1
|
Su R, Hong X, Yang H, Zhang W, Hu N, Wang X, Li Y. Evaluating the diagnostic validity of CBCL-OCS in Chinese children and adolescents with OCD. BMC Psychiatry 2025; 25:369. [PMID: 40217209 PMCID: PMC11992804 DOI: 10.1186/s12888-025-06724-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Accepted: 03/14/2025] [Indexed: 04/14/2025] Open
Abstract
BACKGROUND AND OBJECTIVES Obsessive-compulsive disorder (OCD) is recognized globally as a serious mental health concern among children and adolescents. Accurate early diagnosis and intervention are crucial for effective management and improving patient outcomes. The primary objective of this study was to evaluate the diagnostic validity of the Child Behavior Checklist-Obsessive Compulsive Scale (CBCL-OCS) in Chinese children and adolescents, ensuring its cultural adaptability. The secondary objective was to explore the clinical characteristics of OCD, including prevalence, symptom severity, and comorbidities. METHODS A cross-sectional epidemiological survey was conducted among 8,595 middle school students in Liaoning Province, China. The CBCL-OCS was employed as the primary screening tool. The optimal cutoff value for OCD screening was determined through receiver operating characteristic (ROC) curve analysis. RESULTS The study found an OCD prevalence of 1.710%, which was consistent with the global estimation. ROC analysis determined a cutoff score of 2.5 for CBCL-OCS, with a sensitivity of 0.789 and a specificity of 0.899. Furthermore, adolescents exhibited significantly higher CBCL-OCS scores compared to younger children, suggesting an increase in OCD severity with age. Significant associations were also found between OCD symptoms and comorbid emotional disorders, behavioral problems, and anxiety symptoms. CONCLUSIONS This study confirms the utility of CBCL-OCS as an effective early screening tool for OCD in Chinese middle school students, highlighting its sensitivity and specificity, and cultural adaptability. Results contributed valuable insights to the epidemiology of OCD among children and adolescents, underscoring the need for targeted interventions during critical developmental periods, especially in adolescence.
Collapse
Affiliation(s)
- Rongkun Su
- Shenyang Mental Health Center, Mental Health Management Center, Shenyang, China
| | - Xu Hong
- Cloud Services Innovation Laboratory, Institute of Intelligent Science and Technology, China Electronics Technology Group Corporation, Beijing, China
| | - Hanxue Yang
- School of Psychology, Beijing Language and Culture University, Beijing, China
| | - Wanling Zhang
- Department of Psychosomatic Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Na Hu
- Department of Psychosomatic Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Xiuzhen Wang
- Shenyang Mental Health Center, Mental Health Management Center, Shenyang, China.
- Shenyang Mental Health Center, No. 12 Jinfan Middle Road, Hunnan District, Shenyang, 110168, China.
| | - Ying Li
- Department of Psychosomatic Medicine, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China.
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nanlishi Road, Beijing, 100101, China.
| |
Collapse
|
2
|
Moreno Tarazona E, Orozco Gonzalez M, La Rosa Giron A, Ruiz-Grosso P, Lazo-Porras M. Prevalence of obsessive-compulsive symptoms in patients with schizophrenia treated with clozapine: a scoping review. BMC Psychiatry 2025; 25:71. [PMID: 39849391 PMCID: PMC11759428 DOI: 10.1186/s12888-024-06466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2024] [Accepted: 12/31/2024] [Indexed: 01/25/2025] Open
Abstract
BACKGROUND Schizophrenia is a complex psychiatric disorder, and in patients treated with clozapine, it may induce or exacerbate obsessive-compulsive symptoms (OCS), which negatively affect patients' quality of life, functionality and treatment adherence. Despite its clinical relevance, the reported prevalence and characteristics of clozapine associated OCS vary widely, limiting effective management. OBJECTIVE This scoping review synthesizes evidence on the prevalence of OCS in patients with schizophrenia treated with clozapine and explores treatment characteristics (types, severity, dose, and time to onset/exacerbation). METHODS The PRISMA-ScR methodology guided the search in PubMed, LILACS, Embase, and Scielo. Observational studies in Spanish, English, Portuguese, and French reporting prevalence, incidence, or frequency of OCS in patients over 18 years with schizophrenia treated with clozapine were included. Clinical, qualitative studies, and those with access restrictions were excluded. Risk of bias was assessed using JBI tools. RESULTS Fourteen studies were included, reporting OCS prevalence between 20% and 76%, and de novo OCS between 4.8% and 46.4%. Clozapine dose ranged from 196 to 525 mg/day, and treatment duration from 5 to 210 months. The most common obsessions were aggression and checking, with severity ranging from mild to moderate. CONCLUSIONS The prevalence of OCS in patients treated with clozapine varies widely. Further research is needed to clarify the relationship between dose, treatment duration, and the onset/exacerbation of OCS.
