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PubMed2003

Does comorbid attention-deficit/hyperactivity disorder impact the clinical expression of pediatric obsessive-compulsive disorder?

What is the impact of attention-deficit/hyperactivity disorder (ADHD) on the phenotypic expression of pediatric obsessive-compulsive disorder (OCD). We examined phenotypic features, and functional and clinical correlates in youths with OCD, with and without comorbid ADHD, from a large sample of consecutively referred pediatric psychiatry patients. Although comorbid ADHD had no meaningful impact on the phenotypic expression or clinical correlates of OCD, it was associated with higher rates of compromised educational functioning compared with other OCD youths. Our findings suggest that the OCD phenotype runs true and is not impacted by comorbid ADHD in youths diagnosed with both OCD and ADHD. In such affected youths, both disorders contribute to morbid dysfunction and require treatment. More work is needed to determine whether OCD plus ADHD represents a developmentally and etiologically distinct form of the OCD syndrome.

Attention Deficit Disorder with Hyperactivity↗
PubMed2000

Comorbidity of obsessive-compulsive disorder in recovered inpatients with bipolar disorder.

OBJECTIVE: To determine the frequency of obsessive-compulsive disorder (OCD) in inpatient subjects with bipolar disorder (BD) and to examine the clinical characteristics of BD subjects with OCD. METHOD: The sample consisted of 143 inpatient subjects with DSM-III-R BD-I and BD-NOS (BD-II), recovered from a current episode of either depression or mania. Demographic and clinical variables were obtained on the day of admission. Current comorbid conditions including OCD were determined by the Structured Clinical Interview for DSM-III-R Ifollowing recovery from the acute affective episode. RESULTS: The frequency of current OCD was 7% (N = 10). All BD subjects with OCD were BD-II, were male, and had a diagnosis of current dysthymia. They had fewer episodes and a higher incidence of prior suicide attempts than bipolar subjects without OCD. None of the bipolar subjects with OCD fulfilled criteria for cyclothymia. CONCLUSIONS: Our findings suggest that BD-II, OCD, dysthymia, and suicidality cluster together in some subjects with BD. We discuss the clinical implications of our findings.

Adult↗
PubMed2000

Low novelty-seeking differentiates obsessive-compulsive disorder from major depression.

OBJECTIVE: To make a direct comparison of patients with obsessive-compulsive disorder (OCD) and major depression (MD) and a normal control group in terms of the Temperament and Character Inventory (TCI) personality dimensions. METHOD: Additionally to 43 patients with primary OCD, 43 MD patients and 43 normal subjects who were matched against the OCD patients for sex and age filled out the TCI. RESULTS: Compared to the controls, the OCD and MD patients scored significantly higher on harm avoidance and significantly lower on self-directedness and co-operativeness. The OCD patients scored significantly lower on novelty-seeking than the MD patients and the controls. CONCLUSION: Whereas OCD and MD share similar personality deviations on harm avoidance, self-directedness and co-operativeness, OCD is distinguishable from MD in terms of low novelty-seeking. Low novelty-seeking may have a profound relationship to the specific aetiology of OCD.

Adolescent↗
PubMed2006

False beliefs maintenance for fear-related information in obsessive-compulsive disorder: an investigation with the hindsight paradigm.

The present study tested whether participants with obsessive-compulsive disorder (OCD) overestimate the incidence frequency of OCD-relevant phenomena and display a decreased hindsight bias for concern-related information, which may represent a maintenance factor for OCD. Thirty participants with OCD and 39 control participants were requested to estimate the incidence frequency of 8 events in each of 4 domains: washing-relevant, checking-relevant, negative, or neutral. Subsequently, participants received the correct statistics for all items and were requested to affectively appraise these. Two hours later participants had to reproduce their initial estimates. No differences emerged between participants with OCD and control participants regarding initial estimates. In case the frequency of an OCD-relevant item was initially largely overestimated, control participants expressed more relief when confronted with the correct solution than participants with OCD, especially for washing-relevant items. The recalled estimates showed a typical hindsight bias (i.e., the reproduced estimates were biased toward the correct response), but with no difference between groups. In sum, participants were normal in their subjective estimates of OCD-relevant events, and there was no evidence for a heightened maintenance of false beliefs.

Adult↗
PubMed1997

Obsessive compulsive disorder, response to serotonin reuptake inhibitors and the serotonin transporter gene.

