No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Directionality of change in obsessive compulsive disorder and depression over six years of prospective follow-up
Abstract
Major Depressive Disorder (MDD) is often comorbid with obsessive-compulsive disorder (OCD) yet little is known about the directionality of the association between OCD and depression symptoms. We aim to investigate the effect OCD symptoms has on depression symptoms and vice versa over an extended period of time. This is one of the first longitudinal studies to evaluate the relationship between OCD and depression in a large clinical sample. Participants (n = 324) were treatment-seeking adults with a primary diagnosis of OCD. OCD and depression symptoms were assessed annually over the six-year follow-up period. Random intercepts cross-lagged panel models (RI-CLPM) were conducted to compare unidirectional and bidirectional models over time. The best-fitting and most parsimonious model included paths with OCD symptoms predicting depression symptoms, but not vice versa. OCD symptom severity in a given year predicted next year depression severity. However, depression severity did not predict next-year OCD symptom severity in this sample. Our results suggest that depression severity may be secondary to OCD symptoms and treating OCD should be prioritized over treating depression.
... Additionally, depressive symptoms as a common secondary symptom of obsessive-compulsive symptoms have been extensively validated in children (15) and particularly in adolescents (16,17).When depressive symptoms are secondary to obsessive-compulsive symptoms, they may lead to more severe impairment (18) and a higher risk of suicide (19). Longitudinal studies show that obsessive-compulsive symptoms can predict depressive symptoms over a two-year follow-up (20), with more severe obsessive-compulsive symptoms indicating more severe depressive symptoms in the following year (21). In summary, depressive symptoms may mediate the relationship between obsessivecompulsive symptoms and suicide risk. ...
Background
Suicide has become one of the leading causes of death among adolescents, with an increased risk observed in the psychiatric outpatient population. Therefore, exploring its risk factors is crucial. Obsessive-compulsive symptoms, being common in this patient group, warrant investigation into their impact mechanisms on suicide risk.
Methods
This study enrolled 526 outpatient adolescents [396 females (75.29%); Mage = 15.39, SD = 1.23] who completed relevant questionnaires and provided demographic data during their clinic visit.
Results
Obsessive-compulsive symptoms positively predicted suicide risk in both males and females, with depressive symptoms mediating this effect. Sleep disturbances played a mediating role only in females, while anxiety symptoms did not mediate the relationship in either gender.
Conclusion
Clinicians should pay closer attention to adolescents presenting with obsessive-compulsive and depressive symptoms, as well as female adolescents with sleep disturbances, to mitigate their elevated suicide risk.
... Suicidal thoughts are reported by 36%-63.5% of OCD patients [47][48][49] and suicidal attempts by 10%-16.5% [50,51]. Depressive disorders are commonly co-occurring with OCD, with lifetime prevalence rates as high as 48% [52,53]. In their paper, Devi et al. reported that the prevalence of OCD among schizophrenic patients ranges from 0% to 64% [54]. ...
Introduction
Obsessive-compulsive disorder (OCD) is a persistent psychiatric condition that causes significant clinical
and functional impairments. Recent research suggests a link between deficiencies in micronutrients,
particularly vitamin B12, folic acid, and elevated homocysteine, and the development of OCD. This study
investigates the blood levels of these micronutrients and their relationship to OCD severity, with an
emphasis on potential gender differences.
Methods
This cross-sectional study included 300 drug-free OCD patients. Serum levels of vitamin B12, folic acid, and
homocysteine were measured using established biochemical methods. The Yale-Brown Obsessive
Compulsive Scale (Y-BOCS) was used to assess clinical severity. Data were examined to determine
relationships between micronutrient levels and OCD severity and differences between male and female
patients.
Results
This study found that women had higher levels of vitamin B12 (405.3 ± 15.1 vs. 360.4 ± 14.3) and folic acid
(7.18 ± 0.27 vs. 5.76 ± 0.25) but lower levels of homocysteine (9.35 ± 0.64 vs. 14.4 ± 0.60) compared to men.
Higher folic acid levels were linked to study participants having higher levels of education (at a college or
university, where subjects are studied at an advanced level) compared to those with primary-level education.
Lower vitamin B12 levels were linked to family mental health history and noncommunicable diseases.
Women exhibited lower levels of substance use but higher rates of self-harm and suicide attempts. Elevated
homocysteine levels were linked to longer illness duration and more severe OCD symptoms.
Conclusion
These findings suggest that imbalances in micronutrients, particularly vitamin B12, folic acid, and
homocysteine, may contribute to OCD severity and treatment resistance. Gender-specific variations in
micronutrient levels could provide valuable insights into personalized OCD therapy choices. Further
longitudinal studies are needed to understand these relationships and their potential as therapeutic targets
... In addition, as the risk of suicide is increased in patients with depression, continuous monitoring of depressive symptoms and suicidal ideation is required when treating OCD. There is also a possibility that patients with severe depression and lower motivation in performing daily activities may be hampered in their ability to engage in OCD treatment [39]. Hence, the treatment of adolescents with co-morbid conditions requires a multi-pronged approach. ...
Background: Depression is the most common mental illness in the world, found in nearly three in ten adolescents globally. This study aims to evaluate the prevalence of antidepressant prescriptions and the types of antidepressant therapy administered among adolescents diagnosed with depression in Germany. Methods: This retrospective cohort study, based on data provided by 30 child and adolescent psychiatrists, included adolescents aged 13–17 years with an initial diagnosis of depression between 2010 and 2022 (index date) documented in the IQVIATM Disease Analyzer database. Kaplan–Meier curves were used to investigate the one-year cumulative incidence of antidepressant prescriptions stratified by age, sex, and depression severity. Multivariable Cox regression analyses were used to assess the association between age, sex, depression severity, co-diagnoses, and antidepressant drug prescription. Results: A total of 6338 adolescents (mean age: 16 years, 67% female, 59% with moderate depression) were available. The cumulative incidence of antidepressant prescriptions was 61% and increased with age from 13 years old to 17 years old. Fluoxetine was the most prescribed drug, followed by Sertraline, Escitalopram, Serotonin and Norepinephrine reuptake inhibitors, herbal medications, and Mirtazapine. Obsessive–compulsive disorder and eating disorders were found to be significantly associated with antidepressant prescriptions within the spectrum of co-diagnosed conditions. Conclusions: Higher age, depression severity, and a co-diagnosis of an obsessive–compulsive disorder or eating disorder were significantly positively associated with antidepressant prescriptions in adolescents. Fluoxetine was the most frequently prescribed drug for depression.
