Early onset of obsessive–compulsive disorder and associated comorbidity

Background: Previous studies have aimed to identify subtypes of obsessive–compulsive disorder (OCD) based on their age of onset (AOO). Obsessive–compulsive spectrum disorders (OCS disorders) such as tic disorders have been particularly associated with an early onset in some studies. However, subtypes of early‐ and late‐onset OCD are unevenly determined, and the biological and the clinical validity of these subtypes are unknown. This study was undertaken to discriminate the subtypes of OCD in different AOO levels and to test the hypothesis that different AOO bands are associated with a differential pattern of comorbidity. Methods: Two hundred fifty‐two patients with OCD were interviewed directly with the German version of the Schedule for Affective Disorders and Schizophrenia—Lifetime Anxiety Version, which provides DSM‐IV diagnosis. Subgroups with different ages of onset were investigated (cut‐off levels of 10, 15, and 18 years). Results: Subjects with an early AOO (onset ≤10 years) were significantly more likely to have OCS disorders (odds ratio [OR]=3.46; P =.001; 95% confidence interval [CI]: 1.72–6.96), in particular tic/Tourette's disorders (OR=4.63; P =.002; 95% CI: 1.78–12.05), than were late‐onset subjects. Conclusions: For most mental disorders (e.g., anxiety and mood disorders), no associations with AOO of OCD were identified. However, subjects in the early‐onset group (≤10 years) had a significant increase in comorbid tic and Tourette's disorders. Future research should examine potential neurobiological features associated with early‐onset presentations of OCD. Early detection and management of comorbidities may offset impairments later in life. Depression and Anxiety 26:1012–1017, 2009. © 2009 Wiley‐Liss, Inc.     

Correlates and mediators of functional disability in obsessive–compulsive disorder

Background: This study examined factors associated with obsessive–compulsive disorder (OCD) related functional disability in 87 treatment‐seeking adults with OCD. Methods: A trained evaluator administered the Yale‐Brown Obsessive–Compulsive Scale and Brown Assessment of Beliefs Scale. Patients completed the Sheehan Disability Scale, Obsessive–Compulsive Inventory‐Revised, Interpretation of Intrusions Inventory, Thought–Action Fusion Scale, Beck Depression Inventory Second Edition, and State Trait Anxiety Inventory‐Trait Version. Results: Results indicated that OCD symptoms, anxiety, depression, and the tendency to misinterpret the significance of intrusive thoughts were related to functional disability. Two variables—depressive symptoms and the extent to which a patient attempts to resist and is able to control OCD symptoms—emerged as unique predictors of functional disability. Mediational analyses indicated that both of these variables fully mediated the relationship between OCD‐related distress and functional disability. Conclusions: Results are discussed in terms of predictors of functional disability in OCD and in terms of implications for assessment and treatment. Depression and Anxiety, 2009. © 2009 Wiley‐Liss, Inc.     

Perceived parental rearing in subjects with obsessive–compulsive disorder and their siblings

Lennertz L, Grabe HJ, Ruhrmann S, Rampacher F, Vogeley A, Schulze‐Rauschenbach S, Ettelt S, Meyer K, Kraft S, Reck C, Pukrop R, John U, Freyberger HJ, Klosterkötter J, Maier W, Falkai P, Wagner M. Perceived parental rearing in subjects with obsessive–compulsive disorder and their siblings. Objective: Perceived parenting in patients suffering from obsessive–compulsive disorder (OCD) is examined. We attempted to overcome some methodological limitations of prior studies by taking age of onset, parental OCD and comorbid depression into consideration. In addition, we included data from unaffected siblings to corroborate information on parental rearing. Method: One hundred and twenty‐two cases with OCD and 41 of their siblings as well as 59 healthy controls and 45 of their siblings completed the German short‐version of the EMBU (FEE). Results: Obsessive–compulsive disorder cases reported less parental warmth and more parental rejection and control. Further analyses indicated that parenting is also associated with OCD in cases with late onset and cases without parents affected by OCD. OCD cases with comorbid depression described their parents particularly negatively. Data from siblings indicated good validity of perceived parenting in OCD. Conclusion: This study provides further evidence for dysfunctional child rearing being relevant to the development of OCD and depression.     

Ten‐year follow‐up study of Japanese patients with obsessive–compulsive disorder

Aim

Obsessive–compulsive disorder (OCD) is a well‐known chronic illness. This study retrospectively investigated 10‐year outcomes and associated clinical factors in Japanese OCD patients. We focused on the impact of several sociocultural factors, including medical expenses and insurance systems specific to each country, on the differences or biases in follow‐up procedures of OCD.

Methods

Seventy‐nine patients diagnosed with OCD who received a standardized combination of treatments for 10 continuous years were divided into three groups according to their improvement rates on the Yale–Brown Obsessive–Compulsive Scale after 10 years of treatment.

Results

A survival analysis revealed that the rate of patients achieving full remission increased every year. Following 10 years of treatment, 56% of OCD patients experienced ‘full remission’ for at least 1 year. Consequently, 48% exhibited full remission, and 37% exhibited partial remission at the end‐point of this study. We identified several factors that were predictive of poorer outcomes, including lower Global Assessment of Functioning Scale scores and the presence of hoarding symptoms or involvement behaviors. In addition, improvement rates after 1 year significantly predicted better 10‐year outcomes.

Conclusion

Our findings highlight the transcultural nature of long‐term outcomes of OCD treatment, which appear to be independent of sociocultural differences.