Collapse
Affiliation(s)
| | | | | | - Paulo Ruiz-Grosso
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Maria Lazo-Porras
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- CRONICAS Center of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Peru
| |
Collapse
|
3
|
Etkin RG, Bloch MH, Lebowitz ER. Family accommodation: a diagnostic feature of obsessive-compulsive disorder? Expert Rev Neurother 2024; 24:129-131. [PMID: 38258501 DOI: 10.1080/14737175.2024.2309239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Affiliation(s)
- Rebecca G Etkin
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Michael H Bloch
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| | - Eli R Lebowitz
- Yale Child Study Center, Yale University School of Medicine, New Haven, CT, USA
| |
Collapse
|
4
|
Browning ME, Guzick AG, McCarty RJ, Cooke DL, Toledano S, Olsen BT, Barthle MA, Bailey BA, Guastello AD, Lazaroe LM, McNamara JPH. An examination of obsessive-compulsive symptom domains, depression, and quality of life within an online survey sample. Bull Menninger Clin 2022; 86:133-158. [PMID: 35647779 DOI: 10.1521/bumc.2022.86.2.133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a heterogeneous and highly impairing disorder that is frequently comorbid with other conditions. Participants in this study were 212 individuals recruited through Mechanical Turk who filled out validated measures of obsessive-compulsive symptoms, quality of life (QoL), generalized anxiety, and depressive symptoms. Analyses examined the influences of each symptom variable on QoL and the mediating role of depression as an indirect link between unacceptable thoughts (UT) and QoL. Depressive symptoms had a significant negative relationship with multiple domains of functioning. Generalized anxiety was not significant. Higher endorsement of UT symptoms was related to lower physical, emotional, and social QoL. Depression partially mediated the relationship between UT symptoms and physical, emotional, and social health. Depressive symptoms are important to consider in clinical work surrounding OCD. The significant associations between UT symptoms and QoL in a nonclinical population illustrate a relevant area for future intervention, public awareness, and education.
Collapse
Affiliation(s)
- Morgan E Browning
- Psychology graduate student, Department of Psychology, University of Massachusetts Dartmouth, North Dartmouth, Massachusetts
| | - Andrew G Guzick
- Assistant Professor, Baylor College of Medicine, Houston, Texas
| | - Ryan J McCarty
- Clinical psychology doctoral student, Department of Psychiatry, College of Medicine, and the Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Danielle L Cooke
- Clinical psychology doctoral student, Department of Psychiatry, College of Medicine, and the Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Shanee Toledano
- Psychologist, Rogers Behavioral Health, Sandy Springs, Georgia
| | - Brian T Olsen
- Psychologist, St. Lukes Health System, Twin Falls, Idaho
| | - Megan A Barthle
- Psychologist and clinical assistant professor, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Brittany A Bailey
- Clinical psychology doctoral student, Department of Psychiatry, College of Medicine, and the Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Andrea D Guastello
- Psychologist and clinical assistant professor, Department of Psychiatry, College of Medicine, University of Florida, Gainesville, Florida
| | - Lacie M Lazaroe
- Clinical psychology doctoral student, Department of Psychiatry, College of Medicine, and the Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| | - Joseph P H McNamara
- Associate Professor and Chief, Department of Psychiatry, College of Medicine, and the Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, Florida
| |
Collapse
|
5
|
Nelson J, Kelly JM, Wadsworth L, Maloney E. Co-occurring OCD and Panic Disorder: A Review of Their Etiology and Treatment. J Cogn Psychother 2022; 36:JCP-2021-0009.R2. [PMID: 35470149 DOI: 10.1891/jcp-2021-0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Estimated rates of co-occurrence between obsessive and compulsive disorder (OCD) and panic disorder (PD) are notable, but vary considerably, with rates from epidemiological and clinical studies ranging from 1.8% to 22% (Rector et al., 2017). We reviewed the current empirical literature on the etiology, treatment, diagnostic assessment, and differential diagnosis of co-occurring OCD/PD. Best practices for cognitive-behavioral treatment, including identifying and addressing treatment barriers are also addressed. Although it is acknowledged in current literature that co-occurring OCD and PD levels may be clinically significant, there remains a need to thoroughly examine the possible consequences and future research directions of this overlap. Future research must continue to elucidate the biological and environmental causes of OCD/PD co-occurrence.