... Previous studies have shown that obsessive-compulsive symptoms and functional impairment are more severe in OCD patients with depressive symptoms compared with those without depressive symptoms (6). Additionally, OCD patients with depressive symptoms are less likely to progress in treatment, have a prolonged illness duration, and are at greater risk of suicide (5,7). Therefore, additional research is urgently needed to improve our understanding of the neural mechanisms of depressive symptoms in OCD patients. ...
Objectives
Depressive symptoms are the most prevalent comorbidity in individuals with obsessive-compulsive disorder (OCD). The objective of this study was to investigate the dynamic characteristics of resting-state neural activities in OCD patients with depressive symptoms.
Methods
We recruited 29 OCD patients with depressive symptoms, 21 OCD patients without depressive symptoms, and 27 healthy controls, and collected data via structural and functional magnetic resonance imaging (fMRI). We analyzed the fMRI results using the dynamic amplitude of low-frequency fluctuation (dALFF) and support vector machine (SVM) techniques.
Results
Compared with OCD patients without depressive symptoms, OCD patients with depressive symptoms exhibited an increased dALFF in the left precuneus and decreased dALFF in the right medial frontal gyrus. The SVM indicated that the integration of aberrant dALFF values in the left precuneus and right medial frontal gyrus led to an overall accuracy of 80%, a sensitivity of 79%, and a specificity of 100% in detecting depressive symptoms among OCD patients.
Conclusion
Therefore, our study reveals that OCD patients with depressive symptoms display neural activities with unique dynamic characteristics in the resting state. Accordingly, abnormal dALFF values in the left precuneus and right medial frontal gyrus could be used to identify depressive symptoms in OCD patients.
... The comorbidity of depression in treatment-seeking samples of patients with OCD is the norm rather than the exception [56,57]. MDD usually develops in the course of OCD, secondary to OCS [56,58]. It remains unclear, however, whether the high prevalence of depression among OCD patients can be attributed to the burden of OCS alone (the so-called 'demoralization syndrome' characterized by helplessness, hopelessness, meaningless, and inability to cope caused by a situation the individual is in [59]) or to common risk factors for both disorders [50]. ...
Introduction:
Obsessive-compulsive disorder (OCD) is a debilitating psychiatric disorder that affects a significant number of individuals worldwide. Major depressive disorder (MDD) is among the most common comorbidities reported in people with OCD. The emergence of MDD in individuals with OCD can be attributed to the increased severity of OCD symptoms and their profound impact on daily functioning. Depressive symptoms can also modify the course of OCD.
Areas covered:
In this review, the authors explore potential shared neurobiological mechanisms that may underlie both OCD and MDD, such as disturbed sleep patterns, immunological dysregulations, and neuroendocrine changes. Furthermore, they address the challenges clinicians face when managing comorbid OCD and MDD. The authors also discuss a range of treatment options for OCD associated with MDD, including augmentation strategies for serotonin reuptake inhibitors (e.g. aripiprazole), psychotherapy (especially CBT/EPR), transcranial magnetic stimulation (TMS), electroconvulsive therapy (ECT), and deep brain stimulation (DBS).
Expert opinion:
Although there is no 'rule of thumb' or universally acceptable strategy in the treatment of OCD comorbid with MDD, many clinicians, including the authors, tend to adopt a unique transdiagnostic approach to the treatment of OCD and related disorders, focusing on strategies known to be effective across diagnoses. Nevertheless, the existing 'cisdiagnostic approaches' still retain importance, i.e. specific therapeutic strategies tailored for more severe forms of individual disorders.
Purpose of Review
We aimed to investigate the recent understanding of the frequent coexistence of obsessive-compulsive disorder (OCD) and major depression (MDD), exploring both clinical and mechanistic perspectives. Our focus was on deriving conclusions with therapeutic implications.
Recent Findings
While biological factors contribute to the development of OCD-MDD, the comorbidity seems to be primarily induced by the convergence of symptoms that complicate the course of OCD. Tailored cognitive-behavioral therapy programs, specifically addressing MDD, alongside SSRI medication, may prove beneficial for patients experiencing moderate to severe forms of this comorbidity.
Summary
The review underscores the significance of comorbidity from both diagnostic and therapeutic perspectives. However, existing research has yet to offer a clear understanding of the underlying mechanisms. Further research in the field, notably coming from network studies, could enrich our practice by helping to target specific dimensions that underly OCD-MDD comorbidity.
Adjustment disorder has three main subtypes: adjustment disorder with depressed mood, adjustment disorder with anxiety, and adjustment disorder with disturbance of conduct. The disorder is moderately heritable and has lifetime comorbidities with major depressive disorder (MDD), anxiety disorders, or risk-tolerant personality. However, it remains unclear whether the degrees of genetic correlations between adjustment disorder and other psychiatric disorders and intermediate phenotypes are similar or different to those between MDD, anxiety disorders or risk-tolerant personality and these other psychiatric disorders and intermediate phenotypes. To compare patterns of genetic correlations, we utilized large-scale genome-wide association study summary statistics for adjustment disorder-related disorders and personality trait, eleven other psychiatric disorders and fifteen intermediate phenotypes. Adjustment disorder had highly positive genetic correlations with MDD, anxiety disorders, and risk-tolerant personality. Among other psychiatric disorders, adjustment disorder, MDD, anxiety disorders and risk-tolerant personality were positively correlated with risks for schizophrenia (SCZ), bipolar disorder (BD), SCZ + BD, attention-deficit/hyperactivity disorder, and cross disorders. In contrast, adjustment disorder was not significantly correlated with risks for obsessive-compulsive disorder, Tourette syndrome, or posttraumatic stress disorder despite significant genetic correlations of MDD or anxiety disorders with these disorders. Among intermediate phenotypes, adjustment disorder, MDD, anxiety disorders, and risk-tolerant personality commonly had a younger age at first sexual intercourse, first birth, and menopause, lower cognitive ability, and higher rate of smoking initiation. Adjustment disorder was not genetically correlated with extraversion, although the related disorder and personality were correlated with extraversion. Only adjustment disorder was correlated with a higher smoking quantity. These findings suggest that adjustment disorder could share a genetic etiology with MDD, anxiety disorders and risk-tolerant personality trait, as well as have a disorder-specific genetic etiology.
