Jaisoorya TS, Janardhan Reddy YC, Thennarasu K, Beena KV, Beena M, Jose DC. An epidemological study of obsessive compulsive disorder in adolescents from India. Compr Psychiatry 2015; 61:106-14. [PMID: 26038283 DOI: 10.1016/j.comppsych.2015.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 04/21/2015] [Accepted: 05/06/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES There is scarce data on the prevalence of OCD among adolescents in India. This study reports point prevalence of OCD among school students (age 12-18years) in the Kerala state of India and examines its association with ADHD, psychological distress, tobacco/alcohol abuse, suicide risk and history of sexual abuse. METHOD 7560 students of 73 schools were self-administered the OCD subsection of Clinical Interview Schedule-Revised, the Composite International Diagnostic Interview (CIDI) for obsessive compulsive symptoms and other relevant instruments to identify OCD and related clinical measures. A diagnosis of ICD-10 OCD was derived through the CIS-R algorithm which required duration of at least 2weeks and at least a thought/behavior to be resisted along with a cut-off score for severity and impairment. RESULTS In the sample, 50.3% were males with a mean age of 15.2years (range of 12-18years). The response rate was 97.3% (7380 valid responses). 0.8% (n=61) fulfilled criteria for OCD with a male predominance (1.1 vs. 0.5%, p=0.005). Prevalence was higher among Muslims and increased with age. Taboo thoughts (62.3%) and mental rituals (45.9%) were the commonest symptoms. Those with OCD had significantly higher suicidal thoughts (59 vs. 16.3%, p<0.01) suicide attempts (24.6 vs. 3.8%, p<0.01), ADHD (28 vs. 4%, p<0.001), sexual abuse (24.6 vs. 4.2%, p<0.01), and tobacco use (23 vs. 6.8%, p=0.01). They also reported greater psychological distress and poorer academic performance. CONCLUSIONS OCD is common among adolescents in India. Its associations with ADHD, sexual abuse, psychological distress, poorer academic performance and suicidal behavior are additional reasons for it to be recognized and treated early.
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Affiliation(s)
- T S Jaisoorya
- Department of Psychiatry, Government Medical College, Ernakulam, Kerala 683503, India.
| | | | - K Thennarasu
- Department of Biostatistics, NIMHANS, Bangalore India
| | - K V Beena
- National Rural Health Mission, Thiruvanthupuram, Kerala, India
| | - M Beena
- National Rural Health Mission, Thiruvanthupuram, Kerala, India
| | - Dalia C Jose
- National Rural Health Mission, Ernakulam, Kerala, India
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Huang LC, Tsai KJ, Wang HK, Sung PS, Wu MH, Hung KW, Lin SH. Prevalence, incidence, and comorbidity of clinically diagnosed obsessive-compulsive disorder in Taiwan: a national population-based study. Psychiatry Res 2014; 220:335-41. [PMID: 25169892 DOI: 10.1016/j.psychres.2014.08.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2013] [Revised: 08/06/2014] [Accepted: 08/09/2014] [Indexed: 12/29/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a chronic debilitating anxiety disorder significant in intrusive thoughts and compensation repetitive behaviors. Few studies have reported on this condition Asia. This study estimated the prevalence, incidence and psychiatric comorbidities of OCD in Taiwan. We identified study subjects for 2000-2008 with a principal diagnosis of OCD according to the International Classification of Disease, 9th Revision, Clinical Modification (ICD-9-CM) diagnostic criteria by using National Health Research Institute database. These patients received either outpatient or inpatient care for their condition. Rates were directly age- and sex-adjusted to the 2004 Taiwan population distribution. The estimated mean annual incidence was 27.57 per 10(5) inhabitants and the one year prevalence was 65.05 per 10(5) inhabitants. Incidence and prevalence increased with age, peaking at age 18-24 years in males and at 35-44 years in females. About 53% of adults (≥18 years) and 48% of child and adolescent patients (6-17 years) had one or more comorbid psychiatric conditions. The most common comorbid diagnosis was depressive disorders for both adult and child-adolescent patients. We found a lower prevalence and incidence of clinically diagnosed OCD than that of community studies. Many Asian patients with OCD also had various psychiatric comorbidities, a clinically relevant finding.