Obsessive compulsive disorder (OCD) is a common illness, characterized by anxiety-provoking thoughts and the need to perform rituals. OCD is most commonly treated with a class of pharmacological agents known as serotonin reuptake inhibitors (SRIs). SRIs block the reuptake of serotonin (5-HT) into the presynaptic neuron, a process mediated by the serotonin transporter (5-HTT). The successful use of SRIs in OCD has led to the hypothesis that 5-HTT may play a pivotal role in the pathogenesis of OCD. We decided to study this hypothesis from a genetic perspective, because family and twin studies suggest that there is a strong genetic component to OCD. In addition, the sequence of the gene for 5-HTT is available, and a 44-bp insertion/deletion polymorphism has been detected in the promoter region of the gene. There is evidence that this polymorphism alters expression of the transporter protein. We typed 72 OCD patients and 72 matched controls, and found no statistically significant difference between the two groups (chi 2 = 4.319, P = 0.115, 2 d.f.). We observed however a trend towards increased homozygosity in the patient group. We also rated (retrospectively) the patients' clinical responses to SRIs. No association was observed between these ratings and the promoter region polymorphism in the serotonin transporter gene. Given the pharmacological evidence favoring a role for 5-HTT in OCD and SRI response, further genetic evaluation of the serotonin transporter in OCD is indicated.

Adult↗
PubMed2002

5HT1Dbeta Receptor gene implicated in the pathogenesis of Obsessive-Compulsive Disorder: further evidence from a family-based association study.

Obsessive-Compulsive Disorder (OCD) is a psychiatric condition with strong evidence for a genetic component and for the involvement of genes of the serotonin system. In a recent family-based association study we reported an association between the G allele of the G861C polymorphism of the 5HT1Dbeta receptor gene and OCD. The aim of the present study was to further investigate for the presence of linkage disequilibrium between each of two polymorphisms of the 5HT1Dbeta receptor gene and OCD in a larger sample of OCD families. In a total of 121 families the G861C and the T371G polymorphisms of the 5HT1Dbeta receptor gene were genotyped using standard protocols. The genotyping data were analyzed with a new extension of the Transmission Disequilibrium Test (FBAT). The phenotypes considered in the analyses were the diagnosis of OCD and two quantitative phenotypes related to the diagnosis and clinically relevant, ie, the age at onset and the severity of OCD symptoms. We confirmed the previously found preferential transmission of the G861 allele to the affected subjects (z = 2.262, P = 0.02). No significant association was found between the polymorphism and the quantitative phenotypes considered. These results represent a confirmation of our previous published study and thus, could have important implications for the role of the 5HT1Dbeta receptor gene in the pathogenesis and treatment of OCD. Further genetic investigations on this marker considering additional polymorphisms and other quantitative phenotypes related to OCD are warranted.

Family Health↗
PubMed2005

Platelet serotonergic markers as endophenotypes for obsessive-compulsive disorder.

Although compelling evidence has shown that obsessive-compulsive disorder (OCD) has a strong genetic component, its genetic basis remains to be elucidated. Identifying biological abnormalities in nonaffected relatives is one of the strategies advocated to isolate genetic vulnerability factors in complex disorders. Since peripheral serotonergic disturbances are frequently observed in OCD patients, the aim of this study was to investigate if they could represent endophenotypes, by searching for similar abnormalities in the unaffected parents of OCD patients. We assessed whole blood serotonin (5-HT) concentration, platelet 5-HT transporter (5-HTT) and 5-HT2A receptor-binding characteristics, and platelet inositol trisphosphate (IP3) content in a sample of OCD probands (n = 48) and their unaffected parents (n = 65), and compared them with sex- and age-matched controls (n = 113). Lower whole blood 5-HT concentration, fewer platelet 5-HTT-binding sites, and higher platelet IP3 content were found in OCD probands and their unaffected parents compared to controls. Whole blood 5-HT concentration showed a strong correlation within families (p < 0.001). The only parameter that appeared to discriminate affected and unaffected subjects was 5-HT2A receptor-binding characteristics, with increased receptor number and affinity in parents and no change in OCD probands. The presence of peripheral serotonergic abnormalities in OCD patients and their unaffected parents supports a familial origin of these disturbances. These alterations may serve as endophenotypic markers in OCD, and could contribute to the study of the biological mechanisms and genetic underpinnings of the disorder.

Adolescent↗
PubMed2002

Validation study of the Japanese version of the Obsessive-Compulsive Drinking Scale.