Background:
Obsessive-compulsive disorder (OCD) is a debilitating illness with substantial morbidity. Although pharmacological and behavioral evidence-based treatments have shown efficacy, many patients remain unresponsive to this first-line care. Repetitive transcranial magnetic stimulation (rTMS) has shown significant promise for patients with treatment-refractory affective disorders. In response, we conducted a meta-analysis of randomized controlled trials (RCTs) to examine the therapeutic benefit of rTMS in patients with OCD and explore moderators of its treatment effects.
Methods:
PubMED (1997- December 31, 2022) and PsycInfo were searched for randomized sham-controlled trials of rTMS to treat OCD using the terms: "obsessive compulsive disorder" AND "transcranial magnetic stimulation" AND "randomized controlled trial". Clinical characteristics and effect sizes (ESs) were extracted from 25 RCTs (860 participants). A random effects model calculated the ES for treatment efficacy and treatment response using the clinician-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS).
Results:
Across RCTs, rTMS exhibited a moderate therapeutic effect (g=0.65) for OCD symptom severity and a three-fold increased likelihood of treatment response (RR=3.15) compared to sham conditions. Greater improvement in comorbid depression severity corresponded with greater treatment effects from rTMS on OCD symptom severity. Additionally, longer rTMS sessions and fewer overall sessions predicted greater clinical improvement.
Conclusions:
RTMS is moderately effective for reducing OCD symptom severity. It holds potential to serve as a therapeutic intervention, particularly for patients with OCD who have failed standard treatments and especially for those with comorbid depression. Further research is needed to optimize rTMS protocols and evaluate the long-term efficacy of rTMS for OCD.
The random intercept cross-lagged panel model (RI-CLPM) is rapidly gaining popularity in psychology and related fields as a structural equation modeling (SEM) approach to longitudinal data. It decomposes observed scores into within-unit dynamics and stable, between-unit differences. This paper discusses three extensions of the RI-CLPM that researchers may be interested in, but are unsure of how to accomplish: (a) including stable, person-level characteristics as predictors and/or outcomes; (b) specifying a multiple-group version; and (c) including multiple indicators. For each extension, we discuss which models need to be run in order to investigate underlying assumptions, and we demonstrate the various modeling options using a motivating example. We provide fully annotated code for lavaan (R-package) and Mplus on an accompanying website.
This article aims to provide a critical analysis of how much we know about the effectiveness of parental monitoring in preventing adolescent delinquency. First, it describes the historical developments in parental monitoring research. Second, it explains why it is uncertain whether causal inferences can be drawn from contemporary research findings on the link of parenting and adolescent problem behaviors. Third, it is empirically demonstrated, using Random-Intercept Cross-Lagged Models, how distinguishing between-person and within-person associations may alter or strengthen conclusions regarding the links of parental monitoring and adolescent disclosure with adolescent delinquency. Previously detected correlations between parental monitoring and adolescent delinquency were not present at the within-family level. However, there were significant associations between within-person fluctuations in disclosure and delinquency. Together, these models provide stronger evidence for a potential causal link between disclosure and delinquency, but also suggest that previously detected linkages of parental monitoring and delinquency can be explained by stable between-person differences rather than causal processes operating within families.
Obsessive-compulsive disorder (OCD) is difficult to treat, and more so when comorbid with major depressive disorder (MDD). The aim of the present case study was to examine effects of behavioral activation (BA) and pharmacotherapy with an adult with chronic comorbid OCD and MDD. BA aimed at increasing approach behaviors in life activities and decreasing avoidant and inactive behaviors. After 21 months of treatment at a community mental health clinic, OCD and MDD symptoms, including compulsive checking behaviors, were no longer at clinical levels. Symptom alleviation and psychological health improved in line with increases in activities of living such as self-care, domestic, social, and studying, and decreases in medications from a regimen of mood stabilizers and anxiolytics to a sole antidepressant. The participant was satisfied with treatment procedures and outcome. The results add to growing evidence of effective BA treatments for comorbid disorders that include depression. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
The cross-lagged panel model (CLPM) is believed by many to overcome the problems associated with the use of cross-lagged correlations as a way to study causal influences in longitudinal panel data. The current article, however, shows that if stability of constructs is to some extent of a trait-like, time-invariant nature, the autoregressive relationships of the CLPM fail to adequately account for this. As a result, the lagged parameters that are obtained with the CLPM do not represent the actual within-person relationships over time, and this may lead to erroneous conclusions regarding the presence, predominance, and sign of causal influences. In this article we present an alternative model that separates the within-person process from stable between-person differences through the inclusion of random intercepts, and we discuss how this model is related to existing structural equation models that include cross-lagged relationships. We derive the analytical relationship between the cross-lagged parameters from the CLPM and the alternative model, and use simulations to demonstrate the spurious results that may arise when using the CLPM to analyze data that include stable, trait-like individual differences. We also present a modeling strategy to avoid this pitfall and illustrate this using an empirical data set. The implications for both existing and future cross-lagged panel research are discussed. (PsycINFO Database Record
(c) 2015 APA, all rights reserved).
Depression is commonly co-morbid with obsessive-compulsive disorder (OCD). However, it is unknown whether depression is a functional consequence of OCD or whether these disorders share a common genetic aetiology. This longitudinal twin study compared these two hypotheses. Method Data were drawn from a longitudinal sample of adolescent twins and siblings (n = 2651; Genesis 12-19 study) and from a cross-sectional sample of adult twins (n = 4920). The longitudinal phenotypic associations between OCD symptoms (OCS) and depressive symptoms were examined using a cross-lag model. Multivariate twin analyses were performed to explore the genetic and environmental contributions to the cross-sectional and longitudinal relationship between OCS and depressive symptoms.
