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Uncomplicated and comorbid obsesive-compulsive disorder in an epidemiologic sample
Depression and Anxiety
Abstract
This study investigated lifetime prevalence rates, demographic characteristics, childhood conduct disorder and adult antisocial features, suicide attempts, and cognitive impairment in individuals with obsessive-compulsive disorder (OCD) uncomplicated by or comorbid with any other psychiatric disorder. The data are from the NIMH Epidemiologic Catchment Area (ECA) study, and the current analyses compared subjects with uncomplicated OCD (no history of any other lifetime psychiatric disorder), comorbid OCD (with any other lifetime disorder), other lifetime psychiatric disorders, and no lifetime psychiatric disorders across these variables. OCD in its uncomplicated and comorbid form had significantly higher rates of childhood conduct symptoms, adult antisocial personality disorder problems, and of suicide attempts than did no or other disorders. Comorbid OCD subjects had higher rates of mild cognitive impairment on the Mini-Mental Status Exam than did subjects with other disorders. These findings suggest that a subgroup of OCD patients may have impulsive features, including childhood conduct disorder symptoms and an increased rate of suicide attempts; wider clinical attention to these outcomes is needed.
... We then examined whether epidemiological studies, enrolling all patients with a diagnosis of OCD independently from the severity of the disorder and regardless of them being treated or not, confirmed that OCD is at greater risk for suicide than the general population. Table 2 presents results of epidemiological studies [49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Fourteen studies provided data on the association in the general population between a baseline diagnosis of OCD (whether or not comorbid with other disorders) and suicidality (suicide attempts and/or suicidal ideation); two studies [59,60] have been performed on National Registers (Danish Registers and Swedish National Patient Register, respectively), recruiting a huge sample of subjects diagnosed with OCD (10155 and 36788 individual affected by OCD, respectively) and providing data on the longitudinal association between OCD and death by suicide and lifetime suicide attempts over a follow-up of 9.7 and 44 years, respectively. ...
... Concerning the association between OCD and lifetime suicide attempts in the general population, results are more controversial; the majority of studies found that the odds of having a history of lifetime suicide attempts is significantly higher in individuals with OCD (OR ranging from 1.6 to 9.9) [49,51,54,55,57,58,61]. However, controversy exists about the influence of psychiatric comorbidities on such risk: while two studies confirmed that this risk is significantly higher even in pure OCD subjects (without lifetime comorbidities) [55,60], two other epidemiological studies were negative (no increased risk in pure OCD versus controls) [52,58]. ...
Background:
Historically, OCD has been considered to be associated with a relatively low risk of suicide. Recent studies, on the contrary, revealed a significant association between OCD and suicide attempts and ideation. A huge variation in prevalence rates, however, is reported.
Objective:
To estimate prevalence rates of suicide attempts and suicidal ideation in individuals with OCD, and to identify predictors of suicide risk among subjects with OCD.
Method:
We systematically reviewed the literature on suicide risk (ideation and/or attempts) and OCD. We included studies with appropriate definition of OCD, cross-sectional or prospective design, separating clinical samples from epidemiological studies, that employed a quantitative measure of suicidality and/or reported an outcome measure of the association between suicidality and OCD or examined factors associated with suicidality.
Results:
In clinical samples, the mean rate of lifetime suicide attempts is 14.2% (31 studies: range 6- 51.7%). Suicidal ideation is referred by 26.3-73.5% of individuals (17 studies, mean 44.1%); current suicidal ideation rate ranges between 6.4 and 75% (13 studies, mean 25.9). Epidemiological studies found that OCD increases significantly the odds of having a lifetime suicidal ideation as compared to the general population (OR: 1.9-10.3) and a history of lifetime suicide attempts (OR: 1.6- 9.9). Predictors of greater suicide risk are severity of OCD, the symptom dimension of unacceptable thoughts, comorbid Axis I disorders, severity of comorbid depressive and anxiety symptoms, past history of suicidality and some emotion-cognitive factors such as alexithymia and hopelessness.
Conclusion:
Overall, suicidality appears a relevant phenomenon in OCD.
... A possible reason for this difference could be that previous research did not uniformly account for how depressive symptoms may be involved in suicidality in OCD (seeHung et al., 2010), especially since individuals with OCD commonly experience clinical levels of depression (Kessler, Chiu, Demler, & Walters, 2005;Ruscio et al., 2010), and depressive symptoms are a strong risk factor for suicide (Hawton, Casañas i Comabella, Haw, & Saunders, 2013). The few studies that additionally explored depressive symptoms in OCD simply observed increased suicidality with increased depressive symptom severity, without ascertaining the unique contribution of OCD (Angst et al., 2005;Hollander et al., 1996Hollander et al., /1997). This is further demonstrated by the findings of a meta-analysis byAngelakis et al. (2015): although there was a moderate to high association between OCD and suicidality across studies examined, this was not always obtained exclusively of the influence of comorbid depressive symptoms. ...
... A possible reason for this difference could be that previous research did not uniformly account for how depressive symptoms may be involved in suicidality in OCD (seeHung et al., 2010), especially since individuals with OCD commonly experience clinical levels of depression (Kessler, Chiu, Demler, & Walters, 2005;Ruscio et al., 2010), and depressive symptoms are a strong risk factor for suicide (Hawton, Casañas i Comabella, Haw, & Saunders, 2013). The few studies that additionally explored depressive symptoms in OCD simply observed increased suicidality with increased depressive symptom severity, without ascertaining the unique contribution of OCD (Angst et al., 2005;Hollander et al., 1996Hollander et al., /1997). This is further demonstrated by the findings of a meta-analysis byAngelakis et al. (2015): although there was a moderate to high association between OCD and suicidality across studies examined, this was not always obtained exclusively of the influence of comorbid depressive symptoms. ...
The picture of suicide in obsessive-compulsive disorder (OCD) is unclear because previous research did not uniformly control for depressive symptoms when examining the relationship between OCD and suicidality. Specific links between OC symptom dimensions and suicidality were also not adequately studied. As such, we investigated specific associations between OC symptom dimensions and suicidality, beyond the contribution of depressive symptoms, in an OCD analog sample of college students, a group traditionally at risk for suicide. One hundred and forty-six college students (103 females; 43 males) who exceeded the clinical cutoff for OC symptoms on the Obsessive-Compulsive Inventory, Revised (OCI-R) were recruited. Participants completed an online questionnaire containing measures that assessed suicidality and OC and depressive symptom severity. Total OC symptom severity, unacceptable thoughts, and especially violent obsessions exhibited significant positive zero-order correlations with suicidality. However, analyses of part correlations indicated that only violent obsessions had a significant unique association with suicidality after controlling for depressive symptoms. Our findings support the hypothesis that violent obsessions have a specific role in suicidality beyond the influence of depressive symptoms in an OCD analog sample of college students. A strong clinical focus on suicide risk assessment and safety planning in college students reporting violent obsessions is therefore warranted. Future related research should employ longitudinal or prospective designs and control for other possible comorbid symptoms in larger and more representative samples of participants formally diagnosed with OCD in order to verify the generalizability of our findings to these groups.
... A number of studies have noted that patients with OCD may also manifest impulsive behaviors or comorbid impulse control disorders (Hollander et al., 1996; Matsunaga et al., 2005; Stein, Hollander, Simeon, & Cohen, 1994). In addition to impulsivity, some patients with OCD may also demonstrate reward-focused or pleasure-seeking behaviors (Blum et al., 2000; Hollander et al., 1996). ...
... A number of studies have noted that patients with OCD may also manifest impulsive behaviors or comorbid impulse control disorders (Hollander et al., 1996; Matsunaga et al., 2005; Stein, Hollander, Simeon, & Cohen, 1994). In addition to impulsivity, some patients with OCD may also demonstrate reward-focused or pleasure-seeking behaviors (Blum et al., 2000; Hollander et al., 1996). Likewise, some data suggest that individuals with OCD, as compared with control subjects, demonstrate high levels of cognitive impulsiveness (Ettelt et al., 2007). ...
Not Just Right Experiences (NJREs) are considered to be a perceptually tinged phenomenon mainly related to obsessive-compulsive disorder (OCD). The evidence of an association between NJREs and OCD or OC symptoms have been accumulating in the last few years, whereas there is a paucity of studies about the role of this construct in other clinical conditions considered part of the "OCD spectrum". In the current study, the NJRE-Q-R Severity scale (a well-validated measure of NJREs) was administered to 41 patients with OCD, 53 with hair-pulling disorder (HPD), 38 with gambling disorder (GD) and 43 with eating disorders (ED) along with measures of OC symptoms and general distress. In each group, NJREs were consistently associated with OC symptoms; moreover, the pattern of associations appeared coherent with the main clinical features of each disorder. The OCD group reported higher levels of NJREs severity than GD and ED, whereas there were no differences between the OCD and HPD groups. However, HPD patients did not have higher scores of NJREs severity than GD and ED counterparts. NJREs appear to be specific to OCD, but further study is needed to establish the role of this construct in OCD-related disorders.
Copyright © 2015. Published by Elsevier Ltd.
... In the present study, the mean untreated duration of OCD was 7.1 years, which closely corresponded to the 7 years reported by previous studies [70]; however, the period may be as long as 17 years [71]. The prevalence of OCD in the general population is reportedly as high as 1.1-1.8% ...
(1) Background: Even though the comorbidity of obsessive-compulsive disorder (OCD) and a psychotic disorder (PD), such as schizophrenia, is being increasingly recognized, the impact of this comorbidity on the clinical presentation, including insight into obsessive-compulsive symptoms and the functioning of OCD, remains unclear. (2) Methods: To investigate clinical differences between OCD patients with and without PD, 86 Japanese outpatients who met the DSM-IV-TR criteria for OCD were recruited and divided into two groups: 28 OCD patients with PD, and 58 OCD patients without PD. The two groups were cross-sectionally compared in terms of their sociodemographic profiles and clinical characteristics, including the DSM-IV-TR insight specifier and the Global Assessment of Functioning (GAF). (3) Results: The results showed that OCD patients with PD scored lower on both the insight and GAF assessments. (4) Conclusions: The present study suggests that comorbid PD in OCD is a clinical entity.
... Although OCD is associated with high impairment in quality of life (13,14) and considerable interference in OCD sufferers' lives, including social, emotional, and/or academic functioning (15), there is usually a long delay in seeking treatment in adults (16,17), as well as in children and adolescents (18,19). In adults, studies have pointed out that between 38 and 89.8% of OCD sufferers neither ask for nor receive treatment for their symptoms (20)(21)(22)(23)(24). ...
