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PubMed2001

Prevalence of obsessive-compulsive disorder in the British nationwide survey of child mental health.

BACKGROUND: Obsessive-compulsive disorder (OCD) is a disorder that appears to be underdiagnosed and undertreated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends. AIMS: To establish the prevalence and associates of OCD in young people aged 5-15 years. METHOD: A nationwide (UK) epidemiological study of rates of psychiatric disorder in 5- to 15-year-olds (1999 British Child Mental Health Survey): 10 438 children were assessed. RESULTS: Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% CI 0.14-0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services. CONCLUSIONS: Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.

Adolescent↗
PubMed2006

The evolutionary psychology of obsessive-compulsive disorder: the role of cognitive metarepresentation.

Repetitive unpleasant thoughts and ritualized behaviors are the key features of obsessive-compulsive disorder (OCD). The classical neuroethological models of OCD rely largely on behavioral similarities between animal stereotypies and human compulsive rituals and are unable to account for the cognitive component of OCD. The cognitive symptoms of OCD need to be addressed in an evolutionary psychological context that incorporates information about human brain evolution. OCD can be understood as an extreme on a continuum of evolved harm-avoidance strategies. A pathological exaggeration of our evolved capacity to cognitively represent future scenarios, including imagined consequences of our own thoughts and actions (metarepresentation), may be part of the set of evolved psychological mechanisms contributing to the psychopathology of OCD. The costly side of the adaptive ability to anticipate future needs or threats could be that etiologically heterogeneous affections of the underlying striatal-frontal brain circuits may render an individual vulnerable to develop OCD.

Animals↗
PubMed2006

Disgust and obsessive-compulsive disorder: an update.

In this paper, we review the growing body of literature investigating the association between obsessive-compulsive disorder (OCD) and the emotion of disgust. Initially studied with regard to specific phobias, the potential role of disgust responses in contamination concerns has led researchers to investigate possible associations between disgust and OCD symptoms. The literature on disgust-sensitivity in OCD is reviewed. Studies of disgust recognition in OCD and research using neuroimaging methods are then summarized. We suggest that disgust has a moderate association with OCD symptoms, particularly those which are contamination-based or which have a religious focus. Evidence for a disgust recognition deficit in patients with OCD is lacking; however, neuroimaging findings have confirmed hypothesized associations between contamination-focused OCD and the insula cortex, which has been implicated in disgust processing. Finally, treatment implications are discussed, and suggestions are made for further research.

Association Learning↗
PubMed2001

Obsessive-compulsive scale of the child behavior checklist: specificity, sensitivity, and predictive power.

OBJECTIVE: To create an obsessive-compulsive disorder subscale (OCS) of the Child Behavior Checklist (CBCL) and to determine its internal consistency, sensitivity, specificity, and positive and negative predictive power to identify obsessive-compulsive disorder (OCD) in children and adolescents. METHODS: Three samples of equal size (n = 73) of children and adolescents, matched for age, gender, and race, were selected for these analyses: 1) a clinically ascertained OCD group, 2) a psychiatrically treated group whose records revealed no evidence of OCD, and 3) a general population control group. An OCS was created by applying factor analysis to 11 CBCL items. Examinations of internal consistency, sensitivity, specificity, and positive and negative predictive value were undertaken. RESULTS: Of 11 items hypothesized to predict OCD, 8 items were retained after factor analyses (smallest factor loading: 0.49) and used to calculate OCS scores. The retained items displayed excellent internal consistency (Cronbach's alpha coefficient = 0.84). OCD participants had significantly higher OCS scores than either psychiatrically treated or general population control groups. With the use of the 2 cutoff scores closest to the true rate of OCD in the overall sample, sensitivity was 75.3% to 84.9%, specificity was 82.2% to 92.5%, positive predictive value was 70.5% to 83.3%, and negative predictive value was 88.2% to 91.6%. CONCLUSION: The performance of the proposed CBCL OCS compares favorably with that of the only previously studied screening instrument for OCD, the Leyton Obsessional Inventory-Child Version. Unlike the Leyton Obsessional Inventory-Child Version, the CBCL is already in widespread use as a screen for most other forms of psychopathology. As the performance of the CBCL OCS will need to be replicated in other sample populations, data with various cutoff levels are provided to enable investigators and clinicians to tailor its use to specific study populations.