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Affiliation(s)
- Li-Chung Huang
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Psychiatry, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan; Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Kuen-Jer Tsai
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hao-Kuang Wang
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurosurgery, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan
| | - Pi-Shan Sung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Ming-Hsiu Wu
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Chi Mei Medical Center, Liouying, Tainan, Taiwan
| | - Kuo-Wei Hung
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Neurology, Yuan׳s General Hospital, Kaohsiung, Taiwan
| | - Sheng-Hsiang Lin
- Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan.
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Amerio A, Odone A, Liapis CC, Ghaemi SN. Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review. Acta Psychiatr Scand 2014; 129:343-58. [PMID: 24506190 DOI: 10.1111/acps.12250] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/08/2014] [Indexed: 01/12/2023]
Abstract
OBJECTIVE At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Defining the nosology of BD-OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. METHOD A systematic review was conducted on: i) BD-OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. RESULTS Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD-OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9±4.2 vs. 4.1±2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). CONCLUSION In this first systematic review of BD-OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease.
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Affiliation(s)
- A Amerio
- Section of Psychiatry, Department of Neuroscience, University of Parma, Parma, Italy; Mood Disorders Program, Tufts Medical Center, Boston, MA, USA
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Abstract
Zwangsstörungen zählen mit einer Prävalenz von 1 bis 2 % zu den häufigeren Störungen im Kindes- und Jugendalter. Komorbide Störungen sind regelhaft vorhanden und die psychosozialen Beeinträchtigungen sind oftmals gravierend. Trotz guter Behandelbarkeit der Zwangsstörung gestaltet sich der Langzeitverlauf bei einem bedeutsamen Teil der Betroffenen insgesamt ungünstig. Der vorliegende Beitrag gibt eine selektive Übersicht zu Definition und Klassifikation, Epidemiologie, Symptomatik, Komorbidität, Diagnostik und Verlauf der Zwangsstörung im Jugendalter.
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Affiliation(s)
- Thomas Jans
- Universitätsklinikum Würzburg, Klinik und Poliklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie
| | - Andreas Reichert
- Diakonisches Werk Würzburg, Tagesklinik für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie
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Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry Res 2012; 200:554-9. [PMID: 22503329 DOI: 10.1016/j.psychres.2012.03.037] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2010] [Revised: 03/17/2012] [Accepted: 03/20/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study aims to examine the demographic, clinical and comorbid patterns in a large sample of adult OCD subjects at a specialty OCD clinic in India. METHODS Consecutive patients (n=545) who consulted a specialty OCD Clinic over 5 years at a large psychiatric hospital in India were evaluated with the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive-Compulsive Scale, and the Clinical Global Impression scale. RESULTS Earlier age onset of OCD (years) was characterized by male preponderance (19.61±7.98 vs. 25.19±10.39, U=23453.5, p=<0.001), positive family history of OCD (19.60±10.02 vs. 22.27±9.20, U=16590.5, p<0.001) and presence of tic disorder (16.28±8.21 vs. 22.01±9.38, OR=0.86, p=0.001). In addition, early age of onset was associated with presence of sexual obsessions (18.92±7.49 vs. 22.88±9.82, OR=0.96, p=0.02), hoarding (19.61±9.32 vs. 22.21±9.36, OR=0.95, p=0.009), repeating rituals (19.76±8.37 vs. 23.29±9.84, OR=0.95, p=0.006) and need to touch compulsions (16.40±7.19 vs. 22.36±9.43, OR=0.89, p<0.001). CONCLUSIONS Our findings from a large sample not only confirm that early onset OCD could be a valid and distinct subtype of OCD but also support the cross-cultural similarity of early onset phenotype.