Because children and adolescents are vulnerable to developing obsessive-compulsive disorder (OCD), classroom teachers play an important role in the early identification and intervention in students with OCD. The present study aims to explore the recognition of OCD, general knowledge about this disorder, implications in the classroom, and stigmatizing attitudes among teachers, as well as the effectiveness of a brief educational intervention about OCD. Participants (n = 95; mean age = 43. 29 years old; 64.3% female) were primary and secondary school teachers who were randomly assigned to an experimental group or a control group. All of them completed a set of self-report questionnaires, read an educational fact sheet (either about OCD in the experimental group or about a healthy diet in the control group), and again completed the questionnaires. Results show that prior to the intervention, most of the teachers identified the contamination and order OCD symptoms described in a vignette as specific to OCD (82.1%) and would recommend talking about the problem (98.9%) and seeking help (94.7%). However, only a few (36.8%) knew about the most effective OCD treatments or identified compulsions as a main OCD symptom (33%). Moreover, only about half of the teachers correctly identified OCD's possible interference in classroom routines, such as delays to achieve perfection or concentration problems, and strategies for dealing with OCD, such as continuing with the class rhythm. Stigma levels were from low to moderate. After the brief educational intervention, participants in the experimental group increased their knowledge about OCD, improved their strategies for managing a student with OCD symptoms, and had fewer stigmatizing attitudes associated with pity (p < 0.05). These changes were not observed in the control group. We can conclude that this brief and easy-to-administer intervention is an effective educational intervention to significantly improve teachers' knowledge and attitudes, at least in the short-term. These results are especially relevant because OCD is associated with high interference and long delays in seeking treatment, and teachers have a unique opportunity to help with prevention, early identification, and recommending an adequate intervention for OCD.
... Depression alone is one of the major factors for suicidal behavior (Bertolote et al., 2005) and is associated with all suicidal outcomes (Scocco, de Girolamo, Vilagut, & Alonso, 2008). We can hypothesize that the existence of comorbid depressive symptoms results in more severe and incapacitating OCS, with a higher occurrence of suicidal behaviors compared to patients with OCD without depressive symptoms (Hollander et al., 1996). Since mood changes appear to be consequences of chronic stress and injury associated with the severity of OCD symptoms (Angst et al., 2004), depression diagnosis and/or severity may be an indicator of OCD severity and could 'link' OCD and suicide outcomes, even if secondary to OCD (Torres et al., 2007). ...
Background
Patients with obsessive-compulsive disorder (OCD) are at increased risk for suicide attempt (SA) compared to the general population. However, the significant risk factors for SA in this population remains unclear – whether these factors are associated with the disorder itself or related to extrinsic factors, such as comorbidities and sociodemographic variables. This study aimed to identify predictors of SA in OCD patients using a machine learning algorithm.
Methods
A total of 959 outpatients with OCD were included. An elastic net model was performed to recognize the predictors of SA among OCD patients, using clinical and sociodemographic variables.
Results
The prevalence of SA in our sample was 10.8%. Relevant predictors of SA founded by the elastic net algorithm were the following: previous suicide planning, previous suicide thoughts, lifetime depressive episode, and intermittent explosive disorder. Our elastic net model had a good performance and found an area under the curve of 0.95.
Conclusions
This is the first study to evaluate risk factors for SA among OCD patients using machine learning algorithms. Our results demonstrate an accurate risk algorithm can be created using clinical and sociodemographic variables. All aspects of suicidal phenomena need to be carefully investigated by clinicians in every evaluation of OCD patients. Particular attention should be given to comorbidity with depressive symptoms.
... On the other hand, several OCD cohort studies found a correlation between OCD and suicide risk ( Brakoulias et al., 2017;Ching et al., 2017;Chaudhury et al., 2016;Velloso et al., 2016; for a meta-analysis, see Angelakis et al., 2015;Dell' Osso, Casu, Carlini, Conversano, Gremini & Carmassi, 2012;Torres et al., 2011; Fernández de la Cruz et al., 2017;Harris & Barraclough, 1997). These studies have reported that patients with OCD have 3-5 times the risk of attempting suicide (Fernández de la Cruz et al., 2017;Hollander et al., 1996) and 3-10 times the risk of dying by suicide compared to healthy comparisons (Fernández de la Cruz et al., 2017;Harris & Barraclough, 1997;Meier et al., 2016). ...
Background: Obsessive compulsive disorder (OCD) is associated with elevated suicide risk, but the directionality of the association between OCD severity and suicidal ideation has not been established, which was the goal of this study.
Methods: Participants (n = 325) were adults with either a current or past diagnosis of Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) OCD who were assessed annually for suicidal ideation and OCD symptom severity for six years. Cross-lagged panel analyses statistically compared unidirectional and bidirectional models over time. Serious suicide-related adverse events were reported.
Results: The best-fitting and most parsimonious model included paths predicting suicidal ideation from OCD symptom severity, but not vice versa. These results were confirmed by comparing a model with cross-lagged paths constrained equal to a freely estimated model. Higher OCD symptom severity in a given year was associated with a higher suicidal ideation severity in the subsequent year. Five suicide-related adverse events were reported throughout the duration of the study, including two suicide deaths and three suicide attempts.
Limitations: The study relied on a single-item, annual measure of suicidal ideation in adults, with substantial variability in severity of suicide risk, and missing data increased with later observations in the study.
... 3 OKB hastalarında özkıyım girişimi ruhsal bozukluğu olmayanlara göre üç, başka bir ruhsal bozukluğu olanlara göre iki kat daha fazla bildirilmiştir. 4 Özkıyım önemli bir ölüm nedenidir. Özkıyımın önlenebilir bir ölüm nedeni olması intihar riskinin değerlendirilmesini önemli bir konu haline getirmektedir. ...
Objective: The data about sleep quality and suicide relationship in patients with obsessive-compulsive disorder (OCD) is limited. In this study, we aimed to investigate the hypothesis that there might be a relationship between sleep quality and suicide in the OCD patients with compare the control group. Methods: A total of 50 patients with OCD (31 female, 19 male) and 40 healthy (24 female, 16 male) individuals as a control group were included in the study. A data form for sociodemographic features, one other forms for clinical characteristics of OCD and Yale Brown Obsessive Compulsive Scale (YB-OCS) have been filled by clinician. After the interview, all patients completed Pittsburgh Sleep Quality Index (PSQI) and Suicide Behavior Scale (SBS). Results: Six (12%) of the OCD patients had lifelong suicide attempts and twenty (40%) had lifelong suicide ideation. When OCD patients and healthy controls were compared, PSQI-2, PSQI-3, PSQI-5, PSQI-6, SBS-1, SBS-2, SBS3 and SBS total scores in patients with OCD were higher than healthy controls. In patients group with lifelong suicide ideations, PSQI-1 and PSQI-6 scores were higher. In patients group with lifelong suicide attempts, PSQI-6 scores were higher. In OCD patients, statistically significant correlations were detected between SBS-1 and PSQI-1, PSQI-6; SBS-3 and PSQI-6. This correlations were not observed in the control group. Conclusion: As a result of this study, it has been shown that the subjective sleep quality of the last 1 month in OCD patients and the intake of additional sleeping pills may be related to past suicidal thoughts and attempts. It may be appropriate to monitor OCD patients with subjective sleep quality impairment and use of additional medication more frequently in terms of suicide risk. In this issue, follow-up studies are needed to include more OCD patients.
... Obsessive-compulsive disorder is also a risk factor for other psychiatric disorders, such as major depression and bipolar disorder [18], generalized anxiety disorder [9], and alcohol abuse or dependence [19], which further diminish HRQOL. Subjects with OCD face an increased risk for suicide attempts [4], which is greater among those with comorbid psychiatric conditions [4,[20][21][22]. Some evidence suggests that short-term (10-to 12-week) treatment of OCD, using either pharmacotherapy combined with exposure and response prevention [23] or cognitive behavioral therapy combined, in some cases, with drug treatment [24], leads to small gains in the psychosocial domains of HRQOL, particularly among treatment responders . ...
Objective: We hypothesized that subjects with obsessive-compulsive disorder (OCD) who received extended-release fluvoxamine (fluvoxamine ER) in a 12-week placebo-controlled trial would exhibit improvements in psychosocial domains of health-related quality of life (HRQOL) and that additional improvements would occur after a 40-week open-label extension trial. We also hypothesized that greater OCD symptom improvement in the first 12 weeks of treatment would be associated with greater HRQOL improvement after 52 weeks of treatment. Methods: In the 12-week placebo-controlled trial, subjects were randomized to receive placebo or 100 mg/d of fluvoxamine ER and then titrated in weekly 50 mg increments to a final dose of 100 to 300 mg/d. All subjects enrolled in the 40-week extension trial followed a similar titration, during which they were maintained on their highest well-tolerated dose. Results: After 12 weeks of treatment, fluvoxamine ER subjects experienced significantly greater decreases than placebo subjects in Yale-Brown Obsessive-Compulsive Scale scores (P = .001). Both the active drug and placebo groups exhibited significant improvements in psychosocial domains of HRQOL; further improvement occurred after 40 weeks of open-label treatment with active drug. The greater the improvement in OCD severity at 12 weeks, the greater the improvement at 52 weeks in the psychosocial domains (Social Functioning r = −0.39, P = .027; Emotional Problems r = −0.37, P = .037; Mental Health r = −0.49, P = .004). Conclusion: Improvement in Yale-Brown Obsessive-Compulsive Scale severity scores during treatment with fluvoxamine ER was associated with improvements in psychosocial aspects of HRQOL that increased over an extended period of treatment.
... However, the limited research available indicates relatively high rates of suicidal risk in OCD samples [1] [2]. For example , Hollander et al. [3] found that individuals with OCD were 3 times more likely to attempt suicide compared to individuals without a psychiatric diagnosis and 2 times more likely to attempt suicide as individuals with another psychiatric diagnosis. Torres et al. [4] extended these findings by examining the associations between OCD symptoms and different aspects of suicidal behavior. ...
... Dans au moins 50 % des cas, le TOC débuterait dans l'enfance ou l'adolescence (Sasson et al., 2001). Mais, malgré cette haute fréquence de début précoce et probablement en raison de la honte qu'ils éprouvent à parler de leurs symptômes, les patients seraient généralement pris en charge bien plus tard dans leur vie (Hollander et al., 1996). Notons que la présence d'obsessions et de compulsions fait partie du développement normal de l'enfant ; ainsi il faudra être prudent afin de ne pas poser un diagnostic trop hâtif de TOC et se référer à la clinique qui inclut une évaluation des contextes personnel, développemental, familial et scolaire entre autres (Sahuc, 2006). ...