In the longitudinal phenotypic analyses, OCS at time 1 (wave 2 of the Genesis 12-19 study) predicted depressive symptoms at time 2 (wave 3 of the Genesis 12-19 study) to a similar extent to which depressive symptoms at time 1 predicted OCS at time 2. Cross-sectional twin analyses in both samples indicated that common genetic factors explained 52-65% of the phenotypic correlation between OCS and depressive symptoms. The proportion of the phenotypic correlation due to common non-shared environmental factors was considerably smaller (35%). In the adolescent sample, the longitudinal association between OCS at time 1 and subsequent depressive symptoms was accounted for by the genetic association between OCS and depressive symptoms at time 1. There was no significant environmental association between OCS and later depressive symptoms.
The present findings show that OCS and depressive symptoms co-occur primarily due to shared genetic factors and suggest that genetic, rather than environmental, effects account for the longitudinal relationship between OCS and depressive symptoms.
Objective:
To examine symptom change over time, the effect of attrition on treatment outcome, and the putative mediators of cognitive therapy (CT) versus behavior therapy (BT) for obsessive-compulsive disorder (OCD) using archival data.
Method:
Sixty-two adults with OCD were randomized to 20 sessions of CT (N = 30) or BT (N = 32) that consisted of 4 weeks of intensive treatment (16 hr total) and 12 weeks of maintenance sessions (4 hr). Independent evaluators assessed OCD severity using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at baseline and at Weeks 4, 16 (posttreatment), 26, and 52 (follow-up). Behavioral avoidance, depressive symptoms, and dysfunctional beliefs regarding responsibility were also measured at each assessment. Study hypotheses were tested using multilevel modeling.
Results:
The slope of change in Y-BOCS scores was significantly greater in BT than in CT (d = 0.69), and those receiving BT had lower Y-BOCS scores at the final assessment than those receiving CT (d = 1.17). The greater slope of change in BT versus CT did not differ for dropouts versus completers. Reduction in depressed mood mediated changes in Y-BOCS across the 2 treatments, but a reduction in sense of responsibility and a decrease in avoidance did not. Instead, Y-BOCS improvements appeared to precede a decrease in avoidance.
Conclusions:
BT may have some therapeutic advantage over CT in the treatment of OCD, and this advantage does not appear to be due to a differential pattern of responding for treatment dropouts versus completers. Further, inconsistent with hypotheses, improvements in OCD symptoms were mediated by reductions in depressed mood instead of decreases in avoidance and responsibility. Theoretical, methodological, and clinical implications are discussed.
Obsessive–compulsive disorder (OCD) is a neuropsychiatric disorder affecting approximately 1–3% of the population. OCD is probably an etiologically heterogeneous condition. Individuals with OCD frequently have additional psychiatric disorders concomitantly or at some time during their lifetime. Recently, some authors proposed an OCD sub-classification based on comorbidity. An important issue in assessing comorbidity is the fact that the non-response to treatment often involves the presence of comorbid conditions. Non-responsive patients are more likely to meet criteria for comorbid axis I or axis II disorders and the presence of a specific comorbid condition could be a distinguishing feature in OCD, with influence on the treatment adequacy and outcome.
Although obsessive-compulsive disorder (OCD) is typically described as a chronic condition, relatively little is known about the naturalistic, longitudinal course of the disorder. The purpose of the current study was to examine the probability of OCD remission and recurrence as well as to explore demographic and clinical predictors of remission.
This study uses data from the Harvard/Brown Anxiety Disorders Research Program, which is a prospective, naturalistic, longitudinal study of anxiety disorders. Diagnoses were established by means of a clinical interview at study intake. One hundred thirteen Harvard/Brown Anxiety Disorders Research Program participants with OCD were included in the study; all had a history of at least 1 other anxiety disorder. Assessments were conducted at 6-month and/or annual intervals during 15 years of follow-up.
Survival analyses showed that the probability of OCD remission was .16 at year 1, .25 at year 5, .31 at year 10, and .42 at year 15. For those who remitted from OCD, the probability of recurrence was .07 at year 1, .15 by year 3, and by year 5, it reached .25 and remained at .25 through year 15. In predictors of course, those who were married and those without comorbid major depressive disorder (MDD) were more likely to remit from OCD. By year 15, 51% of those without MDD remitted from OCD compared to only 20% of those with MDD.
In the short term, OCD appears to have a chronic course with low rates of remission. However, in the long term, a fair number of people recover from the disorder, and, for those who experience remission from OCD, the probability of recurrence is fairly low.
Despite significant advances in the study of obsessive-compulsive disorder (OCD), important questions remain about the disorder's public health significance, appropriate diagnostic classification, and clinical heterogeneity. These issues were explored using data from the National Comorbidity Survey Replication, a nationally representative survey of US adults. A subsample of 2073 respondents was assessed for lifetime Diagnostic and Statistical Manual of Mental Disorders, 4th edn (DSM-IV) OCD. More than one quarter of respondents reported experiencing obsessions or compulsions at some time in their lives. While conditional probability of OCD was strongly associated with the number of obsessions and compulsions reported, only small proportions of respondents met full DSM-IV criteria for lifetime (2.3%) or 12-month (1.2%) OCD. OCD is associated with substantial comorbidity, not only with anxiety and mood disorders but also with impulse-control and substance use disorders. Severity of OCD, assessed by an adapted version of the Yale-Brown Obsessive Compulsive Scale, is associated with poor insight, high comorbidity, high role impairment, and high probability of seeking treatment. The high prevalence of subthreshold OCD symptoms may help explain past inconsistencies in prevalence estimates across surveys and suggests that the public health burden of OCD may be greater than its low prevalence implies. Evidence of a preponderance of early onset cases in men, high comorbidity with a wide range of disorders, and reliable associations between disorder severity and key outcomes may have implications for how OCD is classified in DSM-V.
To describe lifetime prevalence rates, course and comorbidity of obsessive-compulsive disorder (OCD), obsessive-compulsive syndromes (OCS) and OC-symptoms (OC-sx) up to age 41.