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Coskun M, Zoroglu S, Ozturk M. Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive-compulsive disorder. Child Adolesc Psychiatry Ment Health 2012; 6:36. [PMID: 23173690 PMCID: PMC3556131 DOI: 10.1186/1753-2000-6-36] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Accepted: 11/21/2012] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The study aimed to investigate phenomenology, psychiatric comorbidity, and family history of obsessive-compulsive disorder (OCD) in a clinical sample of normally developing preschool children with OCD. METHOD Subjects in this study were recruited from a clinical sample of preschool children (under 72 months of age) who were referred to a university clinic. Subjects with a normal developmental history and significant impairment related to OCD symptoms were included in the study. Children's Yale-Brown Obsessive-Compulsive Scale was used to assess OCD symptoms. Each subject was assessed for comorbid DSM-IV psychiatric disorders using a semi-structured interview. Parents were evaluated for lifetime history of OCD in individual sessions. RESULTS Fifteen boys and ten girls (age range: 28 to 69 months; 54.12±9.08 months) were included. Mean age of onset of OCD was 35.64±13.42 months. All subjects received at least one comorbid diagnosis. The most frequent comorbid disorders were non-OCD anxiety disorders (n=17; 68.0%), attention-deficit hyperactivity disorder (ADHD) (n=15; 60.0%), oppositional defiant disorder (ODD) (n=12; 48.0%), and tic disorders (n=6; 24.0%). Mean number of comorbid disorders was 3.65 and 2.35 for boys and girls, respectively. At least one parent received lifetime OCD diagnosis in 68 percent of the subjects. CONCLUSIONS The results indicated that OCD in referred preschool children is more common in males, highly comorbid with other psychiatric disorders, and associated with high rates of family history of OCD. Given the high rates of comorbidity and family history, OCD should be considered in referred preschool children with disruptive behavior disorders and/or with family history of OCD.
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Affiliation(s)
- Murat Coskun
- Istanbul University, Istanbul Medical Faculty, Child and Adolescent Psychiatry Department, Istanbul, Turkey.
| | - Salih Zoroglu
- Istanbul University, Istanbul Medical Faculty, Child and Adolescent Psychiatry Department, Istanbul, Turkey
| | - Mucahit Ozturk
- Center for Psychiatric Research, Training and Consultation (PEDAM), Istanbul, Turkey
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Jana AK, Praharaj SK, Sinha VK. Comorbid bipolar affective disorder and obsessive compulsive disorder in childhood: a case study and brief review. Indian J Psychol Med 2012; 34:279-82. [PMID: 23440037 PMCID: PMC3573582 DOI: 10.4103/0253-7176.106036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Obsessive compulsive disorder and bipolar affective disorder in the pediatric population show a bidirectional overlap. Few studies that have addressed this issue show that the prevalence of obsessive compulsive disorder in bipolar affective disorder patients ranges from 0 to 54%, and 1.85 to 36% of the obsessive compulsive disorder patients have a comorbid bipolar affective disorder. We report a case of a patient with an onset of obsessive compulsive disorder at two-and-a-half years of age, who developed mania after exposure to escitalopram. We suggest that in pediatric obsessive compulsive disorder cases, antidepressants be used with caution, especially in cases with a positive family history of bipolar affective disorder.
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Affiliation(s)
- Amlan K Jana
- Department of Psychiatry, KPC Medical College and Hospital, Kolkata, India
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Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder. Eur Child Adolesc Psychiatry 2010; 19:637-45. [PMID: 20349255 PMCID: PMC2910305 DOI: 10.1007/s00787-010-0101-0] [Citation(s) in RCA: 53] [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] [Received: 12/23/2008] [Accepted: 03/03/2010] [Indexed: 10/26/2022]
Abstract
The present study examines the influence of diagnostic comorbidity on the demographic, psychiatric, and functional status of youth with a primary diagnosis of obsessive compulsive disorder (OCD). Two hundred and fifteen children (ages 5-17) referred to a university-based OCD specialty clinic were compared based on DSM-IV diagnostic profile: OCD without comorbid anxiety or externalizing disorder, OCD plus anxiety disorder, and OCD plus externalizing disorder. No age or gender differences were found across groups. Higher OCD severity was found for the OCD + ANX group, while the OCD + EXT group reported greater functional impairment than the other two groups. Lower family cohesion was reported by the OCD + EXT group compared to the OCD group and the OCD + ANX group reported higher family conflict compared to the OCD + EXT group. The OCD + ANX group had significantly lower rates of tic disorders while rates of depressive disorders did not differ among the three groups. The presence of comorbid anxiety and externalizing psychopathology are associated with greater symptom severity and functional and family impairment and underscores the importance of a better understanding of the relationship of OCD characteristics and associated disorders. Results and clinical implications are further discussed.
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Abstract
Obsessive-compulsive disorder (OCD) was considered a relatively rare disorder until about two decades ago. Since then, considerable advance has been made in understanding the various aspects of OCD that include epidemiology, clinical features, comorbidity, biology and treatment. In the last one decade, there has also been interest in a group of related disorders called obsessive-compulsive spectrum disorders. There is substantial research from India on various aspects of OCD, particularly from the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. We attempt to review all the relevant Indian data on OCD.