... In fact, all APD patients in our sample had comorbid BPD. Although some epidemiological studies have suggested a connection between APD and OCD (Hollander et al., 1996;Kolada, Bland, & Newman, 1994), our findings suggest that, in treatments-seeking samples, this relationship may not hold true. In spite of these limitations, our results suggest that three of the most common and impairing PDs are frequently reported in treatment seeking OCD patients and seem to exert an adverse influence on clinical expression. ...
We assessed correlates of obsessive-compulsive (OCPD), schizotypal (SPD) and borderline (BPD) personality disorders in 110 obsessive-compulsive disorder (OCD) patients. We found OCD patients with OCPD (20.9%) to exhibit higher rates of hoarding and bipolar disorders, increased severity of hoarding and symmetry, lower prevalence of unacceptable thoughts involving sex and religion and less non-planning impulsivity. Conversely, OCD patients with SPD (13.6%) displayed more frequently bipolar disorder, increased severity of depression and OCD neutralization, greater prevalence of "low-order" behaviors (i.e., touching), lower low-planning impulsivity and greater "behavioral" compulsivity. Finally, in exploratory analyses, OCD patients with BPD (21.8%) exhibited lower education, higher rates of several comorbid psychiatric disorders, greater frequency of compulsions involving interpersonal domains (e.g. reassurance seeking), increased severity of depression, anxiety and OCD dimensions other than symmetry and hoarding, more motor and non-planning impulsivity, and greater "cognitive" compulsivity. These findings highlight the importance of assessing personality disorders in OCD samples.
Copyright © 2015. Published by Elsevier Ltd.
... Obsesif-kompulsif bozukluk (OKB) ile bipolar bozukluk birlikteliğine yönelik yapılan çalışmalar son dönemlerde artmaktadır. OKB' de ömür boyu bipolar bozukluk ek tanısı değişik çalışmalarda %5 ile %35,1 arasında değişmektedir [1][2][3][4][5] . OKB hastaları bipolar bozukluk açısından, depresyon hastalarına göre 1,7 kat artmış riske sahiptir 6 . ...
Objective: In this study, we investigated the differences and similarities between bipolar disorder positive and bipolar disorder negative obsessive compulsive disorder (OCD) groups in terms of clinical characteristics and the affective temperaments. Patients and Method: Forty-four patients admitted to Baki{dotless}rköy Prof Dr. Mazhar Osman Hospital of Psychiatry and Neurology with the diagnosis of OCD were enrolled to the study. Patients were assessed by interview with patients (SCID I), applying sociodemographic form, Hamilton depression scale (HAM-D), Yale Brown OCD scale(Y-BOCS), and TEMPSA affective temperament questionnaire. Results: The results showed significantly high rates of bipolar disorder comorbidity (38.6), especially bipolar II, in patients with OCD. Seasonal course of OCD was prominent in patients with bipolar disorder comorbidity (70%). The number of lifetime major depressive episodes and hospitalization rate was also higher in bipolar disorder comorbid patients. Depressive (23.4%), anxious (17.6%) and cyclothymic (11.8%) temperament was predominant among bipolar OCD patients. There were no significant differences in scores of the affective temperaments between bipolar and non-bipolar OCD groups. Conclusion: We conclude that there are obvious clinical influences of bipolar disorder on OCD patients. Affective temperamental differences should be investigated on large samples in the bipolar and non-bipolar OCD patients.
... Studies which have evaluated suicidal patients report OCD in 6.7% of the subjects (Rudd et al., 1993). On the other hand, studies which have evaluated patients of OCD, report suicide attempt in 3.6–12.2% of cases (Hollander et al., 1996, 1998; Torres et al., 2007, 2011; Alonso et al., 2010). Studies which have evaluated OCD patients have also reported 20.1% reporting 'feeling life not worth living' (Alonso et al., 2010), 10% 'wished they were dead' (Alonso et al., 2010), 4.1–46% having suicidal thoughts (Torres et al., 2007, 2011; Alonso et al., 2010), and 20% having suicidal plans (Torres et al., 2011). ...
Aim of this study was to evaluate the prevalence of suicidal ideations (SI) and to study the risk factors for SI and suicide attempt in patients with OCD. 130 patients with OCDwere assessed on Yale-Brown Obsessive–Compulsive Scale and Symptom Checklist, Beck Depression Inventory,Beck Hopelessness Scale, Beck Anxiety Inventory, State-Trait Anxiety Inventory, Buss-Durkee Hostility Inventory, Barratt Impulsiveness Scale, Family Interview for Genetic Studies, Brown Assessment of Beliefs Scaleand DSM-IV insight criteria for OCD.Of the 130 patients, 60 (46.15%) had current SI and 81 (62.3%) patients had life time SI. Of the 60 patients with current SI, 30 had current depression as assessed on SCID-CV. More than half (48 out of 81; 59.25%) of the patients with lifetime SI had lifetime comorbid depression. Ten patients had history of lifetime suicide attempts. Current SI in patients without current depression were associated with female gender, presence of comorbid psychiatric illness, contamination obsessions and cleaning/washing compulsions. To conclude this study suggests that SI are highly prevalence in patients with OCD and although depression may be a contributory factor for suicidal ideations in patients with OCD, but it is not the sole risk factor for suicidal ideations.
... Gender is a relevant factor that should be taken into account when evaluating patients with obsessive symptoms , as a significantly higher frequency of sexual obsessions was observed in males than in females [21]. People with OCD feel a great distress about unacceptable thoughts, to the point that some studies found an association between obsessive compulsive spectrum and suicidality [22,23]. Suicide is defined as the act of intentionally ending one's own life. ...
The topic of sexual obsessions as a psychiatric symptom has not been well investigated. The aim of this study was twofold: 1) to explore the presence of sexual obsessions in patients with mood disorders (n=156), panic disorder (n=54) and schizophrenia (n=79), with respect to non-psychiatric subjects (n=100); 2) to investigate the relationship between sexual obsessions and suicidal behaviors, taking into account socio-demographic variables ad mental disorders.
289 psychiatric patients with mood disorders, panic disorder or schizophrenia, were recruited at the Italian University departments of psychiatry along with 100 non-psychiatric subjects, who presented for a routine eye exam at the ophthalmology department of the same Universities. The assessments included: the Structured Clinical Interview for DSM-IV-TR, the Brief Psychiatric Rating Scale (BPRS), the Obsessive-Compulsive Spectrum Self-Report (OBS-SR), for sexual obsession, and the Mood Spectrum-Self Report lifetime version (MOODS-SR). Suicidality was assessed by means of 6 items of the MOODS-SR.
Sexual obsessions were more frequent in schizophrenia (54.4%), followed by mood disorders (35.9%). Among schizophrenia patients, males reported more sexual obsessions than females (P<0.01). Subjects who were more likely to report suicidal behaviors (suicidal ideation, plans and attempts) were female (adjusted OR=1.99), patients with mental disorders, specifically mood disorders (adjusted OR=11.5), schizophrenia (adjusted OR=3.7) or panic disorder (adjusted OR=2.9), and subjects who reported lifetime sexual obsessions (adjusted OR= 3.6). Sexual obsessions remained independently associated with all aspects of suicidal behaviors. Age, education, marital and employment status were not related to suicidal behaviors.
Special attention should be given to investigate and establish effective strategies of treatment for sexual obsessions, especially those with comorbid mood disorders or schizophrenia.
Background: The link between autism spectrum disorder (ASD) and obsessive–compulsive disorder (OCD) and the complexity of their differential diagnosis has been vastly investigated. Growing attention has been paid to the presence of problematic Internet use (PIU) in autistic individuals. Studies assessing OCD traits in autistic individuals are scarce and even less take into account the role that this overlap may have on the development and maintenance of PIU. We aimed to investigate OCD features in ASD individuals and their association with autism severity and the prevalence of PIU, and the potential dimensions associated with a greater probability of PIU. Methods: a total of 46 participants with ASD and 53 controls were assessed with the Adult Autism Subthreshold Spectrum questionnaire and the Obsessive–Compulsive Spectrum—Short Version. Results: There were significantly higher OCD features in ASD participants along with important correlations between OCD and ASD dimensions and a higher prevalence of PIU in the ASD group. Participants with putative PIU reported greater scores on some ASD and OCD dimensions, the with Doubt and Non-verbal communication domains emerging as significant predictors of the presence of putative PIU. Conclusions: These results support the three-way link between ASD, OCD, and PIU, contributing to the hypothesis of a neurodevelopmental basis for those conditions.
Background
Obsessive-compulsive disorder (OCD) is characterised by affective and cognitive symptoms that impair overall functioning and cause psychological discomfort. Due to the use of medical services, these entail high societal costs.
Objective
Our goal was to provide a thorough overview of this topic while evaluating the effectiveness of pharmacological therapies in OCD and clinical recommendations.
Methods
We looked for papers on the use of drugs to treat OCD in the pubmed database, with an emphasis on clinical guidelines, the use of antidepressants, antipsychotics, mood stabilisers, off-label drugs, and pharmacogenomics.
Results
Selective serotonin reuptake inhibitors (SSRIs) work best when taken for a lengthy period of time. A SSRI combination with cognitive behavioural therapy (CBT) or the similarly orientated exposure and response prevention (ERP) can produce better outcomes. Treatment options for refractory OCD include switching to a different SSRI or clomipramine or supplementing with an atypical antipsychotic. Further research is necessary because there is conflicting information about the use of antidepressants intravenously or in addition to antipsychotics. Treatment customization and pharmacogenomics may lessen treatment resistance.
Conclusions
When compared to each treatment separately or to other treatments, SSRI/clomipramine combined with CBT/ERP produces the best results. For refractory OCD, new approaches are required. In the upcoming years, pharmacogenomics may play a more significant role.
The diagnosis and management of anxiety disorders have evolved greatly during the past 50 years. For the clinician, a careful assessment of the patient is critical in formulating an appropriate treatment plan. Once a diagnosis has been made, a range of psychological and medical treatments are available. The authors suggest a structured classification of anxiety disorders according to their symptoms, and of drug therapies according to their mechanism of action. The evidence for effectiveness of medications in each of the major anxiety disorders is reviewed and a series of treatment algorithms are proposed. Likely future developments are considered.
Background:
Little is known about specific obsessive-compulsive clinical features associated with lifetime history of suicide attempt in individuals with obsessive-compulsive disorder (OCD) and major depression.
Methods:
The study sample included 515 adults with OCD and a history of major depression. In exploratory analyses, we compared the distributions of demographic characteristics and clinical features in those with and without a history of attempted suicide and used logistic regression to evaluate the association between specific obsessive-compulsive clinical features and lifetime suicide attempt.