Adolescent↗
PubMed2002

Eye-hand preference dissociation in obsessive-compulsive disorder and dyslexia.

Dyslexia may be a development disturbance in which there are alterations in visual-spatial and visual-motor processing, while obsessive-compulsive disorder (OCD) is a psychiatric disease in which there are alterations in memory, executive function, and visual-spatial processing. Our hypothesis is that these disturbances may be, at least partially, the result of a crossed eye and hand preference. In the present study 16 controls, 20 OCD (DSM-IV criteria) and 13 dyslexic adults (Brazilian Dyslexia Association criteria) were included. All had a neurological examination, the Yale-Brown scale for obsessive-compulsive symptoms application and the Zazzó evaluation for laterality, abridged by Granjon. Results showed a right hand preference for 100% of controls, 84.6% of dyslexics, and 75% of OCD patients and a right eye preference for 73.3% of controls, 69.2% of dyslexics, and 35% of OCD patients. The left eye preference was significantly higher in OCD when compared with the two other groups (p = 0.01) and the left hand preference of OCD patients (25%) was also significant when compared to Brazilian population (4%) or British population (4.5%). It is possible that this crossed preference may be partially the reason for visual-spatial and constructive disturbances observed in OCD.

Adult↗
PubMed2001

Biochemical characterization of cartilage affected by osteochondritis dissecans in the humeral head of dogs.

OBJECTIVE: To determine glycosaminoglycan (GAG) concentration and immunohistochemical staining characteristics of type-I, -II, and -X collagen from cartilage affected by osteochondritis dissecans (OCD) in dogs. ANIMALS: 31 dogs with OCD and 11 clinically normal purpose-bred dogs. PROCEDURE: Cartilage samples were evaluated microscopically, and GAG content was determined. Immunohistochemical staining was performed for type-I, -II, and -X collagen. Sections were subjectively evaluated for location and intensity of staining. RESULTS: Cartilage affected by OCD had a variety of pathologic changes and significantly lower GAG concentrations than did normal cartilage. Normal cartilage had no detectable type-I collagen. For dogs < 9 months of age, cartilage affected by OCD had significantly more type-I collagen but significantly less type-X collagen than did control cartilage. For dogs > 12 months of age, cartilage affected by OCD contained significantly more type-I collagen than did control cartilage. There was a significant negative correlation between immunoreactivity of type-I collagen and that of type-II and -X collagen. A significant positive correlation was found between immunoreactivity of type-II and -X collagen. CONCLUSIONS AND CLINICAL RELEVANCE: Cartilage affected by OCD contains less GAG, more type-I collagen, and less type-X collagen, compared with normal cartilage. A direct correlation between these changes and the etiopathogenesis of OCD was not established.

Animals↗
PubMed2006

Oral hyaluronan gel reduces post operative tarsocrural effusion in the yearling Thoroughbred.