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Affiliation(s)
- Y C Janardhan Reddy
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Hosur Road, Bangalore - 560 029, Karnataka, India
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Abstract
INTRODUCTION The co-occurrence of obsessive-compulsive disorder (OCD) in patients with schizophrenia and related disorders has been increasingly recognized. However, the rate of psychosis comorbidity in OCD patients has yet to be systematically evaluated. METHODS The prevalence of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition psychotic disorders was evaluated in 757 subjects consecutively referred to a specialised diagnostic and treatment facility for OCD. Demographic and clinical characteristics were assessed. RESULTS Thirteen OCD patients (1.7%) also met the DSM-IV criteria for a psychotic disorder. We found no significant differences in clinical characteristic between OCD patients with and without a psychotic disorder, although patients with OCD and a psychotic disorder more likely used illicit substances and more likely were male. CONCLUSION Relatively few patients referred to a specialized treatment OCD center suffer from a psychotic disorder.
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Steinhausen HC, Peloso M, Metzke CW. Performance of the adolescent obsessive-compulsive scale in a community survey. J Anxiety Disord 2009; 23:218-22. [PMID: 18723315 DOI: 10.1016/j.janxdis.2008.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Revised: 07/10/2008] [Accepted: 07/11/2008] [Indexed: 10/21/2022]
Abstract
Obsessive-compulsive behavior was studied in a cohort of N=570 subjects who had been assessed at three times between adolescence and young adulthood. Based on the Youth Self-Report (YSR) and the Young Adult Self-Report (YASR), the adolescent obsessive-compulsive scale (AOCS) was defined. At each of the three assessments, subjects scoring above the cut-off score of the 90th percentile of the AOCS were identified and compared to the rest of the sample serving as control group. The risk group was clearly more abnormal in both domains of internalizing and externalizing across time. Various psychiatric disorders in young adulthood were predicted by the AOCS. However, concomitant general psychopathology also contributed strongly to the prediction. Parent and youth agreement on group membership was rather low. Stability of group assignment across time was significantly increased. The AOCS is a promising instrument both for epidemiological and clinical studies. Its content and predictive validity deserves further studies.
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Abstract
With a prevalence of about 2% obsessive-compulsive disorder is ranking among the most frequent psychiatric disorders in childhood and adolescence. The symptoms often lead to severe impairments in academic and social life, as well as to family conflicts. Despite the high efficacy of cognitive-behavioural and psychopharmacological interventions, the long-term course of the disorder is less favourable in a significant number of patients. A profound knowledge of the disorder is crucial to implement effective treatment strategies shortly after the onset of symptoms. This paper gives a review on juvenile obsessive-compulsive disorder and addresses issues of classification, epidemiology, symptoms, co-morbidity, diagnostics, aetiology, treatment strategies and the course of the disorder.
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Uncomplicated and complicated obsessive-compulsive disorder: an exploratory study from India. Compr Psychiatry 2008; 49:51-4. [PMID: 18063041 DOI: 10.1016/j.comppsych.2007.08.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2007] [Revised: 08/09/2007] [Accepted: 08/13/2007] [Indexed: 11/15/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) is frequently associated with comorbid Axis I disorders. Little data are available from the Indian subcontinent. Recent studies have raised the possibility of different characteristics of Indian patients with OCD. Furthermore, very few studies have compared OCD with comorbid Axis I disorders with pure OCD. This cross-sectional exploratory study was carried out with the objective of studying Axis I comorbidity in OCD in an Indian setting. It also aimed to compare OCD with comorbid Axis I disorder vs pure OCD on multiple parameters. Fifty-four patients with OCD (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) were included in the present study. Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition-I was used to assess Axis I comorbidity. The patients were evaluated on different standardized scales measuring obsessive-compulsive, anxiety, and depressive symptomatology. Axis I comorbidity was seen in 64.8% of the sample. The most common comorbid disorders were depression (38.88%), panic disorder (7.40%), and phobias (7.40%). No significant differences were observed on sociodemographic variables, but on psychopathological scales, the OCD complicated with Axis I disorders subgroup scored higher except in the Yale-Brown Obsessive Compulsive Scale compulsion subscale. Frequency and pattern of Axis I comorbidity in OCD in an Indian setting are not different from the rest of the world. Long-term prospective multicenter epidemiological studies are required to understand the development and influence of comorbidity in OCD.