The Obsessive-Compulsive Drinking Scale (OCDS) is a self-rating questionnaire that measures cognitive and behavioral aspects of craving for alcohol. The OCDS consists of two subscales: the obsessive thoughts of drinking subscale (OS) and the compulsive drinking subscale (CS). This study aims to validate the Japanese version of the OCDS. First, internal consistency and discriminant validity were evaluated. Second, a prospective longitudinal 3-month outcome study of 67 patients with alcohol dependence who participated in a relapse prevention program was designed to assess the concurrent and predictive validity of the OCDS. The OCDS demonstrated high internal consistency. The OS had high discriminant validity, while the CS did not. Twenty-three patients (34.3%) dropped out of treatment. These patients had significantly higher OS scores than those who completed the program. At 3 months, the relapse group had significantly higher OCDS scores than the no relapse group. Also, the OCDS score was higher in subjects who had early-onset alcohol dependence than late-onset dependence. The OCDS is useful for evaluating cognitive aspect of craving and predicts dropout and relapse.

Alcoholism↗
PubMed2005

[Neurological soft signs in patients with obsessive-compulsive disorder].

Neurological soft signs (NSS) are minor neurological deviations signifying unspecific brain dysfunction. Several studies have reported an abnormally high prevalence of NSS in obsessive-compulsive disorder (OCD); however, the significance of their presence in OCD patients is not yet clear. We reviewed studies that investigated NSS in OCD patients, using a clinical examination or kinematical methods. In most studies, OCD patients showed an excess of NSS, especially in the areas of motor coordination, sensory integration and primitive reflexes. NSS in OCD patients may be associated with more severe obsessions as well as disturbances of visuo-spatial function and visual memory. Moreover, they may be already present at childhood, combined with anxiety disorders, thus possibly representing a marker of high risk for OCD. In conclusion, more studies are needed in order to assess both sensory and motor soft signs associated with OCD in a methodologically rigorous manner, to integrate the results with neuroimaging findings and to elucidate the role of NSS as markers of neuropsychological dysfunction in OCD.

Anxiety↗
PubMedDate not supplied

Heterogeneity of obsessive-compulsive disorder: a literature review.

Significant advances have been made in characterizing the phenomenology and psychobiology of obsessive-compulsive disorder (OCD) in recent years. In many ways, such advances suggest a conceptualization of OCD as a relatively homogeneous neuropsychiatric entity, underpinned by particular mechanisms that manifest in universal symptoms. Nevertheless, some data have pointed to the heterogeneity of this disorder. A computerized literature search (MEDLINE: 1964-2001) was used to collect studies addressing the heterogeneity of OCD. In addition, reviews of the phenomenology, psychobiology, family studies, and treatment of OCD were examined in an attempt to collate data addressing this issue. There is a growing consensus that some subtypes of OCD are valid and provide a useful means of integrating data on its symptomatology, neurobiology, and treatment response; for example, OCD with comorbid tics is characterized by earlier onset, a particular range of OCD symptoms, and worse response to selective serotonin reuptake inhibitors. The heterogeneity of OCD has important clinical and research implications.

Dopamine↗
PubMedDate not supplied

Executive functions in obsessive-compulsive disorder: state or trait deficits?

OBJECTIVE: Despite the neuropsychology literature providing reliable evidence of impaired executive functions in obsessive-compulsive disorder (OCD), to date it has not been determined whether these deficits are trait-related (independent of symptomatology) or state-dependent (dependent on symptomatology). The current research examines the executive functions in OCD in a comprehensive manner and, for the first time, assesses the stability of these deficits over the developmental course of the disorder. METHOD: Using a cross-sectional design, Study 1 examined the executive functions (set shifting, inhibition, planning, verbal fluency and working memory) in 60 subjects (20 actively Symptomatic OCD, 20 Remitted OCD and 20 Panic Disorder). Using a longitudinal design, Study 2 reassessed a subsample of OCD subjects (participants in Study 1) once they reached remitted status. RESULTS: Study 1 found that the OCD groups exhibited deficits in set shifting and inhibition relative to Panic Disorder controls; however, no deficits were observed in planning, verbal fluency or working memory. There were no differences found between the Symptomatic and Remitted OCD groups on any of the executive function measures. Study 2 found that the identified executive function deficits in individuals were stable over time and remained unchanged despite symptom remittance. CONCLUSION: Current results confirm the presence of specific executive function deficits in OCD, and indicate that these deficits are trait-like in nature.

Adult↗
PubMedDate not supplied

Frequency of obsessive-compulsive disorder in a community sample of young adolescents.