Collapse
|
6
|
Maye CE, Wojcik KD, Candelari AE, Goodman WK, Storch EA. Obsessive compulsive disorder during the COVID-19 pandemic: A brief review of course, psychological assessment and treatment considerations. J Obsessive Compuls Relat Disord 2022; 33:100722. [PMID: 35194549 PMCID: PMC8855616 DOI: 10.1016/j.jocrd.2022.100722] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/16/2022] [Accepted: 02/16/2022] [Indexed: 11/26/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an impairing mental health condition defined by intense distress in the presence of unwanted, recurrent thoughts, images, or impulses which are accompanied by compulsions and avoidance performed to reduce distress. During the COVID-19 pandemic, OCD has continued to be an impairing mental health condition regardless of symptom dimensionality (e.g., contamination, harm, etc.) with varying reports of the overall clinical course. However, changes in the assessment, treatment, and diagnosis of OCD have occurred to personalize care and be aligned with public health guidelines. Exposure and response prevention and pharmacotherapy remain the treatment of choice, even though the setting in which treatment is conducted may have shifted. Telehealth in particular has been a 'game-changer' for clinicians and patients alike. Given the continued health risk posed by the pandemic, treatment personalization should still be made to ensure safety for both patients and providers while balancing efficacy and patient preferences.
Collapse
Affiliation(s)
- Caitlyn E Maye
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA
| | - Katharine D Wojcik
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA
| | - Abigail E Candelari
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA
| | - Wayne K Goodman
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, USA
| |
Collapse
|
7
|
Zhang CC, Gong H, Zhang Y, Jin H, Yang Y, Li B, Li Y, Luo X, Liu W, Fang F, Li B, Sun B, Fletcher T, La Buissonnière-Ariza V, Goodman WK, Storch EA. Development and psychometric evaluation of the Mandarin Chinese version of the Yale-Brown Obsessive-Compulsive Scale - Second Edition. ACTA ACUST UNITED AC 2020; 41:494-498. [PMID: 30785537 PMCID: PMC6899356 DOI: 10.1590/1516-4446-2018-0126] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 10/15/2018] [Indexed: 02/08/2023]
Abstract
Objective: To examine the psychometric properties of the Chinese version of the Yale-Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II). Method: A total of 86 adults with a primary diagnosis of obsessive-compulsive disorder (OCD), ranging in age from 15 to 78 years, participated in the study. Participants were administered the Y-BOCS-II by a trained clinician who also rated overall illness severity on two additional measures. Patients completed the Obsessive Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21. Results: Results indicated high internal consistency and fair 1-week test retest reliability. The Y-BOCS-II scales correlated strongly with clinician-rated obsessive-compulsive severity and modestly with self-reported obsessive-compulsive symptom frequency and distress. The relationship between Y-BOCS-II total score and depressive and anxiety symptoms was strong, which may reflect high rates of comorbid conditions in this sample or the linkage between obsessive-compulsive symptom severity and distress. Factor analysis demonstrated a two-factor structure consisting of obsession and compulsion factors, with interference due to obsessions cross-loading. Conclusions: Overall, these results support the use of the Y-BOCS-II among individuals from China. Future study by an independent group is necessary to replicate these findings, as well as investigate interrater reliability and treatment sensitivity.