REASONS FOR PERFORMING STUDY: Hyaluronan (HA) has been used to treat joint disease via intra-articular, i.v. and oral administration. The efficacy of intra-articular and i.v. use has been evaluated but the oral route has yet to be examined. OBJECTIVES: To determine the effect of oral hyaluronan gel on joint effusion following arthroscopic surgery for osteochondritis dissecans (OCD) of the tarsocrural joint of yearling Thoroughbreds. METHODS: Forty-eight yearlings diagnosed with unilateral or bilateral osteochondritis dessicans (OCD) of the tarsus were arbitrarily chosen prior to arthroscopic surgery. The yearlings were included only if they had mild or no synovial effusion pre-surgery. Twenty-four of the yearlings (27 joints) were treated with 100 mg of HA orally for 30 days post operatively and 24 (30 joints) with a placebo orally for 30 days. At 30 days post operation, a blinded examiner scored the effusion of the dorsomedial tarsocrural joint individually using a scale of 0 to 5 (0 = no effusion, 1 = barely palpable effusion, 2 = palpable effusion [without plantar effusion], 3 = golf ball sized effusion with plantar effusion, 4 = tennis ball sized effusion with plantar effusion, 5 = > tennis ball sized effusion with plantar effusion). Half grades were allowed and OCD lesion sizes and locations were compared. RESULTS: A total of 57 joints were examined, of which 33 had OCD of the distal intermediate ridge of the tibia, 19 OCD of the distal lateral trochlear ridge of the talus and 5 OCD of the medial malleolus. The mean 30 day effusion score of the HA treated group (27 joints) was 0.67 while the mean of the 30 day placebo group (30 joints) was 2.05 (P < or = 0.0001). Similar results were noted when comparing treated vs. placebo for each lesion location as well as for lesion sizes. CONCLUSIONS AND POTENTIAL RELEVANCE: Oral preparations of hyaluronan are being used to treat joint disease in horse. Anecdotal reports supporting the efficacy of these preparations already exist. This study provides objective evidence that oral HA reduces joint effusion post operatively following the arthroscopic removal of an OCD lesion in the tarsocrural joint.

Adjuvants, Immunologic↗
PubMed2003

A double-blind, placebo-controlled trial of clonazepam in obsessive-compulsive disorder.

Selective serotonin reuptake inhibitors (SSRIs) are currently the first-line pharmacological agents in treating obsessive-compulsive disorder (OCD). Appropriate treatment for OCD also involves cognitive behavioural therapy (CBT), including exposure and response prevention. As there is a time delay in seeing full therapeutic response, and not all patients tolerate SSRIs, there remains an unmet need for additional treatment approaches in OCD. In addition, most responders report only a partial reduction in symptoms. Clonazepam has demonstrated effectiveness in several preliminary reports in treating OCD. Twenty-seven patients with OCD were entered into a 10 week, double-blind, parallel design trial of clonazepam vs. placebo. Overall, only 3 out of 25 patients who had >/= 1 rating on clonazepam/placebo were judged to be treatment responders, by scoring a 1 (very much improved) or 2 (much improved) on the CGI improvement scale. Responders included 2 of 9 in the placebo group and 1 of 16 in the clonazepam group. No significant difference was found between clonazepam and placebo groups on responder/non responder status (Chi(2 )=1.39, df =1,24, p=0.238), nor on change in YBOCS, Ham-A, Ham-D or NIMH scales from beginning to last evaluation carried forward. These findings suggest that clonazepam is not effective as monotherapy in treating OCD. Its effectiveness in specific subgroups of OCD patients with co-morbid anxiety disorders or as an augmentation strategy added to SSRIs remains to be determined.

Adult↗
PubMed2004

Deep brain stimulation of the ventral caudate nucleus in the treatment of obsessive-compulsive disorder and major depression. Case report.