OBJECTIVE: To investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents. METHOD: A two-stage epidemiological study originally designed to investigate adolescent depression was conducted between 1986 and 1988 in the southeastern United States. In the first stage, a self-report depressive symptom questionnaire was administered to a community sample of 3,283 adolescents. In the diagnostic stage, the Schedule for Affective Disorders and Schizophrenia for School-Age Children and the Children's Global Assessment Scale were administered to 488 mother-child pairs. RESULTS: The prevalences of OCD and subclinical OCD were found to be 3% and 19%, respectively. Prevalences were similar in males and females. Females reported more symptoms of compulsions although males reported more obsessions. About 55% of adolescents with OCD reported both obsessions and compulsions. The most common compulsions were arranging (56%), counting (41%), collecting (38%), and washing (17%). Major depressive disorder (45%), separation anxiety (34%), dysthymia (29%), suicidal ideation (15%), and phobia (8%) were the diagnoses most frequently comorbid with OCD. CONCLUSIONS: Findings suggest that OCD is not infrequent among adolescents and that the characteristic comorbidity and symptomatology of OCD may facilitate earlier identification and treatment by clinicians.

Adolescent↗
PubMed1996

Obsessive-compulsive characteristics: from symptoms to syndrome.

OBJECTIVE: To assess the distribution and severity of obsessions and compulsions in a nonclinical adolescent population. METHOD: During preinduction military screening, 861 sixteen-year-old Israelis completed a questionnaire regarding the lifetime presence of eight obsessive-compulsive (OC) symptoms and three severity measures. The presence or absence of obsessive-compulsive disorder (OCD) or subclinical OCD was ascertained by an independent interview. RESULTS: Although only 8.0% and 6.3% of respondents reported disturbing and intrusive thoughts, respectively, 27% to 72% of subjects endorsed the six remaining OCD symptoms. Twenty percent of subjects regarded the symptoms they endorsed as senseless and 3.5% found them disturbing; 8% reported spending more than an hour daily on symptoms. OCD and subclinical OCD cases differed significantly from non-OCD cases, but not from each other, in distress and mean number of symptoms. Although the distribution of nine of the items differed for noncases, compared with OCD and subclinical OCD cases, the distributions for all items overlapped markedly across the three groups. CONCLUSIONS: OC phenomena appear to be on a continuum with few symptoms and minimal severity at one end and many symptoms and severe impairment on the other. Defining optimal cutoff points for distinguishing between psychiatric disorder and OC phenomena that are common in the general population remains an open question.

Adolescent↗
PubMed2000

Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS).

OBJECTIVE: To determine the rates of psychiatric disorders in the first-degree relatives of children with infection-triggered obsessive-compulsive disorder (OCD) and/or tics (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections; PANDAS). METHOD: The probands of this study were 54 children with PANDAS (n = 24 with a primary diagnosis of OCD; n = 30 with a primary diagnosis of a tic disorder). One hundred fifty-seven first-degree relatives (100 parents [93%] and 57 siblings [100%]) were evaluated for the presence of a tic disorder. One hundred thirty-nine first-degree relatives (100 parents [93%] and 39 of 41 siblings over the age of 6 [95%]) were evaluated with clinical and structured psychiatric interviews to determine the presence of subclinical OCD, OCD, and other DSM-IV Axis I disorders. RESULTS: Twenty-one probands (39%) had at least one first-degree relative with a history of a motor or vocal tic; 6 mothers (11%), 9 fathers (19%), and 8 siblings (16%) received this diagnosis. Fourteen probands (26%) had at least one first-degree relative with OCD; 10 mothers (19%), 5 fathers (11%), and 2 siblings (5%), received this diagnosis. An additional 8 parents (8%) and 3 siblings (8%) met criteria for subclinical OCD. Eleven parents (11%) had obsessive-compulsive personality disorder. CONCLUSIONS: The rates of tic disorders and OCD in first-degree relatives of pediatric probands with PANDAS are higher than those reported in the general population and are similar to those reported previously for tic disorders and OCD. Further study is warranted to determine the nature of the relationship between genetic and environmental factors in PANDAS.

Adolescent↗
PubMed2002

Development of a short leyton obsessional inventory for children and adolescents.