Results:
Sixty-four (12%) of the participants reported a lifetime history of suicide attempt. Those who had attempted suicide were more likely to report having experienced violent or horrific images (52% vs. 30%; p < 0.001). The odds of lifetime suicide attempt were more than twice as great in participants with versus without violent or horrific images (O.R. = 2.46, 95%, CI = 1.45-4.19; p < 0.001), even after adjustment for other risk correlates of attempted suicide, including alcohol dependence, post-traumatic stress disorder, parental conflict, excessive physical discipline, and number of episodes of depression. The association between violent or horrific images and attempted suicide was especially strong in men, 18-29 year olds, those with post-traumatic stress disorder, and those with particular childhood adversities.
Conclusions:
Violent or horrific images are strongly associated with lifetime suicide attempts in OCD-affected individuals with a history of major depression. Prospective clinical and epidemiological studies are needed to elucidate the basis of this relationship.
Epidemiological studies show that anxiety disorders are highly prevalent and an important cause of functional impairment; they constitute the most frequent menial disorders in the community. Phobias are the most common with the highest rates for simple phobia and agoraphobia. Panic disorder (PD) and obsessive-compulsive disorder (OCD) are less frequent (2% lifetime prevalence), and there are discordant results for social phobia (SP) (2%-16%) and generalized anxiety disorder (GAD) (3%-30%). These studies underline the importance of an accurate definition of disorders using unambiguous diagnostic and assessment criteria. The boundaries between anxiety disorders are often ill defined and cases may vary widely according to the definition applied. Simple phobia, agoraphobia, and GAD are more common in vmrnen, while there is no gender différence for SP, PD, and OCD, Anxiety disorders are more common in separated, divorced, and widowed subjects; their prevalence is highest in subjects aged 25 to 44 years and lowest in subjects aged >65 years. The age of onset of the different types of anxiety disorders varies widely: phobic disorders begin early in life, whereas PD occurs in young adulthood. Clinical - rather than epidemiological - studies have examined risk factors such as life events, childhood experiences, and familial factors. Anxiety disorders have a chronic and persistent course, and are frequently comorbid with other anxiety disorders, depressive disorders, and substance abuse. Anxiety disorders most frequently precede depressive disorders or substance abuse, Comorbid diagnoses may influence risk factors like functional impairment and quality of life. It remains unclear whether certain anxiety disorders (eg, PD) are risk factors for suicide. The comorbidity of anxiety disorders has important implications for assessment and treatment and the risk factors should be explored. The etiology, natural history, and outcome of these disorders need to be further addressed in epidemiological studies.
Background
Excessive repetitive behavior is a debilitating symptom of several neuropsychiatric disorders. Parvalbumin-positive inhibitory interneurons in the dorsal striatum have been linked to repetitive behavior, and a sizeable portion of these cells are surrounded by perineuronal nets (PNNs), specialized extracellular matrix structures. Although PNNs have been associated with plasticity and neuropsychiatric disease, no previous studies have investigated their involvement in excessive repetitive behavior.
Methods
We used histochemistry and confocal imaging to investigate PNNs surrounding parvalbumin-positive cells in the dorsal striatum of four mouse models of excessive repetitive behavior (BTBR, Cntnap2, Shank3, prenatal valproate treatment). We then investigated one of these models, the BTBR mouse, in detail, with DiI labeling, in vivo and in vitro recordings, and behavioral analyses. We next degraded PNNs in the dorsomedial striatum (DMS) using the enzyme chondroitinase ABC and assessed dendritic spine density, electrophysiology, and repetitive behavior.
Results
We found a greater percentage of parvalbumin-positive interneurons with PNNs in the DMS of all four mouse models of excessive repetitive behavior compared to controls. In BTBR mice, we found fewer dendritic spines on medium spiny neurons (targets of parvalbumin-positive interneurons), and differences in neuronal oscillations as well as inhibitory postsynaptic potentials, compared to controls. Reduction of DMS PNNs in BTBR mice altered dendritic spine density and inhibitory responses, and normalized repetitive behavior.
Discussion
These findings suggest that cellular abnormalities in the DMS are associated with maladaptive repetitive behaviors and that manipulating PNNs can restore normal levels of repetitive behavior while altering DMS dendritic spines and inhibitory signaling.
Objective: The purpose of the present study was to evaluate the factor structure, validity, and reliability of the revised Relationship Obsessive-Compulsive Inventory (ROCI), with emphasis on Iranian culture.
Method: The statistical sample consisted of 341 married students studying in Tehran universities in the academic year 2018-2019, who were selected by available sampling method. The New ROCI, Obsessive-Compulsive Inventory-Revised (OCI-R), Obsessive Beliefs Questionnaire (OBQ), Depression, Anxiety and Stress Scale (DASS), Dyadic Adjustment Scale (DAS), and Relationship beliefs inventory (RBI) were the tools of the present study.
Results: The Content Validity Index (CVI) and Content Validity Ratio (CVR) of the new ROCI were good. Also, there was a significant and negative correlation between all subscales and the total score of the new ROCI with all subscales and the total score of the DAS, and there was also a significant positive correlation between the subscales and the total score of the new ROCI with the subscales and the total score of OBQ, OCI-R, RBI, and DASS. Also, the two factor model explained 54.50% of the variance in the new ROCI. Furthermore, all of the confirmatory factor analysis indices of the new ROCI were better than the original ROCI. The results of test-retest correlation of the factor one and two of ROCI were 0.85 and 0.78, respectively. Also, the Cronbach's alpha of the factor one and two of ROCI were 0.60 and 0.74, respectively.
Conclusion: In general, it can be said that the new ROCI was different from the original ROCI, and the new ROCI had better indicators than the original ROCI.
Introduction
: There is controversy on the magnitude of suicide risk in OCD and on the psychopathological features that raise the risk. This systematic review and meta-analysis aims to estimate the pooled prevalence of suicide attempts and suicidal ideation (current/lifetime) in subjects with OCD and identify sociodemographic and clinical factors associated with greater risk.
Methods
: We conducted a literature search in PubMed/Medline, PsycINFO, Web of Science and CINAHL databases up to June 20, 2019, according to PRISMA guidelines. Stata statistical software (Version 15) was used to obtain forest plots, execute subgroup analyses and perform univariate and multivariate meta-regressions.
Results
: We found 61 eligible studies including OCD patients: 52 investigated suicide attempts and reported a pooled prevalence of 0.135 (95% CI 0.123-0.147); 26 explored current suicidal ideation and reported a pooled prevalence of 0.273 (95% CI 0.214-0.335); 22 researched lifetime suicidal ideation and reported a pooled prevalence of 0.473 (95% CI 0.397-0.548). Severity of obsessions, comorbid substance use and depressive/anxious symptoms increased the risk, whereas compulsions had a comparatively protective effect.
Limitations
: Owing to the small number of studies reporting completed suicide rates, this metric was not included in the meta-analysis. The degree of heterogeneity between the studies was high.
Conclusion
: Clinicians should keep in mind that one out of ten patients with OCD attempts suicide during his/her lifetime, about one third has current suicidal ideation and about half has had suicidal ideation in the past. Several clinical features are associated with increased risk and should be factored into clinical risk management.
Obsessive compulsive disorder (OCD) is a severe, often long-term mental disorder. It may be independent from, or comorbid with other mental disorders, especially depression and anxiety disorders. Suicidal thoughts, ideations and ruminations are prevalent in subjects with OCD, but it is not yet clear if the incidences of attempted and completed suicides have increased in comparison with the general population and with other psychiatric disorders.
Methods
We conducted a systematic literature search on the incidence of suicide attempts and completed suicides in subjects with OCD. Search terms for Pubmed and Medline were OCD and suicide. We selected papers providing follow-up data on the incidence of attempted and completed suicide in OCD.
Results
404 papers were initially identified. Only 8 papers covering six studies provided prospective data on attempted or completed suicide over a defined period in subjects with OCD, four studies included control subjects. Two studies providing follow-up data were limited to high-risk samples and did not provide enough data on the incidence of suicide in comparison with the general population. The conclusion that there is an increased risk of attempted and completed suicides in OCD can only be based on one large Swedish National Registry sample with an up to 44 year follow up. Psychiatric comorbidity is the most relevant risk factor for suicide.
Conclusions
Even though some studies report an increased incidence of attempted and completed suicides in OCD patients from selected high risk samples, the evidence from population based studies is mostly based on one large Swedish study. More long-term studies in the general population with a reduced risk of subject attrition are needed. Using a clear definition and assessment of suicidal behaviour and a common time-frame would improve the comparability of future studies.
We investigated the effects of a large range of clinical factors on the long-term risk of suicide in the general population of South Korea. We analyzed the National Health Insurance Service-National Sample Cohort (NHIS-NSC) database in South Korea. A total of 300,232 individuals were followed for up to 12 years. We obtained information on demographic variables (age and sex), lifestyle variables (cigarette smoking, alcohol drinking and exercise), psychiatric and physical disorders, laboratory examination results and physical examination findings. We conducted a competing risk survival analysis to estimate the risk of completed suicide. 725 individuals (241/100,000) died by suicide in the follow-up period. After Bonferroni correction, we found a significant suicide risk associated with 6 variables: Parkinson's disease, depressive disorder, obsessive-compulsive disorder (inverted association), elevated serum aspartate aminotransferase levels, male gender and age. Before Bonferroni correction, variables such as cigarette smoking, heavy alcohol drinking, psychotic disorder, other psychiatric disorder, benzodiazepine use and higher fasting glucose showed some significant association. In addition, body mass index and height were inversely related to completed suicide before Bonferroni correction. However, only the 6 variables listed above were robust predictors of suicide in the fully adjusted analyses with multiple test correction. Common medical conditions had no clear influence on suicide. Diverse clinical factors influenced the long-term risk of completed suicide in this general population sample. Comprehensive assessment of these risk factors will facilitate more focused suicide surveillance measures.
Introduction:
Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder that causes significant distress to the afflicted individual. About half of OCD patients treated with an adequate trial of serotonin reuptake inhibitors fail to fully respond to treatment and continue to exhibit significant symptoms. Therefore, there is a need for other agents to alleviate the symptoms of these disorders. In spite of considerable research including numerous randomized controlled trials and systematic reviews, there exists uncertainty regarding what treatments are effective. In this systematic review, we evaluated the efficacy of mood stabilizers in treatment-refractory OCD.