Obsessive-compulsive disorder (OCD) is an anxiety disorder associated with recurrent intrusive thoughts and repetitive behaviors. Although conventional pharmacological and/or psychological treatments are well established and effective in treating OCD, symptoms remain unchanged in up to 30% of patients. Deep brain stimulation (DBS) of the anterior limb of the internal capsule has recently been proposed as a possible therapeutic alternative in treatment-resistant OCD. In the present study, the authors tested the hypothesis that DBS of the ventral caudate nucleus might be effective in a patient with intractable severe OCD and concomitant major depression. Psychiatric assessment included the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Hamilton Depression Rating Scale (HDRS), the Hamilton Anxiety Rating Scale (HARS), and the Global Assessment of Functioning (GAF) Scale for determining the symptom severity of OCD, depression, and anxiety as well as the quality of pychosocial and occupational functioning, respectively. Neuropsychological assessment consisted of a wide range of tests primarily exploring memory and executive functions. Deep brain stimulation of the ventral caudate nucleus markedly improved symptoms of depression and anxiety until their remission, which was achieved at 6 months after the start of stimulation (HDRS < or = 7 and HARS < or = 10). Remission of OCD (Y-BOCS < 16) was also delayed after 12 or 15 months of DBS. The level of functioning pursuant to the GAF scale progressively increased during the 15-month follow-up period. No neuropsychological deterioration was observed, indicating that DBS of the ventral caudate nucleus could be a promising strategy in the treatment of refractory cases of both OCD and major depression.

Caudate Nucleus↗
PubMed2004

Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) patients usually experience comorbidities including tics, trichotillomania, body dysmorphic disorder, and mood and anxiety disorders. The present report verifies how age at onset of obsessive-compulsive symptoms and duration of illness are associated with comorbid diagnoses in OCD patients. METHOD: Psychiatric comorbidity was assessed using a structured clinical interview in 161 consecutive outpatients referred for treatment between 1996 and 2001 who met DSM-IV criteria for OCD. Age at onset and duration of illness were retrospectively assessed by direct interviews. RESULTS: An earlier age at onset of obsessive-compulsive symptoms was associated with tic disorders, while longer illness duration was associated with depressive disorder (major depressive disorder or dysthymia) and social phobia. CONCLUSION: Age at onset and duration of OCD illness are meaningful variables affecting the expression of comorbidities in OCD. Tic disorders and OCD may share common etiologic pathways. Depressive disorders, in contrast, may be secondary complications of OCD.

Adolescent↗
PubMed2004

Limbic paroxysmal magnetoencephalographic activity in 12 obsessive-compulsive disorder patients: a new diagnostic finding.

BACKGROUND: We describe frontotemporal paroxysmal rhythmic activity recorded by magnetoencephalography (MEG) in patients with obsessive-compulsive disorder (OCD). METHOD: Twelve patients with OCD (per ICD-10 and DSM-IV criteria), aged 18 to 65 years, were assessed using MEG. Patients' classification according to the Yale Brown OCD Scale was as follows: severe = 8, moderate = 3, and mild = 1. MEG findings were compared with those of 12 age- and sex-matched healthy subjects (control group) with no previous history of psychiatric or neurologic disorders. All study participants underwent neurologic and basic medical examinations, including magnetic resonance imaging, electrocardiograms (EEGs), and electrooculograms. The study was conducted between January 2001 and January 2002. RESULTS: Two types of MEG activity were observed in patients with OCD: (1) frontotemporal paroxysmal rhythmic activity with low-amplitude spikes (< 1 picoTesla) in 92% (11/12) of patients and (2) intermittent isolated spikes and sharp waves in all patients (12/12). The OCD group had paroxysmal rhythmic MEG activity in the cingulate cortex (12/12), insula (10/12), hippocampus (9/12), temporal superior gyrus and angular and supramarginal gyri (9/12), precentral and post-central gyri (8/12), orbitofrontal cortex (5/12), and parietal lobes (5/12). MEG recordings were normal in the control group, and EEG findings were normal in both the OCD and control groups. CONCLUSIONS: Frontotemporal paroxysmal rhythmic activity with a preferential limbic distribution is a sensitive MEG finding in patients with OCD. Although the pathophysiology of this abnormality remains unknown, a corticostriatal network dysfunction was hypothesized.

Adult↗
PubMed1999

Neurobiology of childhood obsessive-compulsive disorder.