OBJECTIVE: To develop a short, cost-effective screening measure for adolescent obsessive-compulsive disorder (OCD). METHOD: The 20-item Leyton Obsessional Inventory-Child Version and the Mood and Feelings Questionnaire were completed by five groups of adolescents: those with a predominant diagnosis of OCD (n = 9), major depressive disorder with comorbid OCD ( n = 14), major depressive disorder without comorbid OCD ( n = 65), a community sample including subjects at high risk for psychopathology ( n = 253), and well controls ( n= 50). Leyton Obsessional Inventory scores for the community sample ( n= 253) were factor analyzed, whereas the remaining groups' scores served as validation. RESULTS: Factor analysis yielded a robust 11-item solution with three distinct components accounting for 47.6% of total variance. Internal reliability was high for the short scale total (Cronbach alpha =.86) and three subscales: Compulsions (alpha =.73), Obsessions/Incompleteness (alpha =.79), and Cleanliness (alpha =.75). Logistic regression found the Compulsions subscale discriminated OCD cases from community controls and discriminated major depressive disorder with and without comorbid OCD. The Obsessions subscale discriminated OCD cases from community, well control, and depressed nonobsessional groups. CONCLUSIONS: The Short Leyton Obsessional Inventory-Child Version is a psychometrically sound, quick, economical screen that discriminates OCD cases from noncases irrespective of comorbid major depressive disorder.

Adolescent↗
PubMed1997

Is obsessive-compulsive disorder a pathology of the human disposition to perform socially meaningful rituals? Evidence of similar content.

This study investigated the theory that obsessive-compulsive disorder (OCD) is a pathology of the human disposition to perform culturally meaningful social rituals. We tested the hypothesis that the same actions and thoughts that are ego-dystonic in OCD are valued when they are appropriately performed in socially legitimated rituals. Two coders analyzed ethnographic descriptions of rituals, work, and another activity in each of 52 cultures. The coders recorded the presence or absence of 49 features of OCD and 19 features of other psychopathologies. The features of OCD were more likely to be present and occurred more frequently in rituals than in either control; rituals also contained more diverse kinds of OCD features. The features of other psychopathologies were less likely to be present and were less numerous in rituals than the features of OCD. Analysis of variance showed that OCD features discriminate between rituals and controls better than the features of other psychopathologies. These results suggest that there could be a psychological mechanism that operates normally in rituals, which can lead to OCD when it becomes hyperactivated.

Analysis of Variance↗
PubMed2001

Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults.

Although juvenile obsessive compulsive disorder (OCD) is increasingly recognized as a putative developmental subtype of the disorder, comparisons among children, adolescents, and adults with OCD have been lacking. We aimed to evaluate clinical correlates of OCD in three developmentally distinct groups. Subjects comprised children, adolescents, and adults meeting DSM-III-R and DSM-IV criteria for OCD referred to separate specialized OCD clinics. All subjects were systematically evaluated with structured diagnostic interviews and clinical assessments by OCD experts. Specific clinical correlates and symptom profiles were associated with the disorder in different age groups. These findings support a hypothesis of developmental discontinuity between juvenile and adult OCD and identify age specific correlates of the disorder across the life cycle. Further work is needed to validate whether juvenile-onset OCD represents a true developmental subtype of the disorder.

Adolescent↗
PubMed2005

Investigating the structure of craving using structural equation modeling in analysis of the obsessive-compulsive drinking scale: a multinational study.

BACKGROUND: Currently, there is no agreement among researchers on the definition of craving and its underlying theoretical model. The Obsessive-Compulsive Drinking Scale (OCDS) seems to measure certain aspects of craving, but its theoretical basis remains unclear. The aim of this study was to investigate the structure of alcohol craving, using OCDS data. METHODS: OCDS data from four studies were pooled to obtain a large and heterogeneous sample of 505 participants. All participants were treatment-seeking alcoholics meeting DSM-IV criteria for alcohol dependence. The factor structures of the OCDS previously found were evaluated using confirmatory factor analyses. The goodness of fit of these solutions was compared with those of alternative causal models: an obsessive-compulsive disorder model, an inhibition model, and a cognitive-behavioral model. These alternative models were based on modern theories about craving and were tested in the OCDS data, using structural equation modeling. In this way, the current study replaced simple correlational analysis by a more sophisticated causal way of analyzing the underlying structure of the OCDS items. The best fitting model was selected by comparing the mean discrepancy between the implied and observed matrices of the models. RESULTS: The data showed that the previously reported factor structures had to be rejected. Also, the inhibition model and obsessive-compulsive disorder model did not fit the data. The cognitive-behavioral model showed encouraging fit. Optimizing strategies were applied to further improve the fit of this model, which resulted in a model with close fit to the data. CONCLUSIONS: The causal cognitive-behavioral model proved to be superior. It showed that the OCDS contains many items that do not represent the core concept of craving but instead are indicators for the consequences of craving. From this model, it seems that craving, in a narrow sense, can be reliably assessed with only five items of the OCDS.

Adult↗