In the Zurich community cohort study 591 subjects were selected after screening at the age of 19 and studied prospectively by 6 interviews from 20 to 40; they represent 1599 subjects of the normal population. The diagnoses of OCD met DSM-IV criteria. Course was assessed by graphic illustrations and prospective data.
The lifetime prevalence rate was 3.5 % for OCD (males 1.7%, females 5.4 %) and 8.7 % for OCS (males 9.9%, females 7.5 %). The onset of OC-sx was 18 years (median); and in 70% before age 20. OCD was treated in one third of cases, OCS in 6.1%. The course of symptoms was chronic in 60%,but OCD and OCS showed in most cases considerable improvements over time. OCD reduced quality of life mostly in the subject's psychological wellbeing and at work but to a considerable extent also in other social roles. Comorbidity was prominent with bipolar disorder, panic disorder and social phobia and also significant with bulimia, binge eating, generalized anxiety disorder and suicide attempts; there was no association with substance abuse/dependence.
OCD and OCD are manifestations of a wide spectrum of severity with high prevalence and strong clinical validity. The long-term course is better than generally assumed.
Pharmacological treatment is a mainstay of the care of individuals with obsessive-compulsive disorder. Robust evidence supports the use of the selective serotonin reuptake inhibitors and the older tricyclic drug clomipramine. Other antidepressants are less effective (or have been insufficiently studied). When first-line treatment with these agents, and with appropriate psychotherapy, is ineffective, several augmentation strategies are available, though their evidentiary support is weaker. A substantial minority of patients have persistent symptoms despite optimal evidence-based treatment. Further work and more treatment options are needed.
Background and objectives
We know little about how symptoms of obsessive-compulsive disorder and depression interact during psychological therapy. Although some previous research suggests that reductions in the severity of depression are driven by reductions in OCD, support for this conclusion is limited due to the exclusion of individuals with severe depression and limitations of the statistical approaches used.
Methods
This study re-examined the interaction between symptoms of OCD and depression during therapy in a sample of 137 adults with a primary diagnosis of OCD and a full range of depression severity. All participants received a 12 to 16-week specialist residential treatment. Participants completed the Florida Obsessive Compulsive Inventory and Patient Health Questionnaire for depression weekly. The relationship between severity of OCD and depression was examined using a random intercept cross-lagged panel model.
Results
Both cross-lagged paths were significant, with prior levels of OCD influencing subsequent levels of depression, and prior levels of depression influencing subsequent levels of OCD.
Limitations
The present study was conducted in a residential setting, meaning the findings may not generalise to outpatient settings characterised by less severe OCD and depression.
Conclusions
Contrary to previous findings, which suggest that the influence of OCD on depression is far greater than the reverse, our findings suggest that OCD and depression influence each other equally. As improvements in mood can help to improve symptoms of OCD, it appears important to target depression concurrently during treatment for OCD. This would be a new treatment target for improvement outcomes in OCD.
Background
Obsessive compulsive disorder (OCD) and depression commonly co-occur. Past research has evaluated underlying mechanisms of depression in the context of other diagnoses, but few to no studies have done this within OCD.
Aims
This study examines the relationships between distress tolerance (DT), experiential avoidance (EA), depression, and OCD symptom severity across intensive/residential treatment (IRT) for OCD. It was hypothesized that all variables would be significantly moderately related and EA would emerge as a potential contributing factor to change in depression and OCD symptoms across IRT for OCD.
Method
The sample included 311 participants with a primary diagnosis of OCD seeking IRT. Correlations were performed between all variables at both admission and discharge. A two-step hierarchical regression with change in OCD symptoms and change in DT in the first block and change in EA in the second block examined if change in EA explained change in depression above and beyond change in OCD and DT ability.
Results
At both admission and discharge, higher EA, lower DT, and higher OCD symptom severity were significantly associated with more depressive symptoms. Change in EA explained a significant amount of variance in change in depression above and beyond change in OCD symptom severity and change in DT.
Conclusions
This study expands past results within an OCD sample, emphasizing EA as an important treatment target in OCD. Future studies could utilize samples from other treatment contexts, use a measure of EA specific to OCD, and utilize a longitudinal model that takes temporal precedence into account.
Background:
Depression is the most common comorbidity in obsessive-compulsive disorder (OCD). However, the mechanisms of depressive comorbidity in OCD are poorly understood. We assessed the directionality and moderators of the OCD-depression association over time in a large, prospective clinical sample of OCD patients.
Methods:
Data were drawn from 382 OCD patients participating at the Netherlands Obsessive-Compulsive Disorder Association (NOCDA) study. Cross-lagged, structural equation modeling analyses were used to assess the temporal association between OCD and depressive symptoms. Assessments were conducted at baseline, two-year and four-year follow up. Cognitive and interpersonal moderators of the prospective association between OCD and depressive symptoms were tested.
Results:
Cross-lagged analyses demonstrated that OCD predicts depressive symptoms at two-year follow up and not vice a versa. This relationship disappeared at four-year follow up. Secure attachment style moderated the prospective association between OCD and depression.
Conclusions:
Depressive comorbidity in OCD might constitute a functional consequence of the incapacitating OCD symptoms. Both OCD and depression symptoms demonstrated strong stability effects between two-year and four-year follow up, which may explain the lack of association between them in that period. Among OCD patients, secure attachment represents a buffer against future depressive symptoms.
Objective:
Despite the frequent occurrence of depressive symptoms in obsessive-compulsive disorder (OCD), little is known about the reciprocal influence between depressive and obsessive-compulsive symptoms during the course of the disease. The aim of the present study is to investigate the longitudinal relationship between obsessive-compulsive and depressive symptoms in OCD patients.
Method:
We used the baseline and 1-year follow-up data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. In 276 patients with a lifetime diagnosis of obsessive-compulsive disorder, depressive and obsessive-compulsive symptoms were assessed at baseline and at one-year follow-up with the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) scale. Relations were investigated using a cross-lagged panel design.
Results:
The association between the severity of depressive symptoms at baseline and obsessive-compulsive symptoms at follow-up was significant (β=0.244, p<0.001), while the association between the severity of obsessive-compulsive symptoms at baseline and depressive symptoms at follow-up was not (β=0.097, p=0.060). Replication of the analyses in subgroups with and without current comorbid major depressive disorder (MDD) and subgroups with different sequence of onset (primary versus secondary MDD) revealed the same results.