Materials and methods:
We conducted a meta-analysis of all randomized clinical trials evaluating lithium, anticonvulsive agents or atypical antipsychotic drugs for OCD to determine which therapies show more effective than a placebo, in reducing obsessive-compulsive symptoms. We acquired eligible studies through a systematic search of Cochrane Central Registry of Controlled Trials, MEDLINE, EMBASE, PsycINFO, Scopus, ProQuest and Google scholar. We conducted meta-analyses to establish the effect of lithium, anticonvulsive agents, or atypical antipsychotic drugs on patient-important outcomes when possible. To assess relative effects of treatments, we constructed a random effect model.
Discussions:
Our review was the first to evaluate all treatments for OCD, to provide the relative effectiveness of lithium, anticonvulsive agents, or atypical antipsychotic drugs, and prioritize patient-important outcomes with a focus on functional gains. Our review facilitated the evidence-based management of patients with resistant OCD, and identified the key areas for future research.
In purely psychogenic dermatoses, the psychiatric disorder is the primary aspect, and somatic findings arise secondarily. These are the direct consequences of psychological or psychiatric disorders. In dermatology, there are four main disorders with primarily psychiatric genesis. Disorders of Primarily Psychiatric Genesis
1. Self-inflicted dermatitis: dermatitis artefacta, dermatitis paraartefacta (disorder of impulse control), malingering
2. Dermatoses due to delusional disorders and hallucinations, such as delusions of parasitosis
3. Somatoform disorders
4. Dermatoses due to compulsive disorders
OBJECTIVE:
Obsessive-compulsive disorder (OCD) is associated with variable risk of suicide and prevalence of suicide attempt (SA). The present study aimed to assess the prevalence of SA and associated sociodemographic and clinical features in a large international sample of OCD patients.
METHODS:
A total of 425 OCD outpatients, recruited through the International College of Obsessive-Compulsive Spectrum Disorders (ICOCS) network, were assessed and categorized in groups with or without a history of SA, and their sociodemographic and clinical features compared through Pearson's chi-squared and t tests. Logistic regression was performed to assess the impact of the collected data on the SA variable.
RESULTS:
14.6% of our sample reported at least one SA during their lifetime. Patients with an SA had significantly higher rates of comorbid psychiatric disorders (60 vs. 17%, p<0.001; particularly tic disorder), medical disorders (51 vs. 15%, p<0.001), and previous hospitalizations (62 vs. 11%, p<0.001) than patients with no history of SA. With respect to geographical differences, European and South African patients showed significantly higher rates of SA history (40 and 39%, respectively) compared to North American and Middle-Eastern individuals (13 and 8%, respectively) (χ2=11.4, p<0.001). The logistic regression did not show any statistically significant predictor of SA among selected independent variables.
CONCLUSIONS:
Our international study found a history of SA prevalence of ~15% in OCD patients, with higher rates of psychiatric and medical comorbidities and previous hospitalizations in patients with a previous SA. Along with potential geographical influences, the presence of the abovementioned features should recommend additional caution in the assessment of suicide risk in OCD patients.
Zwangsstörungen gehören in Deutschland zu den vier häufigsten psychischen Störungen (Jacobi et al. 2014) und sind über alle Bevölkerungsschichten etwa gleichhäufig verteilt. Der Einfluss dieser Erkrankung reicht in alle Lebensbereiche der Betroffenen und führt in der Folge zu massiven Beeinträchtigungen der Lebensqualität (Subramaniam et al. 2013). Zwangsstörungen verlaufen unbehandelt meist chronisch und trotz heute bekannter wirksamer Behandlungsmethoden ist die aktuelle Versorgungssituation noch als unzureichend zu bezeichnen. Gemäß den S3-Leitlinien (Hohagen et al. 2015) gilt die kognitive Verhaltenstherapie (KVT) mit Exposition und Reaktionsverhinderung als Therapie der 1. Wahl. Eine Pharmakotherapie ist indiziert, wenn KVT keine ausreichende Besserung erbringt, wenn der Betroffene eine KVT ablehnt, diese nicht verfügbar ist oder die Erkrankung so schwer ausgeprägt ist, dass eine Psychotherapie erschwert ist.
Objective
There are conflicting reports about whether individual anxiety disorders are independently associated with suicidal ideation and suicide attempts. We examined whether anxiety disorders are related to suicidal ideation and suicide attempts in a community sample of South Korean adults.
Methods
In-person interviews based on the South Korean version of the Composite International Diagnostic Interview were conducted to diagnose mental disorders. Multivariate logistic regression analysis was performed to examine whether anxiety disorders were associated with suicidal ideation and suicide attempts. Each regression model treated lifetime diagnosis of anxiety disorders as independent variables. Sociodemographic characteristics, cohabitation status, lifetime history of mood disorders, alcohol use disorders, and psychotic disorders were included as covariates.
Results
Nationally representative sample of 6,510 South Korean adults aged 18–64 years was recruited. Multivariate analysis adjusted for psychiatric comorbidity and sociodemographic variables revealed that generalized anxiety disorder (GAD) [2.34, 95% confidence interval (CI) (1.27, 4.33)], post-traumatic stress disorder (PTSD) (3.50, 95% CI: 2.16, 5.68), specific phobia (1.55, 95% CI: 1.14, 2.11), social phobia (2.97, 95% CI: 1.27, 6.94), and obsessive-compulsive disorder (OCD) (5.58, 95% CI: 2.70, 11.6) were associated with suicidal ideation, whereas only social phobia (3.78, 95% CI: 1.41, 10.1) and PTSD (5.13, 95% CI: 2.81, 9.37) were associated with suicide attempts.
Conclusion
Individual anxiety disorders are independently associated with suicidal ideation and/or suicide attempts. The importance of the early detection of anxiety disorders and of assessing the suicide risk in individuals with anxiety disorders is emphasized.
The lumping together of the seven deadly sins—pride, covetousness, jealousy, sloth, lust, gluttony, and anger—is, of course, a theological categorization rather than a medical nosology. Nevertheless, these seven sins are oddly reminiscent of various symptoms of a common medical disorder—one that has received increasing neuroscientific investigation in recent years—obsessive-compulsive disorder (OCD). Is such a parallel between sin and symptom purely coincidental, or is modern neurobiology able to provide a more coherent explanation?
Interestingly, the term “obsession” derives from the Roman Catholic concept of obsession—a state of being possessed by the devil. Indeed, obsessions—defined as recurrent intrusive and senseless thoughts and images—are some of the most overwhelming and distressing of psychiatric symptoms. While it is true that hallucinations and delusions lead to a loss of contact with reality, people with obsessions suffer from the very fact that they cannot resist ideas that they know full well to be irrational. Thus, OCD sufferers find themselves having to perform compulsions—recurrent rituals that relieve anxiety—but which are not realistically connected to the preceding obsessions or are clearly excessive.
The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.
Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy, showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.
Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
Our knowledge of the prevalence and demographic and clinical characteristics of obsessive-compulsive disorder (OCD) has, until recently, been based almost exclusively on patient samples. The epidemiology of OCD was first described in a large United States household sample from the Epidemiologic Catchment Area (ECA) study. Since these original observations, the rates of OCD in household populations determined from diagnostic procedures similar to those used in the United States have been published from different parts of the world. Detailed comparisons of rates, sex ratios, age at onset, and demographic and clinical characteristics of OCD in these samples are now available.
This article reports on the cross-national epidemiology of OCD from seven international epidemiologic surveys, including the United States ECA study. Each survey used the Diagnostic Interview Schedule (DIS), a highly structured interview, developed for use in epidemiologic surveys, that yields Diagnostic and Statistical Manual of Mental Disorders , Third Edition (DSM-III) psychiatric diagnoses. All investigators provided the data from their study to be pooled at Columbia University, and the prevalence rates were standardized to the age and sex distribution of the five-site ECA household population so that more precise estimates and comparisons could be made.
The risk of death by suicide in individuals with obsessive–compulsive disorder (OCD) is largely unknown. Previous studies have been small and methodologically flawed. We analyzed data from the Swedish national registers to estimate the risk of suicide in OCD and identify the risk and protective factors associated with suicidal behavior in this group. We used a matched case–cohort design to estimate the risk of deaths by suicide and attempted suicide in individuals diagnosed with OCD, compared with matched general population controls (1:10). Cox regression models were used to study predictors of suicidal behavior. We identified 36 788 OCD patients in the Swedish National Patient Register between 1969 and 2013. Of these, 545 had died by suicide and 4297 had attempted suicide. In unadjusted models, individuals with OCD had an increased risk of both dying by suicide (odds ratio (OR)=9.83 (95% confidence interval (CI), 8.72–11.08)) and attempting suicide (OR=5.45 (95% CI, 5.24–5.67)), compared with matched controls. After adjusting for psychiatric comorbidities, the risk was reduced but remained substantial for both death by suicide and attempted suicide. Within the OCD cohort, a previous suicide attempt was the strongest predictor of death by suicide. Having a comorbid personality or substance use disorder also increased the risk of suicide. Being a woman, higher parental education and having a comorbid anxiety disorder were protective factors. We conclude that patients with OCD are at a substantial risk of suicide. Importantly, this risk remains substantial after adjusting for psychiatric comorbidities. Suicide risk should be carefully monitored in patients with OCD.
In the phase III of the french national study on OCD, 155 patients suffering from-art OCD (full DSM III-R criteria, score on NIMH-OC greater than or equal to 7, not treated or undertreated) had entered a naturalistic follow-up of 12 months duration. Obsessions, compulsions, depression, anxiety, impulsivity and global functioning were assessed by using NIMH-OC, CPRS-OC2, MOCI, MADRS, HAD (-A, -D); BDS (Behavioral Dyscontrol Scale), CGI and GAS (DSM III-R). From the initial population (155 patients), 130 (84 %) had been treated with drugs and were completers,, and assessed at M6 and M12; 18 (11,6 %) were lost to follow-up and 7 (4,5 %) had droped out because of treatment refusal, side-effect or improvement. Only 19 % of patients had received a behavior therapy. In spite of selection of patients with severe and chronic OCD associated to depression (mean MADRS score = 25), 85 % of treated patients had been treated with one anti-OCD drug (105 with fluoxetine, 17 with clomipramine and 17 with other antidepressants), 4,5 % needed a treatment substitution and 4,5 % a bitherapy (combination of 2 anti-OCD drugs); 84 % of patients were considered as good compliant,, with Visit agenda and treatment. At the end of follow-up, global improvement was observed in 77 % of patients treated. Clinical improvement was assessed by different response criteria (final NIMH-OC score, 30 % decrease on NIMH-OC, 35 % decrease on MOCI, final GAF score greater than or equal to 70) which showed 4 patterns of response to treatment: " positive response on M6 and M12" = 43-64 %; " only M12" (slow response) = 13-24 %; " only M6 (escape or relapse) = 4-6 %; " negative response on M6 and M12,, (resistant OCD) = 19-33 %. During 12 month treatment, 31 patients (22,5 %) had presented an adverse effect in which 7 cases (5, 1 %) with "serious adverse event" and 5 cases (3,6%) who required treatment drop-out. Predictive factors of clinical response to anti-OCD drugs were explored : 1) " lack of insight,, was the best factor to characterise the resistant group; 2) high base-line of impulsivity,, predict better response at M6 ;3) important to severe slowness was associated with a longer delay to response (between M6 and M12). The results of the phase III from the french multi-site study will be compared to the international data on longterm treatment of OCD.