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Abstract
AIMS Obsessive-compulsive disorder (OCD) preferentially responds to a class of antidepressants called serotonin reuptake inhibitors (SRI). This review discusses certain issues unique to pharmacological treatment of OCD: choice of SRI, dose and duration of treatment, options after first failed SRI trial and treatment of SRI non-responders. METHODS We performed a MEDLINE search for pharmacotherapy studies published until December 2006. In addition, the reference sections of major articles, and reviews were also screened. We also considered clinical guidelines and narrative reviews in writing this review. RESULTS The SRIs are equally effective in treating OCD. Meta-analyses suggest that clomipramine may be superior to other SRIs. OCD tends to respond to higher doses of SRIs than that used to treat depression. Response to treatment is usually delayed and may take up to 8-12 weeks. Atypical antipsychotics are the only proven augmenting agents in SRI non-responders. Cognitive behaviour therapy (CBT) is an effective treatment strategy in treating OCD and possibly has a role in treating SRI non-responders. DISCUSSION Side effect profile and drug-drug interactions largely determine the choice of SRI. Those who fail to respond to one SRI trial may well respond to another SRI trial. Clomipramine is recommended if 2-3 trials of SRIs fail to produce response. Atypical antipsychotics are the first-line augmenting agents in SRI non-responders. CBT should be considered in all patients with OCD and is a potential option in SRI non-responders. CONCLUSION OCD is a chronic and debilitating disorder. In responders, SRIs have to be continued in the same doses (if possible) for a minimum of 1-2 years and may be lifelong in those with persistent symptoms and in those with multiple relapses. CBT has to be offered in combination with SRIs wherever facilities for CBT exist.
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Affiliation(s)
- S B Math
- OCD clinic, Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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Jans T, Wewetzer C, Klampfl K, Schulz E, Herpertz-Dahlmann B, Remschmidt H, Warnke A. Phänomenologie und Komorbidität der Zwangsstörung bei Kindern und Jugendlichen. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2007; 35:41-50. [PMID: 17230428 DOI: 10.1024/1422-4917.35.1.41] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Zusammenfassung: Fragestellung: Gegenstand der Studie waren die Symptomatologie und die Komorbidität der Zwangsstörung mit Beginn im Kindes- und Jugendalter. Methodik: Untersucht wurde eine Inanspruchnahmestichprobe von 55 kinder- und jugendpsychiatrischen Patienten (29 männlich, 26 weiblich), die überwiegend stationär behandelt wurden (95%). Strukturierte diagnostische Interviews zur Erfassung von Zwangsstörung und weiteren psychischen Störungen wurden zu Befragungen von Eltern und Kind eingesetzt. Ergebnis: Das mittlere Alter bei Beginn der Zwangsstörung betrug 11,3 Jahre. Jungen waren bei Störungsbeginn etwas, aber nicht statistisch signifikant jünger als Mädchen. Zwangshandlungen bezogen sich vorwiegend auf Waschen und Sauberkeit, Kontrollieren sowie Wiederholungen, Ordnen und Zählen. Zwangsgedanken beinhalteten vor allem Verunreinigung, die Erwartung schlimmer Ereignisse, Sexualität oder Aggression. In der klinischen Behandlungsroutine wurden seltener eine gemischte Zwangsstörung mit Gedanken und Handlungen diagnostiziert als bei Anwendung strukturierter Interviews. Die Komorbiditätsrate war Elternangaben zufolge hoch (Lebenszeit-Diagnosen: 69%; aktuelle Diagnosen: 53%). Angststörungen, affektive Störungen, hyperkinetische Störungen, Störungen des Sozialverhaltens und Ess-Störungen standen im Vordergrund. Die Zwangssymptomatik war bei Patienten mit einer höheren Anzahl an komorbiden Lebenszeitdiagnosen signifikant stärker ausgeprägt. Schlussfolgerungen: Die Studienergebnisse stehen in Einklang mit denjenigen internationaler Studien. Deutlich wurde eine Methodenabhängigkeit gestellter Diagnosen. In der Subtypisierung von Patientengruppen durch Symptomdimensionen wird ein fruchtbarer Ansatz für weitere Studien gesehen.