Limitations:
There may be other factors, which affect both depressive and obsessive-compulsive symptoms that were not assessed in the present study.
Conclusion:
The present study demonstrates a relation between depressive symptoms and the course of obsessive-compulsive symptoms in OCD patients, irrespective of a current diagnosis of MDD and the sequence of onset of OCD and MDD.
• The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessivecompulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's α coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
Obsessive-compulsive disorder (OCD) affects up to 2.5% of the population of the course of a lifetime and produces substantial morbidity. Approximately 70% of patients can experience significant symptomatic relief with appropriate pharmacotherapy. Selective serotonin reuptake inhibitors are the mainstay of pharmacological treatment. These drugs are typically used at higher doses and for longer periods than in depression. Proven second-line treatments include the tricyclic clomipramine and the addition of low-dose neuroleptic medications. OCD refractory to available treatments remains a profound clinical challenge.
Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD.
A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation.
Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05).
The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder.
This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
Although comorbid depression is a predictor of poor treatment response in obsessive-compulsive disorder (OCD), there is limited understanding of factors that contribute to depression severity in OCD. The current study examines the influence of OCD-related factors (autogenous obsessions and obsessional beliefs) and non-specific factors (avoidance and anxiety) on depression severity in a sample of OCD patients. There were 56 participants with only OCD and 46 with OCD and comorbid depression. Self-report questionnaires measuring depression, OCD-related factors, and non-specific factors were completed. Although there were no significant differences between the two groups on these variables, depression severity was positively correlated with anxiety, avoidance, obsessional beliefs, and autogenous obsessions in the whole sample. When entered into a multiple regression model to predict depression severity, these factors accounted for 51% of the variance. While OCD-related factors remained significant predictors after controlling for non-specific factors, the non-specific factors made the most significant contributions to the model. Our findings suggest that in addition to dealing with autogenous obsessions, addressing anxiety and avoidance might lead to improvements in the treatment of OCD with comorbid depression.
This study examined differences in clinical presentation and functional impairment in youth with obsessive-compulsive disorder (OCD) with or without comorbid depressive disorders and sought to determine the predictors of youth-reported depressive symptoms. One-hundred and sixty youth were reliably diagnosed with OCD and comorbid disorders using the Anxiety Disorders Interview Schedule for DSM-IV: Parent version (Silverman and Albano, 1996) and confirmed by an experienced clinician. Sixteen percent (n = 25) had a comorbid diagnosis of a current depressive disorder (DD). Significantly more females than males had a DD. Those with a DD showed increased OCD symptom severity, OCD-related functional impairment, and family accommodation relative to those without a comorbid DD. Depressive symptoms were significantly positively correlated with years of age, degree of OCD symptom severity, measures of OCD-related functional impairment, and non-OCD anxiety symptoms. Hierarchical regression analyses showed that age, gender, functional impairment, and non-OCD anxiety were significant predictors of depressive symptoms, even when OCD symptom severity was controlled. Notably, functional impairment was a partial mediator of the relationship between OCD symptom severity and depression levels, suggesting depression levels are the product of both degree of symptoms and amount of day-to-day impairment. Results are discussed in terms of implications for assessment and treatment.
The identification of distinct subtypes based on comorbidity offers potential utility in understanding variations in the clinical expression of obsessive-compulsive disorder (OCD). Hence, we examined the hypothesis whether patients with OCD with major depressive disorder (MDD) or anxiety disorder comorbidity would differ from those without in terms of phenomenology.
A total of 545 consecutive patients who consulted a specialty OCD clinic during the period 2004 to 2009 at a psychiatric hospital in India formed the sample. They were evaluated with the Yale-Brown Obsessive-Compulsive Scale (YBOCS), the Mini International Neuropsychiatric Interview, and the Clinical Global Impression scale.
Among 545 patients, 165 (30%) had current MDD, and 114 (21%) had current anxiety disorder comorbidity. Patients with OCD with MDD were mostly women who had a greater severity of OCD symptoms, more of obsessions (especially religious), greater occurrence of miscellaneous compulsions (need to confess or need to touch), higher suicidal risk, and past suicidal attempts. Patients with OCD with anxiety disorder had an earlier onset of illness that was associated with prior life events, less of compulsions, more of aggressive and hoarding obsessions, pathologic doubts, checking, and cognitive compulsions.
Obsessive-compulsive disorder, when comorbid with MDD, is more severe and is associated with higher suicidal risk. On the other hand, anxiety disorder comorbidity seems to influence not so much the morbidity but the phenotypic expression of OCD.
Many OCD patients present with comorbid conditions, and major depression is one of the most frequent comorbidities observed. OCD patients with comorbid depression exhibit functional disability and poor quality of life. However, it is unclear whether depressive symptoms are predictive of treatment response, and debate remains whether they should be targeted in the treatment of comorbid patients. The current study aimed at assessing the predictive value of depression and OCD symptoms in the long term outcome of OCD treatment.
In the current study, relations between OCD and depressive symptoms were systematically investigated in a group of 121 OCD patients who received 16 sessions of behavior or cognitive therapy either alone or with fluvoxamine.
Depression (either as a continuous or categorical variable) was not predictive of treatment response in any of the treatment modalities for up to 5 years of follow-up. Changes in OCD symptoms largely predicted changes in depressive symptoms but not vice versa.
Subsequent to participation in the RCT, almost two-thirds of the participants received some form of additional treatment (either pharmacological or psychological), and as a result, it is impossible to determine interaction effects with additional treatment received after the trial.
Treatment of OCD with comorbid depression should focus on amelioration of OCD symptoms. When OCD treatment is successful, depressive symptoms are likely to ameliorate as well.