Background
The aim of the study was to determine whether patients with obsessive–compulsive disorder (OCD) resistant to drug therapy may improve their condition using intensive, systematic cognitive behavioral therapy (CBT) lasting for 6 weeks, and whether it is possible to predict the therapeutic effect using demographic, clinical, and selected psychological characteristics at baseline.
Methods
Sixty-six OCD patients were included in the study, of which 57 completed the program. The diagnosis was confirmed using the structured Mini International Neuropsychiatric Interview. Patients were rated using the objective and subjective forms of the Yale–Brown Obsessive Compulsive Scale, objective and subjective forms of the Clinical Global Impression, Beck Anxiety Inventory, Beck Depression Inventory, Dissociative Experiences Scale, 20-item Somatoform Dissociation Questionnaire, and the Sheehan Disability Scale before their treatment, and with subjective Yale–Brown Obsessive Compulsive Scale, objective and subjective Clinical Global Impression, Beck Anxiety Inventory, and Beck Depression Inventory at the end of the treatment. Patients were treated with antidepressants and daily intensive group CBT for the 6-week period.
Results
During the 6-week intensive CBT program in combination with pharmacotherapy, there was a significant improvement in patients suffering from OCD resistant to drug treatment. There were statistically significantly decrease in the scores assessing the severity of OCD symptoms, anxiety, and depressive feelings. A lower treatment effect was achieved specifically in patients who 1) showed fewer OCD themes in symptomatology, 2) showed a higher level of somatoform dissociation, 3) had poor insight, and 4) had a higher initial level of overall severity of the disorder. Remission of the disorder was more likely in patients who had 1) good insight, 2) a lower initial level of anxiety, and 3) no comorbid depressive disorder.
This manuscript summarizes the presentations of an international panel of experts, representing France, Hungary, India, South Africa, and the United States, on obsessive-compulsive disorder (OCD). OCD is culturally universal but probably heterogeneous. New data presented concern a follow-up study from a joint Yale-Brown clinical project; a prevalence study in Hungary; a molecular genetics study from South Africa; a comorbidity study from India; a clinical study from Paris comparing OCD with subclinical OCD; a discussion of compulsive buying as a cross-cultural phenomenon; and survey results showing the impact of OCD on quality of life and economic variables. A roundtable discussion led to a consensus that researchers must continue to: (1) investigate the prevalence of OCD in nonWestern samples and in less developed countries; (2) collect clinical data on OCD in child and adolescent samples, as well as in offspring of adults with OCD; (3) refine the concept of age of onset; (4) study the impact of OCD on quality of life and the economy; (5) investigate the validity of the obsessive-compulsive spectrum in epidemiologic and clinical samples and develop appropriate instruments for its assessment; (6) study personality disorder and how it affects treatment response, and examine its prevalence in epidemiologic samples; (7) explore the concept of OCD heterogeneity, which may reflect differing etiologies but may also suggest differential treatment strategies; (8) conduct follow-up studies, particularly now that effective treatments may alter course of illness; and, finally, (9) investigate treatment response and whether certain subtypes demand unique approaches.
Importance
Several mental disorders have consistently been found to be associated with decreased life expectancy, but little is known about whether this is also the case for obsessive-compulsive disorder (OCD).Objective
To determine whether persons who receive a diagnosis of OCD are at increased risk of death.Design, Setting, and Participants
Using data from Danish registers, we conducted a nationwide prospective cohort study with 30 million person-years of follow-up. The data were collected from Danish longitudinal registers. A total of 3 million people born between 1955 and 2006 were followed up from January 1, 2002, through December 31, 2011. During this period, 27 236 people died. The data were analyzed primarily in June 2015.Main Outcomes and Measures
We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, maternal and paternal age, place of residence at birth, and somatic comorbidities, to compare persons with OCT with persons without OCD.Results
Of 10 155 persons with OCD (5935 women and 4220 men with a mean [SD] age of 29.1 [11.3] years who contributed a total of 54 937 person-years of observation), 110 (1.1%) died during the average follow-up of 9.7 years. The risk of death by natural or unnatural causes was significantly higher among persons with OCD (MRR, 1.68 [95% CI, 1.31-2.12] for natural causes; MRR, 2.61 [95% CI, 1.91-3.47] for unnatural causes) than among the general population. After the exclusion of persons with comorbid anxiety disorders, depression, or substance use disorders, OCD was still associated with increased mortality risk (MRR, 1.88 [95% CI, 1.27-2.67]).Conclusions and Relevance
The presence of OCD was associated with a significantly increased mortality risk. Comorbid anxiety disorders, depression, or substance use disorders further increased the risk. However, after adjusting for these and somatic comorbidities, we found that the mortality risk remained significantly increased among persons with OCD.
The selective serotonin reuptake inhibitors (SSRIs) are effective and safe in a range of different anxiety disorders. This review focuses on citalopram, the most selective of the available SSRIs, in anxiety disorders (generalized anxiety disorder, panic disorder, social phobia, obsessive-compulsive disorder, posttraumatic stress disorder) as well as in anxiety-related conditions (obsessive-compulsive spectrum disorders, alcohol abuse, agitation associated with schizophrenia). An expanding body of evidence indicates that citalopram is not only effective and safe in the treatment of depression, but also useful in the treatment of generalized anxiety symptoms in a number of different conditions and populations. The therapeutic efficacy of citalopram in treating panic disorder has been known for at least a decade: in recent, double-blind studies this has been confirmed, and it has been shown that a dose of 20-30 mg/day is optimal. Patients with obsessive-compulsive disorder (OCD) respond well to treatment with citalopram; the evidence from open-label, multicentre trials has recently found confirmation in a large, multicentre, placebo-controlled, double-blind trial, with the superiority of citalopram over placebo being highly statistically significant at doses between 20 and 60 mg/day. Some patients with psychiatric disorders possibly closely related to OCD (termed OCD-spectrum disorders, and including trichotillomania, pica and olfactory reference syndrome), also appear, on current evidence, amenable to citalopram treatment. Citalopram has recently been found to be useful in the management of social phobia, with significant clinical improvement being seen at a median dose of 40 mg/day. Similarly, although there are few published accounts of citalopram use in treating post-traumatic stress disorder, significant improvement has been seen with this treatment in clinical practice. Analysis of pooled data from double-blind, placebo-controlled studies, involving almost 2000 patients, shows that citalopram treatment leads to a significant improvement of concomitant anxiety in depressed patients. Citalopram has been shown to be particularly useful in treating anxiety disorders in elderly patients, where it is one of the most preferred drugs because of its favourable adverse event and interaction profile, and in children. These findings, together with other reports of the efficacy of citalopram in the treatment of miscellaneous anxiety-related conditions (alcohol abuse, agitation associated with schizophrenia), lead to the conclusion that citalopram holds great promise for the safe and effective treatment of anxiety and anxiety disorders.
Objective: To our knowledge, there are very limited data on suicidal ideation in obsessive-compulsive disorder, despite it is a common psychiatric condition that often runs a chronic course with high rates of comorbidity and treatment nonresponse. Moreover, no studies have, to date, evaluated the role of alexithymia and insight in determining suicidal ideation among these patients. Therefore, the aim of our study was to evaluate suicidal ideation and the relationships with alexithymia and insight in a sample of adult outpatients with obsessive-compulsive disorder. Methods: A sample of 86 adult outpatients with DSM-IV diagnosis of obsessive-compulsive disorder (44 women and 42 men with a mean age of 36.2 ± 13.0 years), has been evaluated with a series of rating scales such as the Yale-Brown Obsessive Compulsive Scale, the Toronto Alexithymia Scale, the Scale for Suicide Ideation and the Montgomery-Åsberg Depression Rating Scale. The score of item #11 on the Yale-Brown Obsessive Compulsive Scale was considered as a measure of insight and scores of ≥ 3 were considered to mark the boundary between illness awareness and no awareness. Scores of ≥ 61 on the Toronto Alexithymia Scale were considered to be within the alexithymic range. As made in previous studies, scores > 5 on the SSI were used to define a person with current suicide risk. Results: There were no significant gender differences concerning demographic and clinical variables. 30 subjects (34.9%) were categorized as alexithymic and showed earlier onset, longer duration of illness and more likelihood to have a chronic course than nonalexithymics; they also scored higher on the Montgomery-Åsberg Depression Rating Scale and the Scale for Suicide Ideation (Table I). Alexithymics without insight (n = 21) scored higher on the Scale for Suicide Ideation than alexithymics with insight (n = 9), nonalexythimics without insight (n = 5) and nonalexithymics with insight (n = 51) (Fig. 1). Partial correlations between the Toronto Alexithymia Scale (and its subscales) and other dimensional variables, controlling for gender, age, illness duration and age at onset, showed that the Toronto Alexithymia Scale total score and Difficulty in Identifying Feelings/Difficulty in Describing Feelings subscales correlated with all study variables, whereas Externally Oriented Thinking correlated with the Yale-Brown Obsessive Compulsive Scale and its subscales (including item#11) but not with scores on the Scale for Suicide Ideation and on the Montgomery-Åsberg Depression Rating Scale (Table II). Results of a linear regression showed that chronic obsessive-compulsive disorder course together with Difficulty in Identifying Feelings dimension of Toronto Alexitohymia Scale and higher Montgomery-Åsberg Depression Rating Scale scores were significantly associated with higher scores on the Scale for Suicide Ideation (Table III). Conclusions: Suicidal ideation is frequent among adult outpatients with obsessive-compulsive disorder and similar to that reported in affective disorders, schizophrenia and substance abuse. Alexithymia and depressive symptoms were highly correlated in obsessive-compulsive disorder patients and were significantly associated with higher suicide risk. The Difficulty in Identifying Feelings dimension of Toronto Alexithymia Scale appears to be significantly associated with presence of suicidal ideation as well as chronic course of the disorder. The Externally Oriented Thinking dimension of Toronto Alexithymia Scale appeared to be a variable fairly independent from depressive symptoms and suicidal ideation but was closely related to the severity of the disorder. Insight alone seems not to play a direct role in increasing suicide risk, but may have some relevance when associated with alexithymia. However, further longitudinal studies on larger samples are needed to definitely clarify this topic.