Despite the observation that obsessive-compulsive disorder (OCD) frequently has its onset during childhood or adolescence, most studies have examined OCD in adults. Because pediatric OCD patients are near illness onset with limited or no medication exposure, this population represents a unique window through which to view the neurobiology of OCD. In this article, the authors summarize data from existing studies of pediatric OCD and attempt to interpret the data within the context of a neurobiologic discourse based largely on research in adults. The authors review current neuroanatomic models of OCD and examine neuroimaging and neuropsychologic studies designed to test those models. In addition, the authors examine irregularities of neurotransmitter systems though to be involved in OCD.

Adolescent↗
PubMed1999

Beyond depression: citalopram for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) and serotonin reuptake inhibitors became inextricably joined with the discovery of their effectiveness for the treatment of OCD in 1969 and 1976. The specificity of response of OCD to serotonin reuptake inhibitors has provided an important platform for the exploration of the neurobiology of OCD. This knowledge has come from many different areas of investigation, including neuroimaging, neuroimmunology and pharmacologic challenge studies. As the research into the pharmacologic treatment of OCD has progressed, a number of serotonin reuptake inhibitors have been approved and marketed for the treatment of OCD. These agents include clomipramine, sertraline, paroxetine, fluoxetine, and fluvoxamine. Because these agents share the same mechanism of action (serotonin reuptake inhibition), choosing which agent to use must be based on other parameters. These include differences in efficacy, dosing, and side-effect profile. Citalopram, a newly marketed selective serotonin reuptake inhibitor could offer some advantages over those agents currently marketed. Theoretically, it should also be effective in the treatment of OCD. In treating depression, it has been shown to have minimal side-effects, low risk of withdrawal symptoms, and little possibility of interaction with other agents.

Citalopram↗
PubMedDate not supplied

[Obsessive psychotic disorder in adolescence].

Relationship between obsessive-compulsive disorder (OCD) and psychotic pathology is a controversial one. Case reports indicate that OCD with psychotic features is generally more severe and antidepressant-refractory than neurotic OCD. Behaviour therapy is shown to be ineffective in OCD patients with psychotic features. One of the subtypes includes reactive paranoid forms, with fluctuating clinical course, in obsessive patients with delusional thoughts that improve with neuroleptic augmentation of the serotonin reuptake inhibitor (SRI) treatment for OCD. We present the case of a 17-year-old woman with family history of OCD, starting with panic symptoms after cannabis use, but suddenly developing OCD with avoidant behavior and delusional ideas of self-reference and persecution. Response to behavior therapy and SRI and neuroleptics is analyzed.

Adolescent↗
PubMed2002

Obsessive-compulsive hoarding: symptom severity and response to multimodal treatment.

BACKGROUND: Compulsive hoarding and saving symptoms, found in many patients with obsessive-compulsive disorder (OCD), are part of a clinical syndrome that has been associated with poor response to medications and cognitive-behavioral therapy (CBT). We sought to determine whether patients with the compulsive hoarding syndrome had more severe symptoms and functional impairment than nonhoarding OCD patients and whether they would respond to intensive, multimodal treatment previously found to be effective for treatment-refractory OCD. METHOD: We studied 190 consecutive patients with DSM-IV OCD treated openly for approximately 6 weeks with intensive CBT, medication, and psychosocial rehabilitation in a partial hospitalization program for severely ill OCD patients. Twenty of the 190 patients (11%) were identified as having the compulsive hoarding syndrome. All patients were assessed before and after treatment with the Yale-Brown Obsessive Compulsive Scale (YBOCS), Hamilton Rating Scale for Depression (HAM-D). Hamilton Rating Scale for Anxiety (HAM-A). and Global Assessment Scale (GAS). We compared the symptom severity and response to treatment of compulsive hoarders versus nonhoarding OCD patients. RESULTS: Compulsive hoarders were significantly older than nonhoarders (p < .001). Hoarders had significantly lower GAS scores and higher HAM-A scores than nonhoarders both before (p = .04) and after (p = .002) treatment, but had similar pretreatment YBOCS scores. Both groups improved significantly with treatment as assessed by YBOCS score (p < .001), but nonhoarders had significantly greater decreases in YBOCS scores than hoarders (p = .02). CONCLUSION: While the compulsive hoarding syndrome appears to be a distinct, more disabling, variant of OCD that does not respond as robustly to treatment, it may still improve significantly with intensive, multimodal treatment tailored to its specific features and associated deficits.