The current study examined factors associated with obsessive-compulsive disorder (OCD) related functional impairment among 99 youth with OCD. A trained evaluator administered the Children's Yale-Brown Obsessive-Compulsive Scale, items assessing family accommodation, and a version of the Brown Assessment of Beliefs Scale that was modified for children. Youth completed the Child Obsessive-Compulsive Impact Scale-Child Version, Obsessive-Compulsive Inventory-Child Version, Multidimensional Anxiety Scale for Children, and Children's Depression Inventory-Short Form. The child's parent completed the Child Obsessive-Compulsive Impact Scale-Parent Version. Results indicated that OCD symptom severity, depressive symptoms, and family accommodation were directly related to impairment, while insight was inversely related to functional impairment. Insight, family accommodation, and depressive symptoms predicted parent- and/or child-rated functional impairment above and beyond OCD symptom severity. Among symptom dimensions, contamination/cleaning and aggressive/checking symptoms were the only dimensions significantly associated with impairment. Assessment and treatment implications are discussed; specifically, we highlight how the variables of interest may impact clinical presentation and treatment course.
To examine the efficacy of cognitive-behavioural therapy (CBT) for obsessive-compulsive disorder (OCD) in patients with comorbid major depressive disorder (MDD).
Participants (n = 29) diagnosed with comorbid OCD and MDD were randomized to receive standard CBT for OCD or integrated CBT that included an exclusive focus on treating MDD in the first phase of treatment and OCD in the second phase of treatment.
Both treatments resulted in statistically significant improvements in OCD and MDD symptoms. Treatment effects and recovery rates in the intent-to-treat sample were lower in both treatments, compared with past studies that excluded patients with MDD. However, among treatment completers, both treatments resulted in statistically significant and clinically meaningful improvements in OCD and MDD symptoms.
CBT holds promise as an efficacious treatment for people with comorbid OCD and MDD. The high treatment dropout rate with comorbid patients suggests that additional treatment strategies are required to enhance retention and optimize clinical outcomes.
Knowledge of the risk of recurrence after recovery of a major depressive disorder (MDD) is of clinical and scientific importance. The purpose of this paper was to provide a systematic review of the prevalence and predictors of recurrence of MDD.
Studies were searched in Medline en PsychINFO using the search terms 'recur*', 'relaps*', 'depress*', 'predict*' and course.
Recurrence of MDD in specialised mental healthcare settings is high (60% after 5 years, 67% after 10 years and 85% after 15 years) and seems lower in the general population (35% after 15 years). Number of previous episodes and subclinical residual symptoms appear to be the most important predictors. Gender, civil status and socioeconomic status seem not related to the recurrence of MDD.
Clinical factors seem the most important predictors of recurrence. Data from studies performed in the general population and primary care on the recurrent course of MDD are scarce.
The Yale-Brown Obsessive Compulsive Scale was designed to remedy the problems of existing rating scales by providing a specific measure of the severity of symptoms of obsessive-compulsive disorder that is not influenced by the type of obsessions or compulsions present. The scale is a clinician-rated, 10-item scale, each item rated from 0 (no symptoms) to 4 (extreme symptoms) (total range, 0 to 40), with separate subtotals for severity of obsessions and compulsions. In a study involving four raters and 40 patients with obsessive-compulsive disorder at various stages of treatment, interrater reliability for the total Yale-Brown Scale score and each of the 10 individual items was excellent, with a high degree of internal consistency among all item scores demonstrated with Cronbach's alpha coefficient. Based on pretreatment assessment of 42 patients with obsessive-compulsive disorder, each item was frequently endorsed and measured across a range of severity. These findings suggest that the Yale-Brown Scale is a reliable instrument for measuring the severity of illness in patients with obsessive-compulsive disorder with a range of severity and types of obsessive-compulsive symptoms.
While the Hamilton Rating Scale for Depression (HRSD) has been the standard instrument for the assessment of the severity of depression for many years, this scale has a number of limitations. We developed the Modified Hamilton Rating Scale for Depression (MHRSD) to overcome some of these limitations and to enable paraprofessional research assistants to make reliable and valid assessments of depressive symptoms. The present study investigates the reliability and validity of the MHRSD. Interrater reliability among paraprofessional research assistants was excellent. The relationship between the MHRSD and expert clinician ratings on the MHRSD and the original HRSD was also high. Thus, the MHRSD appears to be a useful addition to the clinical researcher's assessment battery.
Originally considered a rare disorder, obsessive compulsive disorder (OCD) has been shown to be quite common with a 1% point prevalence in many cultures. Comorbidity with other psychiatric disorders is common, with a lifetime history of major depression present in two thirds of OCD patients. This disorder also coexists with a number of other Axis I disorders including panic disorder, social phobia, eating disorders, and Tourette's disorder. Data collected on phenomenological subtypes have shown that most OC patients have multiple obsessions and compulsions. Another model for subtyping OC symptoms categorizes core features that underlie obsessions and compulsions. These core features such as abnormal risk assessment or incompleteness may be useful in identifying homogeneous subgroups that have distinct treatment responses. The presence of compulsions is helpful in distinguishing this disorder from other anxiety disorders as well as depression. The differential diagnosis of OCD is presented.
Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.
To explore clinical features of symptoms and comorbidity according to the age of onset of patients suffering from obsessive-compulsive disorder (OCD).
The survey involved collecting data from both patient members of an OCD association, and a sample of 175 OCD patients seen in OCD specialty practice. All the patients (n=617) responded to a questionnaire on family and personal psychiatric OCD history, phenomenological features of OCD and comorbidity. They were classified according to OCD age at onset [group early age of onset (EO): under 15, group late age of onset (LO): older than 15].
A higher percentage of patients from Group LO complained of OCD triggering by factors such as professional difficulties and childbirth (P<0.05); also they more often had (P=0.05) a sudden onset of symptoms. On the other hand, clinical features, such as superstition and magic thoughts, parasite obsessions and repeating, counting, hoarding, tapping/rubbing and collecting compulsions were significantly more frequent (P<0.05) in EO; likewise, history of tics was more frequent in this group. The existence of comorbid depression (at least one episode) did not show any significant difference between groups. However, depression preceding OCD was more frequent in LO. There was no significant difference in treatment response according to age of onset OCD.
The results showed a clear association of EO with obsessions of superstition and parasites, repetitive compulsions and motor and vocal tics, whereas a sudden onset, triggering factors and a more frequent depression preceding OCD characterized LO.