Collapse
Affiliation(s)
- Chen C Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hengfen Gong
- Department of Psychiatry, Pudong District Mental Health Center, Shanghai, China
| | - Yingying Zhang
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haiyan Jin
- Department of Psychiatry, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yong Yang
- Department of Psychiatry, Suzhou Guangji Hospital, Suzhou, Jiangsu, China
| | - Bin Li
- Department of Psychiatry, Yangpu District Mental Health Center, Shanghai, China
| | - Yongchao Li
- Department of Psychiatry, Yangpu District Mental Health Center, Shanghai, China
| | - Xiao Luo
- Department of Psychiatry, The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China
| | - Wenjuan Liu
- Department of Psychological Medicine, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Fang Fang
- Department of Psychotherapy, Shanghai Hongkou Mental Health Center, Shanghai, China
| | - Bin Li
- Department of Psychiatry, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Bomin Sun
- Department of Functional Neurosurgery, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Terri Fletcher
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| |
Collapse
|
8
|
van Bennekom MJ, de Koning PP, Denys D. Social media and smartphone technology in the symptomatology of OCD. BMJ Case Rep 2018; 2018:bcr-2017-223662. [DOI: 10.1136/bcr-2017-223662] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
|
9
|
Conley S, Faleer H, Wu K. Integrating Treatments for HD and PTSD: A Clinical Report. Clin Case Stud 2018. [DOI: 10.1177/1534650118793943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This report details the course of psychotherapy methods and outcomes for a 57-year-old White man who sought services for hoarding disorder (HD) and posttraumatic stress disorder (PTSD). Over 14 months, he completed 54 treatment sessions that spanned two distinct treatment approaches. Given his presentation and the conceptualized relations among his symptoms, therapy was sequenced to address PTSD symptoms prior to undergoing cognitive–behavioral therapy (CBT) for HD. The implications of this decision were key to his treatment progress and outcome, and they are reviewed in detail. Together, treatment consisted of psycho-education, cognitive restructuring, and a combination of in-clinic and home-based exposures. Results were positive, with the client experiencing a decrease in self-reported HD and PTSD symptoms, reduction in home clutter and decreased distress related to discarding, and increased feelings of self-efficacy. In light of limited data addressing treatment for individuals with HD who have a salient trauma history, the major aim of this report is to detail how each step of the client’s treatment was approached, what factors and data were considered for reaching specific decision points, and how the sequencing of treatment is believed to have contributed to the positive outcome achieved.
Collapse
Affiliation(s)
| | | | - Kevin Wu
- Northern Illinois University, DeKalb, USA
| |
Collapse
|
10
|
Motivala SJ, Arellano M, Greco RL, Aitken D, Hutcheson N, Tadayonnejad R, O'Neill J, Feusner JD. Relationships between obsessive-compulsive disorder, depression and functioning before and after exposure and response prevention therapy. Int J Psychiatry Clin Pract 2018; 22:40-46. [PMID: 28691550 PMCID: PMC5777899 DOI: 10.1080/13651501.2017.1351991] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Obsessive-compulsive disorder (OCD) is associated with impaired functioning and depression. Our aim was to examine relationships between OCD symptoms, depression and functioning before and after exposure and response prevention (ERP), a type of cognitive-behavioural therapy for OCD, specifically examining whether functioning, depression and other cognitive factors like rumination and worry acted as mediators. METHODS Forty-four individuals with OCD were randomised to 4 weeks of intensive ERP treatment first (n = 23) or waitlist then treatment (n = 21). We used a bootstrapping method to examine mediation models. RESULTS OCD symptoms, depression and functioning significantly improved from pre- to post-intervention. Functioning mediated the relationship between OCD symptoms and depression and the relationship between functioning and depression was stronger at post-treatment. Depression mediated the relationship between OCD symptoms and functioning, but only at post-intervention. Similarly, rumination mediated the relationship between OCD symptoms and depression at post-intervention. CONCLUSIONS Our findings suggest that after ERP, relationships between depression and functioning become stronger. Following ERP, treatment that focuses on depression and functioning, including medication management for depression, cognitive approaches targeting rumination, and behavioural activation to boost functionality may be important clinical interventions for OCD patients.