Suicide is a complex term. Suicide attempts are common in women, but completed suicide rates are higher in men. Several demographic factors, stressful life events, previous suicide attempts, childhood abuse, physical or psychiatric disorders are risk factors for suicide. Suicide rates in a variety of mental disorders is more than the normal population. Data on rates and risk factors of suicide in patients with obsessive-compulsive disorder and related disorders are limited. Present data are often associated with patients with obsessive compulsive disorder and body dysmorphic disorder. Lifetime suicidal ideation rates in patients with obsessive compulsive disorder is within a range of 36-63%. Any comorbid psychiatric diagnosis is an important risk factor for suicide in this disorder. This article aims to review the relationship between suicide and obsessive compulsive and related disorders
The construct of quality of life (QOL), which has both subjective and objective components, has gained increasing importance in psychiatric research for several important reasons, not the least being the current importance of pharmacoeconomic issues. Obsessive-compulsive disorder (OCD) has been suggested to be the world's 10th most disabling disorder, and pharmacoeconomic studies have indicated that its cost to the world economy runs into the billions of dollars. The use of QOL scales derived from general medicine and other areas of psychiatry has demonstrated the enormous negative impact of OCD on several domains, including occupational function, social function, and family function. Further work to ascertain the extent of changes in QOL during treatment of OCD is necessary.
The study presented was conducted to analyze the effects of obsessive-compulsive symptoms on patients' quality of life and the costs incurred by patients and society for the treatment of obsessive-compulsive disorder (OCD). To accomplish this, a detailed 410-item questionnaire of psychosocial function and economic cost was sent to every fourth member of the Obsessive Compulsive Foundation. Of the 2,670 members who received the survey, 701 (26.9%) returned it.
Outcome measures included symptomatology, course of illness, impact of illness on psychosocial and other functioning, effects of diagnosis and treatment, and economic consequences. The demographics of this group were similar to those in smaller treatment-seeking clinical samples, but not necessarily to OCD sufferers within the US population as a whole. More than half of the patients reported moderate to severe interference in family relationships, socializing, and ability to study or work, secondary to OCD symptoms. A 10.2-year gap was observed between the onset of symptoms and the first attempt to seek professional help, and a 17.2-year gap was observed between the onset of symptoms and receipt of effective treatment. Specific treatments, such as serotonin reuptake inhibitors and behavior therapy showed greater symptom improvement, and significantly reduced the total annual fees incurred by OCD patients when compared with nonspecific treatments.
Our study results indicate that OCD has a profound effect on psychosocial functioning and quality of life. Large direct costs for OCD, and even larger indirect costs due to lost wages and underemployment were found. Greater awareness of OCD among practitioners may result in earlier diagnosis and more appropriate and cost-effective treatments.
IntroductionCurrent StatusApproachPitfalls and TipsThe FutureReferences
Many children and adults with Obsessive-Compulsive Disorder experience incomplete symptom relief despite treatment with several evidence-based interventions for OCD. Converging lines of evidence from genetic, neuroimaging, biochemical and pharmacological studies implicate the importance of abnormalities in the glutamate symptoms in the pathogenesis of OCD. Strong evidence suggests that oxidative stress may be important in the progression of several psychiatric disorders, especially psychotic and affective disorders. N-acetylcysteine (NAC) is a cheap, relatively safe over-the-counter supplement that crosses the blood-brain barrier and acts potentially as a glutamate modulating agent and antioxidant. NAC has demonstrated efficacy in the treatment of a wide variety of psychiatric conditions in individual randomized, controlled trials including psychosis, autism, bipolar depression, trichotillomania. A recent double-blind placebo-controlled in adults with SRI-refractory OCD demonstrated the efficacy of NAC compared to placebo. In this review we summarize the preclinical and clinical data demonstrating NAC is a potentially promising new pharmacological agent in the treatment of OCD.
Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program focuses on the methodology employed in the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area (ECA) Program. The selection first elaborates on the historical context, major objectives, and study design and sampling the household population. Topics include the development of the ECA program, DIS instrument, program design, general issues in sampling community resident populations, household and respondent eligibility, household and respondent selection, weighting, and variance estimation. The manuscript then examines institutional survey and the characteristics, training, and field work of interviewers. Discussions focus on the changing nature of institutions, value of the institutional component, institutions included in institutional stratum, interviewer recruitment and selection, demographic characteristic of interviewers, and field work. The publication ponders on nonresponse and nonresponse bias in the ECA surveys, data preparation, and proxy interview, as well as quality of proxy data, item nonresponse, editing and coding, data entry and data cleaning, understanding nonresponse, and assessment of evidence for nonresponse bias. The selection is a valuable source of information for psychiatrists and readers interested in the Epidemiologic Catchment Area (ECA) Program.
During the past decade, there has been rapid growth in understanding the clinical features, pathophysiology, and treatment of obsessive compulsive disorder (OCD). This article reviews the current state of knowledge of the epidemiology and clinical features of OCD with a focus on the disorder's phenomenologic heterogeneity and its comorbidity with other Axis I and Axis II syndromes.
Obsessive-compulsive spectrum disorders comprise a unique category of related disorders with important diagnostic, aetiologieal and therapeutic implications. This group of disorders may overlap with obsessive-compulsive disorder (OCD) in symptomatic profile, demographics, family history, neurobiology, comorbidity, clinical course and response to selective anti-obsessional behavioural and pharmacotherapies. OCD-related disorders can be viewed along a continuum with risk avoidance on the compulsive end and risk seeking at the other. This dimension may be defined within a framework which relates hyperfrontality and increased serotonergic sensitivity with compulsive disorders and hyperfrontality and low presynaptic serotonergic levels with impulsive disorders. Most biological models of OCD-related disorders stress the importance of serotonin in their pathophysiology and these disorders have also been shown to be preferentially responsive to selective serotonergic reuptake inhibitors (SSRIs). This paper reviews the management of the OCD spectrum and the evidence for efficacy of the SSRIs and the differential treatment responses of the compulsive and impulsive disorders with regard to therapeutic dosage, response lag time and maintenance of symptom remission.
• Previous studies indicated that for two subgroups of patients, schizophrenics with premorbid asociality (SPA) and individuals with emotionally unstable character disorders (EUCD), central nervous system damage may have etiologic significance. It was hypothesized that these two patient groups would also have an increased number of neurologic soft signs.
The relationship of neurologic examination, tests of auditoryvisual integration, and intelligence quotient, and diagnoses was studied for 350 patients. Tests of reliability and persistence for all observed signs were performed.
The EUCD and SPA groups had increased evidence of neurologic soft signs. Differences in patterns of IQ scores also suggest that different forms of brain damage may be present in these two groups. When the two groups were removed from the larger patient sample, those patients with other types of schizophrenia and character disorder did not exhibit evidence of neurologic impairment. This study of neurologic soft signs adds to the validity of considering SPA and EUCD as separate diagnostic entities.
• We examined the level of agreement between diagnoses derived from data gathered by lay interviewers using the Diagnostic Interview Schedule (DIS) in a general population survey (the Epidemiologic Catchment Area project) and both DIS and clinical diagnoses made by psychiatrists. Overall percent agreement between the lay DIS and the psychiatrists clinical impression ranged from 79% to 96%. The chancecorrected concordance was .60 or better for eight of the 11 diagnoses. Specificities were all 90% or better. Sensitivities were lower, but lay results showed a bias for only two diagnoses: major depression was significantly underdiagnosed and obsessive illness was overdiagnosed. We compared the present results with those of previous studies from clinical settings. We explored possible reasons for disagreement and discussed the implications of the findings for psychiatric epidemiologic research.
Objective:
Due to the generally poor prognosis previously reported for patients with obsessive-compulsive disorder (OCD), this report systematically assessed the outcome of patients who had had access to new psychopharmacologic treatments to determine whether there had been any long-term gains and if there were any predictors of outcome.Design:
Prospective follow-up study of a cohort of consecutive pediatric patients with OCD who had participated in controlled treatment (clomipramine hydrochloride) trials and then received a variety of interim treatments.Patients:
Fifty-four children and adolescents were reevaluated 2 to 7 years (mean, 3.4±1.0 years initial clomipramine treatment. Information for 48 (89%) of the patients was from direct interview and for the remaining six (11%) from at least two sources.Results:
On follow-up, 23 of the subjects (43%) still met diagnostic criteria for OCD, and only three (6%) could be considered in true remission. Thirty-eight subjects (70%) were taking psychoactive medication at the time of follow-up. Although OCD symptoms continued, the group as a whole was significantly improved at follow-up, with only 10 subjects (19%) rated as unchanged or worse. A worse OCD outcome score at follow-up was predicted in a stepwise multiple regression by (1) more severe OCD symptoms score after 5 weeks of clomipramine therapy, (2) lifetime history of a tic disorder, and (3) presence of parental Axis I psychiatric diagnosis (R2=.31, P<.01).Conclusions:
With new treatments available, most patients with pediatric OCD can expect significant longterm improvements but not complete remission. This study supports previous reports of the chronicity and intractability of the disorder, as there still remained a significant subgroup of subjects who exhibited continued morbidity despite multiple interventions.
A subgroup of subjects (4 of 12) with childhood soft signs and adolescent anxiety-withdrawal disorders were followed up into adulthood and assessed for soft signs and psychiatric diagnoses. These subjects continued to have soft-sign abnormalities and most had adult anxiety or affective disorders, including obsessive-compulsive disorder (OCD). In contrast, control subjects with childhood soft signs but no adolescent anxiety disorders had fewer soft signs at follow-up and no discrete adult anxiety or affective disorders, but they did have obsessive-compulsive symptoms that did not meet criteria for OCD.
Children with conduct disorder have long been known to be at high risk for developing externalizing disorders, alcohol and drug abuse, and antisocial personality. Relationships of conduct disorder to other adult psychiatric disorders, on the other hand, have not been definitively shown. Taking advantage of the large community sample (N = 19,482) interviewed in the NIMH Epidemiologic Catchment Area Program, the authors examined the effects of childhood conduct problems on ten DSM-III psychiatric disorders: somatization, phobia, panic, obsessive-compulsive, depression, mania, alcohol use disorder, drug use disorder, schizophrenia and antisocial personality. Each of the ten adult disorders showed an increase in prevalence with an increasing number of conduct problems, although effects were stronger for externalizing disorders. The predictive power of conduct problems was similar for males and females. The effect of conduct problems on nonexternalizing disorders was found to be largely mediated through externalizing disorders, particularly for men but direct effects also occurred for both sexes. These findings raise questions about the conventional view of psychiatric disorders as divisible into externalizing and internalizing disorders. They also suggest that the increasing rates of conduct problems in younger cohorts may be responsible in part for the rising rates of other disorders. Thus, prevention of and early intervention with conduct disorder may hold promise for reducing rates of a broad range of disorders.