Many patients who have obsessive-compulsive disorder (OCD) also meet criteria for additional diagnoses such as mood, anxiety, and personality disorders. The presence of severe depression, and major depressive disorder per se, impedes response to treatment for OCD that uses the best available treatments. In this article, the comorbidity data in OCD are reviewed, then the relationship between depression and OCD treatment outcome is reviewed. Next, the derivation and implementation of a treatment program specifically for depressed OCD patients are illustrated with a case example. The article closes with a discussion of implications and directions gleaned from this single case study.
The present study examines the effect of concomitant major depressive or bipolar disorder on clinical symptoms of patients with obsessive-compulsive disorder (OCD). Forty-nine patients classified as OCD without a mood disorder, 26 classified as OCD with bipolar disorder (OCD-BD) and 42 classified as OCD with major depressive disorder (OCD-MDD) according to DSM-IV diagnostic criteria were included in the study. The groups were compared with respect to demographic variables and scores obtained on various scales. The OCD-BD group had more symmetry/exactness obsessions and ordering/arranging compulsions, and a more episodic course of illness and had better insight compared to the other two groups. Levels of anxiety, depression, disability and obsessive-compulsive symptom severity were significantly higher in the OCDMDD group. The rate of social phobia was higher in OCD-BD patients, whereas the rates of generalized anxiety disorder and simple phobias were higher in OCDMDD group. These findings suggest that comorbidity of major depressive disorder may increase the severity of OCD symptoms. On the other hand, bipolar disorder comorbidity may constitute a subgroup which is characterized by a higher rate of episodic course and better insight.
This article describes the method and intake findings of the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the naturalistic course of obsessive-compulsive disorder (OCD) in a large clinical sample using longitudinal research methodology.
Intake data, collected between June 2001 and October 2004, are presented for 293 adult participants in a prospective, naturalistic study of OCD. Participants had a primary diagnosis of DSM-IV OCD and had sought treatment for the disorder.
Our findings indicate that OCD typically has a gradual onset and a continuous course regardless of age at onset. There is a substantial lag between the onset of the disorder and initiation of treatment. OCD, which almost always coexists with other psychiatric symptoms, leads to serious social and occupational impairment. Compared with participants with late-onset OCD, early-onset participants had higher rates of lifetime panic disorder, eating disorders, and obsessive-compulsive personality disorder. The groups also differed on the types of obsessive-compulsive symptoms that were first noticed, as well as on rates of current obsessions and compulsions.
The demographics, clinical characteristics, comorbidity rates, and symptom presentation of the sample are consistent with those reported for cross-sectional studies of OCD, including the DSM-IV Field Trial. The current sample has a number of advantages over previously collected prospective samples of OCD in that it is large, diagnostically well characterized, recruited from multiple settings, and treatment seeking. This unique data set will contribute to the identification of meaningful phenotypes in OCD based on stability of symptom dimensions, prospective course patterns, and treatment response.
We aimed to investigate the correlates of major depressive disorder (MDD) occurring after the onset of obsessive-compulsive disorder (OCD).
Forty-three OCD patients who developed MDD after the onset of OCD (OCD-MDD group) and 67 OCD patients without MDD (non-MDD, NMDD group) were compared with regard to sociodemographic characteristics, clinical history, symptom severity, types of obsessions and compulsions, insight degree, comorbid axis I and axis II diagnosis and quality-of-life level.
The OCD-MDD group scored significantly higher on measures of obsessions, compulsions and depression severity than did the NMDD. Significantly more aggressive obsessions were identified in the OCD-MDD group than in the NMDD group. The OCD-MDD group was also significantly more likely than the NMDD group to have generalized anxiety disorder (GAD). There was no significant difference in the rate of personality disorders between the groups. The OCD-MDD group reported significantly lower levels of quality of life (QOL) in the domains of physical health, psychological health and social relationships. Depression severity was associated with obsession but not with compulsion severity. In a logistic regression model, obsession severity, presence of GAD and aggressive obsessions emerged as the factors associated with the occurrence of MDD.
To exclude ineligible patients, we gathered the information about past mood episodes cross-sectionally.
These results suggest that psychopathological processes mediated by specific obsessions as well as excessive anxiety and worries may render the neurocircuities more vulnerable to the development of MDD. The occurrence of MDD in OCD cannot sufficiently be explained as a secondary complication to the disability of OCD.
DSM-IV major depressive disorder (MDD) is a clinical syndrome notable for heterogeneity of its clinical presentation, genetics, neurobiology, clinical course, and treatment responsiveness. In an attempt to make sense of this heterogeneity, clinicians and researchers have proposed a number of MDD "subtypes" based on differences in characteristic symptoms (e.g., atypical, melancholic, psychotic), onset (e.g., early vs. late, post-partum, seasonal), course of illness (e.g., single vs. recurrent, chronic, double), and severity. This article provides a brief review of the status of several of the most common subtypes in terms of their clinical features, biological correlates, course of illness, and treatment implications.
Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition
- First
Obsessive-compulsive disorder: prevalence, comorbidity, impact, and help-seeking in the British national psychiatric morbidity survey of 2000
- Torres
Torres, A.R., Prince, M.J., Bebbington, P.E., Bhugra, D., Brugha, T.S., Farrell, M.,
Jenkins, R., Lewis, G., Meltzer, H., Singleton, N., 2006. Obsessive-compulsive
disorder: prevalence, comorbidity, impact, and help-seeking in the British national
psychiatric morbidity survey of 2000. Am. J. Psychiatr. 163 (11), 1978-1985.
https://doi.org/10.1176/ajp.2006.163.11.1978.
It's time to abandon the cross-lagged panel model
- R E Lucas
Lucas, R.E., 2022. It's time to abandon the cross-lagged panel model. https://doi.org/10
.31234/OSF.IO/PKEC7.
The epidemiology of obsessivecompulsive disorder in the national comorbidity survey replication
- A M Ruscio
- D J Stein
- W T Chiu
- R C Kessler
Ruscio, A.M., Stein, D.J., Chiu, W.T., Kessler, R.C., 2010. The epidemiology of obsessivecompulsive disorder in the national comorbidity survey replication. Mol. Psychiatr.
15 (1), 53-63. https://doi.org/10.1038/mp.2008.94.