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Affiliation(s)
- Thomas Jans
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und Psychotherapie der Julius-Maximilians-Universität Würzburg, Germany
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Abstract
The available literature indicates that OCD affecting children and adolescents is highly prevalent. Pediatric-onset OCD seems to share important similarities with the adult disorder but also shows important differences. For example, the clinical phenotype of OCD is remarkably consistent at all ages with some allowances for developmental expression. Pediatric patients frequently demonstrate poor insight into the nature of their obsessions, which in association with their limited verbal expression may make the diagnosis more difficult. Obsessions involving fear of harm and separation, compulsions without obsessions, and rituals involving family members are more common in younger patients. Treatment response,including serotonergic specificity and the need for robust dosing, is another feature shared by early- and adult-onset OCD. Imporfant differences across the life span can also be identified. Perhaps the clearest difference pertains to age of onset. Age-at-onset data have shown a bimodal distribution of age of onset of OCD, with one peak in preadolescent childhood and another peak in adulthood. Another distinction between child and adult OCD is gender representation. Whereas adult studies report equal gender representation or a slight female preponderance, pediatric clinical samples are clearly male predominant. Patterns of psychiatric comorbidity in pediatric OCD show high rates of tic and mood and anxiety disorders, similar to the patterns in adults, but also show a distinct association with disruptive behavior disorders (ADHD and oppositional defiant disorder) and other specific and pervasive developmental disorders. Family studies indicate that the disorder is highly familial and that a childhood onset of the disorder seems to be associated with a markedly increased risk for familial transmission of OCD, tic disorders, and ADHD. Both scientifically and clinically, the recognition of developmentally specific OCD phenotypes may be valuable. For example, research efforts aimed at identifying OCD-associated genes are likely to be more successful if developmentally homogeneous samples are studied instead of combining data from children, adolescents, and adults, as has been common in OCD studies. Clinical management is also informed by an appreciation of the unique cor-relates of OCD affecting youth, especially comorbidity with chronic tic dis-orders and ADHD and their impact on treatment. The so-called "spectrum disorders" related to OCD are less prominent in children and adolescents than in adults. Although sharing some features with typical OCD, these symptoms are less clearly ego-dystonic and less anxiety producing, frequently provide a measure of gratification, and are less responsive in general to SSRIs. Often cognitive antecedents to these behaviors are less well developed than in more typical OCD, and behavioral interventions are the mainstay of treatment but with more variable success.
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Affiliation(s)
- Daniel A Geller
- Pediatric Obsessive Compulsive Disorder Program, Division of Pediatric Psychopharmacology, Massachusetts General Hospital, YAW 6A, Fruit Street, Boston, MA 02114, USA.
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Arnold PD, Ickowicz A, Chen S, Schachar R. Attention-deficit hyperactivity disorder with and without obsessive-compulsive behaviours: clinical characteristics, cognitive assessment, and risk factors. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2005; 50:59-66. [PMID: 15754667 DOI: 10.1177/070674370505000111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine the prevalence of obsessive--compulsive behaviours (OCB) in a clinical sample of children with attention-deficit hyperactivity disorder (ADHD) and to compare ADHD children (with and without OCB) with respect to clinical and cognitive characteristics and risk factors. METHOD We compared ADHD children (n = 134) with and without OCB, and we compared all ADHD children with a group of normal control subjects (n = 26) on various clinical, cognitive, and inhibitory control measures; neurobiological and psychosocial risk factors; and family histories of psychiatric illness. RESULTS Clinically significant OCB was identified in 11.2% (15/134) of children with ADHD. Comorbid OCB was associated with significantly increased perfectionism, improved teacher ratings of inattention, and a decreased likelihood of having a first-degree relative with ADHD. Comorbid ADHD and OCB may also be associated with increased oppositional behaviour at home and better inhibitory control, though these differences were not statistically significant. CONCLUSIONS Comorbid OCB is common in clinically referred children with ADHD and is associated with increased impairment relative to ADHD alone. Further, children with ADHD and OCB may develop symptoms as the result of different genetic and environmental risk factors, compared with children with ADHD only.
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Affiliation(s)
- Paul Daniel Arnold
- Neurogenetics Section, Child Psychiatry Program, Centre for Addiction and Mental Health, Toronto, Ontario
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