Seventeen of 59 patients admitted to hospital for treatment of Obsessive-Compulsive Disorder (OCD) were found to have significant slowness, mainly due to difficulty in initiating goal-directed action and suppressing intrusive and perseverative behaviour. In this subgroup subtle neurological abnormalities were found more frequently than in healthy controls and included loss of motor fluency, hesitancy of initiation of limb movements, speech and gait abnormalities, cogwheel rigidity, complex repetitive movements and tics. Difficulties in cognitive set-shifting and complex spatial-and-shifting abilities were found on neuropsychological testing, but no correlation was found between these disturbances and either the degree of obsessionality or the severity of motor dysfunction. These results suggest that patients with obsessional slowness may have a dysfunction in the frontal-basal-ganglia loop system.
Phenomenology and family history in 21 clinically referred children and adolescents with obsessive compulsive disorder are described. Each child and family participated in a standard clinical psychiatric assessment. The most frequently reported symptoms were repeating rituals, washing, ordering and arranging, checking, and contamination concerns. Controlling behaviors involving other family members were seen in 57% of the patients. Associated psychopathology was common: 38% received an anxiety disorder diagnosis; 29% received a mood disorder diagnosis; tics were observed in 24%. Fifteen (71%) of the children had a parent with either obsessive compulsive disorder (N = 4) or obsessive-compulsive symptoms (N = 11). The clinical and research implications of these findings are discussed.
Obsessive-compulsive disorder (OCD) has been linked to altered neurological function following head trauma, encephalitis, abnormal birth events, and Gilles de la Tourette's syndrome. Abnormalities in computed tomographic scans, electroencephalograms, positron emission tomographic scans, and evoked potentials have been described in this disorder, but are neither consistent nor pathognomonic of OCD. Neurological soft signs are nonlocalizing signs of deviant performance on a motor or sensory test where no other sign of a neurological lesion is present. We studied 41 medication-free patients with OCD who met DSM-III-R criteria, as well as 20 normal controls, matched for age, sex, and handedness, on 20 individual tasks that involved fine motor coordination, involuntary movements, and sensory and visuospatial function. There were significantly more signs of central nervous system dysfunction in the OCD group, as shown by abnormalities in fine motor coordination, involuntary and mirror movements, and visuospatial function. An excess of findings on the left side of the body and abnormalities of cube drawing may suggest right hemispheric dysfunction in a subgroup of patients with OCD. Soft signs correlated with a severity of obsessions. There was also a correlation between abnormalities in visual memory and recognition on neuropsychological testing and total soft signs. These findings provided additional evidence for a neurological deficit in some patients with OCD. However, further comparisons with other psychiatric populations are needed to determine whether these findings are unique to OCD or are a property of other psychiatric disorders as well.
In the second part of a two-stage epidemiologic study of obsessive-compulsive symptoms in nonreferred adolescents, clinicians interviewed high school students selected from screening measures administered in the first stage. Of the 356 students interviewed, 93 scored above clinically derived thresholds on the 20-item Leyton Obsessional Inventory-Child Version, 188 scored below the clinical threshold but positively on at least one other screen for psychopathology, and 75 scored negatively on all screens. The Leyton inventory had a sensitivity of 75%, a specificity of 84%, and a predictive value of 18% as a screen for obsessive-compulsive disorder (OCD). The OCD cases identified had characteristics similar to those of clinical cases, except for the nonpredominance of males. There was a high frequency of associated disorders, but only four of the 18 cases had been under professional care. OCD is much more common during adolescence than has been previously thought; it is both underdiagnosed and undertreated.
The prevalence of obsessive-compulsive disorder was measured in five US communities among more than 18,500 persons in residential settings as part of the National Institute of Mental Health (Bethesda, Md)--sponsored Epidemiologic Catchment Area program. Lifetime prevalence rates ranged from 1.9% to 3.3% across the five Epidemiologic Catchment Area sites for obsessive-compulsive disorder diagnosed without DSM-III exclusions and 1.2% to 2.4% with such exclusions. These rates are about 25 to 60 times greater than had been estimated on the basis of previous studies of clinical populations.
We examined specific genetic hypotheses about the mode of transmission of Gilles de la Tourette's syndrome, by performing segregation analyses in 30 nuclear families identified through 27 index cases. Because data from earlier family studies had suggested that chronic tics and obsessive-compulsive disorder may be alternative phenotypic expressions of the diathesis of Tourette's syndrome, we used three diagnostic schemes to specify affected family members (Tourette's syndrome only; Tourette's syndrome or chronic tics; and Tourette's syndrome, chronic tics, or obsessive-compulsive disorder). The estimates of penetrance for the genotypes AA, Aa, and aa (A denotes the abnormal allele) in the analyses of subjects with Tourette's syndrome, chronic tics, or obsessive-compulsive disorder were 1.000, 1.000, and 0.002, respectively, for male subjects and 0.709, 0.709, and 0.000 for female subjects. These results predict that approximately 10 percent of all patients are phenocopies. We conclude that our analyses provide strong support for the hypothesis that obsessive-compulsive disorder is etiologically related to Tourette's syndrome and chronic tics in these families, and that Tourette's syndrome is inherited as a highly penetrant, sex-influenced, autosomal dominant trait.
Obsessive-compulsive disorder (OCD) can be considered a complex entity with possibly different subgroups responsive to specific treatment. This article presents two cases of OCD with self-mutilation, successfully treated with serotonergic antidepressants. The authors discuss a sub-group of OCD patients whose rituals present as self-destructive behavior and are responsive to pharmacotherapy.
The authors present the clinical characteristics, demographic features, and family history of a clinical sample of 44 patients who met DSM-III criteria for obsessive-compulsive disorder. Their findings are consistent with those of previous epidemiologic studies completed before the introduction of DSM-III with regard to phenomenology, course, and demographic characteristics. Most of the 44 patients had concomitant or lifetime histories of a major depressive disorder or another anxiety disorder. A number of first-degree relatives of these patients had probable obsessive-compulsive disorder or obsessive traits. The findings of this study should prove useful in further epidemiologic, biologic, and behavioral studies.
A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).
Obsessive-compulsive patients with a history of poor impulse control were identified and compared with non-impulsive obsessive-compulsive patients. Although both groups reported comparable obsessive-compulsive symptoms, the impulsive group rated significantly higher on disturbances during childhood, which included learning problems, low frustration tolerance, poor interpersonal relationships and attention-seeking behaviour. The impulsive group also scored highly on the neuroticism scale of the Eysenck Personality Questionnaire and reported a higher incidence of somatic symptoms. It appears that poor impulse control was related to disturbances which had already manifested themselves during childhood, while the obsessive-compulsive disorder was superimposed at a later time.
The National Institute of Mental Health Diagnostic Interview Schedule (DIS) was translated into Spanish. The reliability of the Spanish instrument, its equivalence to the English version, and its agreement with clinical diagnoses were examined in a study of 90 bilingual (English-and Spanish-speaking) and 61 monolingual (Spanish-speaking only) patients from a community mental health center. The study design involved two independent DIS administrations and one independent clinical evaluation of each subject.
Two adolescents are described presenting with obsessive-compulsive neurosis and conduct disorder. The presence of conduct disorder is in marked contrast to the compliance and over-control characteristic of obsessionality, and was found to give rise to great difficulties in instigating and carrying through a programme of response-prevention for the obsessive-compulsive symptoms.
Data on the epidemiology of psychiatric disorders from different parts of the world using similar methods and diagnostic criteria have previously not been available. This article presents data on lifetime and annual prevalence rates, age at onset, symptom profiles, and comorbidity of obsessive compulsive disorder (OCD), using DSM-III criteria, from community surveys in seven countries: the United States, Canada, Puerto Rico, Germany, Taiwan, Korea, and New Zealand. The OCD annual prevalence rates are remarkably consistent among these countries, ranging from 1.1/100 in Korea and New Zealand to 1.8/100 in Puerto Rico. The only exception is Taiwan (0.4/100), which has the lowest prevalence rates for all psychiatric disorders. The data for age at onset and comorbidity with major depression and the other anxiety disorders are also consistent among countries, but the predominance of obsessions or compulsions varies. These findings suggest the robustness of OCD as a disorder in diverse parts of the world.
To investigate the frequency and phenomenology of obsessive-compulsive disorder (OCD) and subclinical OCD in young adolescents.
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.
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.
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.
Clinical experience with children and adolescents with obsessive compulsive disorder (OCD) suggests the need for long-term care. In addition to maintenance drug treatment, behavior therapy and family counseling are usually indicated. Family counseling can help prevent the avoidant behavior that is a serious complication of OCD. The outcome for OCD in children and adolescents has been improved by the use of these active long-term therapies.
Due to the generally poor prognosis previously reported for patients with obsessive-compulsive disorder (OCD), this report systematically assessed the outcome of patients who had had access to new psychopharmacologic treatments to determine whether there had been any long-term gains and if there were any predictors of outcome.
Prospective follow-up study of a cohort of consecutive pediatric patients with OCD who had participated in controlled treatment (clomipramine hydrochloride) trials and then received a variety of interim treatments.
Fifty-four children and adolescents were reevaluated 2 to 7 years (mean, 3.4 +/- 1.0 years) after initial clomipramine treatment. Information for 48 (89%) of the patients was from direct interview and for the remaining six (11%) from at least two sources.
On follow-up, 23 of the subjects (43%) still met diagnostic criteria for OCD, and only three (6%) could be considered in true remission. Thirty-eight subjects (70%) were taking psychoactive medication at the time of follow-up. Although OCD symptoms continued, the group as a whole was significantly improved at follow-up, with only 10 subjects (19%) rated as unchanged or worse. A worse OCD outcome score at follow-up was predicted in a stepwise multiple regression by (1) more severe OCD symptoms score after 5 weeks of clomipramine therapy, (2) lifetime history of a tic disorder, and (3) presence of parental Axis I psychiatric diagnosis (R2 = .31, P < .01).
With new treatments available, most patients with pediatric OCD can expect significant longterm improvements but not complete remission. This study supports previous reports of the chronicity and intractability of the disorder, as there still remained a significant subgroup of subjects who exhibited continued morbidity despite multiple interventions.
Popula-tion-based norms for the Mini-Mental State Examination by age and educational level
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A comparison of two diagnostic methods
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