Collapse
Affiliation(s)
- Sarosh J Motivala
- a Department of Psychiatry , University of California Los Angeles , Los Angeles , CA , USA
| | - Maria Arellano
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - Rebecca L Greco
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - David Aitken
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - Nathan Hutcheson
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - Reza Tadayonnejad
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - Joseph O'Neill
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA
| | - Jamie D Feusner
- b Semel Institute for Neuroscience and Human Behavior , University of California Los Angeles , Los Angeles , CA , USA.,c David Geffen School of Medicine , University of California Los Angeles , Los Angeles , CA , USA
| |
Collapse
|
11
|
Castro-Rodrigues P, Camacho M, Almeida S, Marinho M, Soares C, Barahona-Corrêa JB, Oliveira-Maia AJ. Criterion Validity of the Yale-Brown Obsessive-Compulsive Scale Second Edition for Diagnosis of Obsessive-Compulsive Disorder in Adults. Front Psychiatry 2018; 9:431. [PMID: 30254588 PMCID: PMC6141833 DOI: 10.3389/fpsyt.2018.00431] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 08/21/2018] [Indexed: 01/17/2023] Open
Abstract
Background: While the Yale-Brown Obsessive-Compulsive Scale Second Edition (Y-BOCS-II) is the gold-standard for measurement of obsessive-compulsive (OC) symptom severity, its factor structure is still a matter of debate and, most importantly, criterion validity for diagnosis of OC disorder (OCD) has not been tested. This study aimed to clarify factor structure and criterion validity of the Y-BOCS-II. Methods: We first validated and quantified the psychometric properties of a culturally adapted Portuguese translation of the Y-BOCS-II (PY-BOCS-II). The PY-BOCS-II and other psychometric instruments, including the OCD subscale of the Structured Clinical Interview for the DSM-IV, used to define OCD diagnosis, were administered to 187 participants (52 patients with OCD, 18 with other mood and anxiety disorders and 117 healthy subjects). In a subsample of 20 OCD patients and the 18 patients with other diagnoses, PY-BOCS-II was applied by clinicians blinded to diagnosis. Results: PY-BOCS-II had excellent internal consistency (Cronbach's α = 0.96) and very good test-retest reliability (Pearson's r = 0.94). Exploratory factor analysis revealed a two-factor structure with loadings consistent with the Obsessions and Compulsions subscales, and there was good to acceptable convergent and divergent validity. Importantly, the area under the curve (AUC) of the receiver operating characteristic (ROC) curve suggested elevated accuracy in discriminating between patients with OCD and control subjects (AUC = 0.96; 95% confidence interval [CI]: 0.92-0.99), that was retained in comparisons with age, gender and education matched controls (AUC = 0.95; 95% CI: 0.91-0.99), as well as with patients with other mood and anxiety disorders (AUC = 0.93; 95% CI: 0.84-1). Additionally, a cut-off score of 13 had optimal discriminatory ability for the diagnosis of OCD, with sensitivity ranging between 85 and 90%, and specificity between 94 and 97%, respectively when all samples or only the clinical samples were considered. Conclusion: The PY-BOCS-II has excellent psychometric properties to assess the severity of obsessive-compulsive symptoms, reflecting obsessive, and compulsive dimensions, compatible with currently defined subscales. Furthermore, we found that a cut-off of 13 for the Y-BOCS-II total score has good to excellent sensitivity and specificity for the diagnosis of OCD.
Collapse
Affiliation(s)
- Pedro Castro-Rodrigues
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Marta Camacho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Sílvia Almeida
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal
| | - Mónica Marinho
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Centro Hospitalar Psiquiátrico de Lisboa, Lisbon, Portugal
| | - Catarina Soares
- NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal
| | - J Bernardo Barahona-Corrêa
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| | - Albino J Oliveira-Maia
- Champalimaud Clinical Centre, Champalimaud Centre for the Unknown, Lisbon, Portugal.,Champalimaud Research, Champalimaud Centre for the Unknown, Lisbon, Portugal.,NOVA Medical School, Faculdade de Ciências Médicas, Universidade Nova de Lisboa, Lisbon, Portugal.,Department of Psychiatry and Mental Health, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
| |
Collapse
|
12
|
Shaw AM, Carbonella JY, Arditte Hall KA, Timpano KR. Obsessive-Compulsive and Depressive Symptoms: The Role of Depressive Cognitive Styles. THE JOURNAL OF PSYCHOLOGY 2017; 151:532-546. [PMID: 29077549 DOI: 10.1080/00223980.2017.1372341] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) commonly co-occurs with depression, resulting in heightened severity and poorer treatment response. Research on the associations between specific obsessive-compulsive symptoms (OCS) and depressive symptoms has utilized measures that have not fully considered the relationship across OCS dimensions. Little is known about which factors explain the overlap between OCS and depressive symptoms. OCS and depressive symptoms may be related via depressive cognitive styles, such as rumination or dampening (i.e., down-regulating positive emotions). We evaluated the associations of OCS dimensions with depressive symptoms and cognitive styles. We also examined the indirect effects of rumination and dampening in the relationship between OCS and depressive symptoms. Participants (N = 250) completed questionnaires online. Greater depressive symptoms, rumination, and dampening were associated with greater levels of all OCS dimensions. Path analysis was utilized to examine a model including the direct effect of depressive symptoms on overall OCS and two indirect effects (through rumination and dampening). There was a significant indirect effect of depressive cognitive styles on the relationship between OCS and depressive symptoms, through rumination and dampening. Replication in a clinical sample and experimental manipulations may bear important implications for targeting depressive cognitive styles in treatments for OCD and depression.