Adolescent↗
PubMed2002

[The state with the predominance of obsessive-compulsive disorders in the structure of childhood onset schizophrenia].

Sixty inpatients, aged 7 to 15 years, with obsessive-compulsive disorders (OCD) have been examined. The inclusion criteria comprised diagnostic ICD-10 criteria for OCD (F42), schizophrenia childhood type (F20.83) and neurotic-like schizophrenia (F21.3). Patients with organic CNS disorder signs and marked somatic pathology were excluded from the study. According to clinical features of the disease and its course (disease progressiveness), three OCD types have been determined: OCD in the structure of affective and neurotic-like spectra disorders (type 1); OCD in the structure of paranoid spectrum disorders (type 2); OCD in the structure of states with prevail of "acquired" affective and negative disorders (type 3). Consideration of OCD types in childhood schizophrenia and the disease course allows to predict severity of negative changes and remissions that facilitates an adequate determination of the patients' adaptive potential.

Adaptation, Psychological↗
PubMed2001

Early and long-term results using older kidneys from cadaver or living donors.

The persisting shortage of organs for transplantation justifies the use of all possible donors. We compared results for 110 patients, who received solitary kidneys from cadaver donors over age 60 years (OCD) with those for 976 patients, who were transplanted with kidneys from 11-49-year-old cadaver donors, whom we defined as "ideal" age. Although the 4% incidence of primary nonfunction and the 24% rate of delayed graft function were significantly higher (p < 0.001) in the OCD group compared with the ideal group (0.8% and 8.0%, respectively), OCD kidneys can offer good results when low-risk recipients are carefully selected and the cold ischemia time is sharply reduced. Moreover, graft survival rates for 14 OCD grafts, implanted in patients under age 45 were 93% at one, 3 and 10 years compared with 79%, 74% and 42% at the same time points for 96 OCD recipients over age 45. The rate of delayed graft function was higher among 19 OCD grafts preserved for more than 20 hours, and these grafts yielded significantly lower survival rates than 91 OCD grafts preserved for less than 20 hours; with rates of 67%, 58% and 44% and 85%, 81% and 51%, respectively, after one, 3 and 10 years. Thirty-five kidneys from living donors over age 60 had comparable overall graft survival rates to living donor kidneys from donors under age 60 (92%, 92% and 92% vs. 92%, 88% and 80% at one, 3 and 10 years, respectively). An original point scoring system, based only on macroscopic evaluation of the graft, avoids the need for a biopsy and does not prolong cold ischemia time. Microvascular bench reconstructions of the renal artery, damaged by atherosclerosis, expand the possibility for safe transplantation of older kidneys without performing a double renal transplant.

Adolescent↗
PubMedDate not supplied

[Epidemiology of obsessive-compulsive disorder].

In the article the problems of prevalence of obsessive-compulsive disorder (OCD), comorbidity with other mental disorders and the most commonly used diagnostic instruments were presented. Epidemiological data indicate OCD as the fourth most common mental disorder, which appears as frequent as asthma or diabetes. In an international study from 1994 the year's prevalence of OCD was from 1.1% to 1.8%. In each country obsessions and compulsions appear with different intensity, what can testify for certain cultural conditionings of disorder. Men suffer from OCD equally often as women, however both first symptoms and full symptom disorder appear several years earlier in men than in women. The prevalence of OCD among children is from 2% to 4%. At least half of the patients suffer from OCD also in maturity. OCD should be differentiated from generalized anxiety disorder, panic disorder, phobias, anancastic personality and hypochondria.

Cultural Characteristics↗