Collapse
|
13
|
Cath DC, Nizar K, Boomsma D, Mathews CA. Age-Specific Prevalence of Hoarding and Obsessive Compulsive Disorder: A Population-Based Study. Am J Geriatr Psychiatry 2017; 25:245-255. [PMID: 27939851 PMCID: PMC5316500 DOI: 10.1016/j.jagp.2016.11.006] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 11/07/2016] [Accepted: 11/09/2016] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Little is known about the age-specific prevalence of hoarding and obsessive compulsive symptoms (OCS), particularly in older age groups. The objectives of this study were to estimate the age-specific prevalence, severity, and relationships between hoarding and OCS in males and females using a large population-based sample. METHODS We assessed the age-specific prevalence rates of hoarding disorder (HD) and OC disorder (OCD) in males and females (at various age ranges between 15 and 97 years) from the Netherlands Twins Register (N = 15,194). Provisional HD and OCD diagnoses were made according to Diagnostic and Statistical Manual of Mental Health Disorders, 5th Edition, criteria using self-report measures. We also assessed hoarding and OCS severity in the various age groups and explored specific hoarding and OCS patterns (e.g., difficulty discarding, excessive acquisition, clutter, checking, washing, perfectionism, and obsessions) with age. RESULTS Prevalence of provisional HD diagnoses (2.12%) increased linearly by 20% with every 5 years of age (z = 13.8, p < 0.0001) and did not differ between males and females. Provisional OCD diagnoses were most common in younger individuals and in individuals over age 65. Co-occurring OCD increased hoarding symptom severity (coefficient: 4.5; SE: 0.2; 95% CI: 4.1-4.9; t = 22.0, p < 0.0001). Difficulty discarding for HD and checking behaviors for OCD appeared to drive most increases in these diagnoses in older ages. CONCLUSION Increased prevalence and severity of HD with age appears to be primarily driven by difficulties with discarding. Increases in OCD prevalence with older age were unexpected and of potential clinical relevance.
Collapse
Affiliation(s)
- Danielle C Cath
- Department of Clinical Psychology, Utrecht University, the Netherlands, University Medical Center Groningen, Department of Psychiatry, Rob Giel Onderzoekscentrum, Groningen, the Netherlands
| | - Krystal Nizar
- Department of Psychiatry, University of California, San Francisco, San Francisco, CA
| | - Dorret Boomsma
- Department of Biological Psychology, Vrije Universiteit, Amsterdam, the Netherlands
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL.
| |
Collapse
|
14
|
Storch EA, De Nadai AS, do Rosário MC, Shavitt RG, Torres AR, Ferrão YA, Miguel EC, Lewin AB, Fontenelle LF. Defining clinical severity in adults with obsessive-compulsive disorder. Compr Psychiatry 2015; 63:30-5. [PMID: 26555489 PMCID: PMC4643407 DOI: 10.1016/j.comppsych.2015.08.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 07/17/2015] [Accepted: 08/12/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) is the most commonly used instrument to assess the clinical severity of obsessive-compulsive symptoms. Treatment determinations are often based on Y-BOCS score thresholds. However, these benchmarks are not empirically based, which may result in non-evidence based treatment decisions. Accordingly, the present study sought to derive empirically-based benchmarks for defining obsessive-compulsive symptom severity. METHOD Nine hundred fifty-four adult patients with obsessive-compulsive disorder (OCD), recruited through the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders, were evaluated by experienced clinicians using a structured clinical interview, the Y-BOCS, and the Clinical Global Impressions-Severity scale (CGI-Severity). RESULTS Similar to results in treatment-seeking children with OCD, our findings demonstrated convergence between the Y-BOCS and global OCD severity assessed by the CGI-Severity (Nagelkerke R(2)=.48). Y-BOCS scores of 0-13 corresponded with 'mild symptoms' (CGI-Severity=0-2), 14-25 with 'moderate symptoms' (CGI-Severity=3), 26-34 with 'moderate-severe symptoms' (CGI-Severity=4) and 35-40 with 'severe symptoms' (CGI-Severity=5-6). Neither age nor ethnicity was associated with Y-BOCS scores, but females demonstrated more severe obsessive-compulsive symptoms than males (d=.34). Time spent on obsessions/compulsions, interference, distress, resistance, and control were significantly related to global OCD severity although the symptom resistance item pairing demonstrated a less robust relationship relative to other components of the Y-BOCS. CONCLUSIONS These data provide empirically-based benchmarks on the Y-BOCS for defining the clinical severity of treatment seeking adults with OCD, which can be used for normative comparisons in the clinic and for future research.
Collapse
Affiliation(s)
- Eric A. Storch
- Department of Pediatrics, University of South Florida,Department of Health Policy & Management, University of South Florida,Rogers Behavioral Health – Tampa Bay,All Children’s Hospital - Johns Hopkins Medicine
| | | | | | - Roseli G. Shavitt
- Department of Psychiatry, University of São Paulo Medical School, Brazil
| | - Albina R. Torres
- Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, Univ Estadual Paulista, Brazil
| | - Ygor A. Ferrão
- Department of Psychiatry, Health Sciences Federal University of Porto Alegre, Brazil
| | | | - Adam B. Lewin
- Department of Pediatrics, University of South Florida,All Children’s Hospital - Johns Hopkins Medicine
| | - Leonardo F. Fontenelle
- Anxiety and Obsessive-Compulsive Spectrum Research Program, Institute of Psychiatry, Federal University of Rio de Janeiro & D’Or Institute for Research and Education, Brazil
| |
Collapse
|
15
|
Timpano KR, Carbonella JY, Bernert RA, Schmidt NB. Obsessive compulsive symptoms and sleep difficulties: exploring the unique relationship between insomnia and obsessions. J Psychiatr Res 2014; 57:101-7. [PMID: 25038630 DOI: 10.1016/j.jpsychires.2014.06.021] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 06/26/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND Sleep complaints have been linked with Obsessive Compulsive Disorder (OCD), though there is a dearth of research exploring the association between a range of disturbed sleep indicators and obsessive compulsive symptoms (OCS). Two separate studies were conducted to rigorously investigate this relationship in further detail, considering a number of different sleep indices and also the heterogeneous nature of OCS. METHODS Study 1 (n = 167) examined the relationship between OCS and the gold standard self-report assessments for delayed bedtime, sleep quality, nightmares, and insomnia symptoms. Study 2 (n = 352) replicated the primary findings from Study 1 in an independent sample and with an alternative measure of OCD, which takes into account the different OCS dimensions. RESULTS Results revealed a significant, independent link between obsessions and insomnia symptoms, but not between insomnia and compulsions. When examining the different OCS dimensions, insomnia was again found to bear a specific relationship to obsessions, above and beyond that with the other dimensions. Although depression is often highly comorbid with both OCD and sleep disturbances, depressive symptoms did not explain the OCS-sleep relationship in either study, suggesting a unique association between obsessions and insomnia. CONCLUSIONS Findings indicate that high levels of intrusive thoughts exhibit a specific association with insomnia symptoms-one that is not observed with other OCS. Future research may help elucidate the mechanisms and causal nature of this relationship.
Collapse
|
16
|
Roh D, Kim K, Chang JG, Kim SI, Kim CH. Development and validation of a computer-based measure of symmetry and arranging behavior in obsessive-compulsive disorder: a preliminary study. Compr Psychiatry 2013; 54:885-92. [PMID: 23618605 DOI: 10.1016/j.comppsych.2013.03.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 03/17/2013] [Accepted: 03/19/2013] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE While compulsive ordering and arranging, and a preoccupation with symmetry are common presentations of obsessive-compulsive disorder (OCD), little attention has been given to these types of symptoms in the assessment of patients with OCD. The goal of the present study was to develop and evaluate psychometric properties for the objective and quantitative measurement of compulsive symptoms related to symmetry and arranging. METHODS Thirty-five normal volunteers performed computer-simulated environment tasks under four different conditions with or without a target and distraction. Primary dependent variables included several indices of time and manipulation of arranging behaviors. We evaluated the validity of the task by comparing the novel behavioral measures with standardized measures such as the Symmetry, Ordering and Arranging Questionnaire (SOAQ), Obsessive Compulsive Inventory-Revised (OCI-R), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Barratt Impulsiveness Scale (BIS-11), and Quality of Life Scale (WHOQOL). RESULTS We found a significant positive correlation between the arrangement time (time to complete the task) with the SOAQ score and the "ordering" subscore of the OCI-R. In addition, the number of manipulations was positively correlated with the SOAQ score and the "ordering" subscore of the OCI-R. There were no significant correlations between behavioral parameters and other scales measuring constructs less relevant to the symptoms of OCD related to ordering/symmetry. There was only a significant main effect of the target on the arrangement time. CONCLUSION This study demonstrates the good convergent and discriminant validity of this task as a novel behavioral measure for the assessment of arranging compulsion symptoms. We can infer from the results that subjects are likely to spend more time in compulsive arranging when the target for the task is given.
Collapse
Affiliation(s)
- Daeyoung Roh
- Department of Psychiatry and Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Korea
| | | | | | | | | |
Collapse
|
17
|
McGuire JF, Lewin AB, Geller DA, Brown A, Ramsey K, Mutch J, Mittelman A, Micco J, Jordan C, Wilhelm S, Murphy TK, Small BJ, Storch EA. Advances in the treatment of pediatric obsessive-compulsive d-cycloserine with exposure and response prevention. NEUROPSYCHIATRY 2012; 2:10.2217/npy.12.38. [PMID: 24174993 PMCID: PMC3808983 DOI: 10.2217/npy.12.38] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Exposure-based cognitive-behavioral therapy and serotonin reuptake inhibitor medications are efficacious treatment options for the management of pediatric obsessive-compulsive disorder. Despite established efficacy, many youths receiving either therapy remain symptomatic after acute treatment. Regardless of the rationale for persistent symptoms, a clear need emerges for treatment options that restore functioning efficiently to symptomatic youths. One innovative approach builds upon the identified role of NMDA receptors in the fear extinction process. Instead of breaking existing connections during fear extinction, new associations develop that eventually predominate over prior associations. Recent investigations have explored augmenting exposure-based cognitive-behavioral therapy with the NMDA partial agonist d-cycloserine, with preliminary results demonstrating expedited treatment gains and moderately larger effects above exposure and response prevention therapy alone. A large randomized clinical trial is underway to evaluate the efficacy and efficiency of this therapeutic combination in pediatric obsessive-compulsive disorder. Results from this trial may translate into improved management practices.
Collapse
Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| | - Adam B Lewin
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
- Department of Psychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| | - Daniel A Geller
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Ashley Brown
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Kesley Ramsey
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Jane Mutch
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| | - Andrew Mittelman
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Jamie Micco
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Cary Jordan
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114, USA
| | - Tanya K Murphy
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
- Department of Psychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| | - Brent J Small
- School of Aging Studies, University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA
| | - Eric A Storch
- Department of Psychology, University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA
- Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
- Department of Psychiatry, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA
| |
Collapse
|
18
|
McGuire JF, Lewin AB, Horng B, Murphy TK, Storch EA. The nature, assessment, and treatment of obsessive-compulsive disorder. Postgrad Med 2012; 124:152-65. [PMID: 22314125 DOI: 10.3810/pgm.2012.01.2528] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder that affects between 1% to 2% of individuals and causes considerable impairment and disability. Although > 50% of individuals experience symptom onset in childhood, symptoms can continue to develop throughout adulthood. Accurate and timely assessment of clinical presentation is critical to limit impairment and improve prognosis. Presently, there are 2 empirically supported treatments available for OCD in children and adults, namely cognitive-behavioral therapy and pharmacotherapy with serotonin reuptake inhibitors. This article provides an introduction to the phenomenology, etiology, and clinical course of OCD. Assessment practices used to evaluate symptom severity are described, and evidence-based treatment options are reviewed, with appropriate distinctions drawn between children and adults. Finally, recommendations for assessment and treatment practices for OCD are explicated.
Collapse
Affiliation(s)
- Joseph F McGuire
- Department of Psychology, University of South Florida, St. Petersburg, FL 33701, USA
| | | | | | | | | |
Collapse
|