     

Etiology of obsessive–compulsive symptoms and obsessive–compulsive personality traits: common genes,mostly different environments

Background: Little is known about the etiologic relationship between obsessive–compulsive (OC) symptoms and traits of OC personality disorder. The traits include perfectionism and rigidity. Some theorists have proposed that OC personality disorder is one of several disorders falling within an OC spectrum. This implies that OC personality traits and symptoms should have etiologic factors in common, and this should not be simply because symptoms and traits are both shaped by nonspecific etiological influences, such as those shaping negative emotionality (neuroticism). Methods: To investigate these issues, a community sample of 307 pairs of monozygotic and dizygotic adult twins provided scores on six types of OC‐related symptoms, two markers of negative emotionality, and a measure of OC personality traits. Results: Analyses indicated that symptoms and traits arose from a combination of genetic and nonshared environmental factors. A matrix of genetic correlations was computed among the variables, which represented the correlations between the genetic components of pairs of variables. A matrix of environmental correlations was similarly computed. Each matrix was factor analyzed. One genetic factor was obtained, indicating that all variables were influenced by a common genetic factor. Three environmental factors were obtained, with salient loadings on either (a) all six OC symptoms, (b) negative emotionality and obsessing, or (c) OC personality traits and ordering. Conclusions: OC symptoms and traits were etiologically related primarily because they are shaped by the same nonspecific genetic factor that influenced negative emotionality. Implications for the concept of the OC spectrum are discussed. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Individual versus group cognitive behavioral treatment for obsessive–compulsive disorder: Follow up

Aim: To compare the effectiveness of two forms of cognitive behavioral treatment (CBT; group and individual) in a sample of patients with obsessive–compulsive disorder (OCD) at 6‐month and 12‐month follow up. Method: Thirty‐eight subjects meeting DSM‐IV‐TR OCD criteria completed 20 sessions of individual and group CBT. They were assessed using the Yale–Brown Obsessive–Compulsive Scale and the Hamilton Anxiety and Depression Scales at baseline, after treatment and at 6‐month and 12‐month follow up. Results: The clinical improvement obtained at the end of the treatment was maintained at 6‐month and 12‐month follow up. The clinical outcome of the individual treatment (IT) and the group treatment (GT) was the same. The dropout rates were significantly higher in women than in men, but were similar for IT and GT. Conclusions: CBT was effective in a sample of OCD patients. Individual and group CBT had similar results at 6‐month and 12‐month follow up. The clinical implications of these findings are discussed.     

The buildup of an urge in obsessive–compulsive disorder: Behavioral and neuroimaging correlates

Obsessive–compulsive disorder (OCD) is highly heterogeneous. While obsessions often involve fear of harm, many patients report uncomfortable sensations and/or urges that drive repetitive behaviors in the absence of a specific fear. Prior work suggests that urges in OCD may be similar to everyday “urges‐for‐action” (UFA) such as the urge to blink, swallow, or scratch, but very little work has investigated the pathophysiology underlying urges in OCD. In the current study, we used an urge‐to‐blink approach to model sensory‐based urges that could be experimentally elicited and compared across patients and controls using the same task stimuli. OCD patients and controls suppressed eye blinking over a period of 60 s, alternating with free blinking blocks, while brain activity was measured using functional magnetic resonance imaging. OCD patients showed significantly increased activation in several regions during the early phase of eyeblink suppression (first 30 s), including mid‐cingulate, insula, striatum, parietal cortex, and occipital cortex, with lingering group differences in parietal and occipital regions during late eyeblink suppression (last 30 s). There were no differences in brain activation during free blinking blocks, and no conditions where OCD patients showed reduced activation compared to controls. In an exploratory analysis of blink counts performed in a subset of subjects, OCD patients were less successful than controls in suppressing blinks. These data indicate that OCD patients exhibit altered brain function and behavior when experiencing and suppressing the urge to blink, raising the possibility that the disorder is associated with a general abnormality in the UFA system that could ultimately be targeted by future treatments.     

Executive control of attention in individuals with contamination‐related obsessive–compulsive symptoms

Background: In this study, we examined executive control of attention in individuals with contamination‐related obsessive–compulsive (OC) symptoms using a modified version of the Eriksen flanker task. The task indexes one's ability to resolve attentional conflict between different responses and to ignore task distracters. Methods: For this study, we modified the original flanker task using affective words to examine the effect of threat‐relevant stimuli on executive control of attention. Consistent with research on information processing biases in individuals with OC symptoms, we hypothesized that the flanker interference effect (i.e., difference in response latencies between incongruent and congruent flanker trials) will be greater for threat‐related flankers in individuals with OC symptoms (n=32), relative to a control group (n=36). Results: Results of our study were consistent with our hypothesis: The interference effect for threat flankers was greater in individuals with OC symptoms than in those low in symptoms. Moreover, there was no differential interference effect in the low and high symptom groups for neutral flankers. Conclusions: These findings suggest that the presence of threat‐relevant distracters disrupts executive control of attention in individuals with contamination‐related OC symptoms. These results are consistent with extant research on attentional biases in individuals with clinical and subclinical symptoms of OCD. Depression and Anxiety, 2010. © 2010 Wiley‐Liss, Inc.     

Potential role of anticonvulsants in the treatment of obsessive–compulsive and related disorders

We reviewed the extant literature to evaluate the current evidence regarding the efficacy and safety of anticonvulsants in the treatment of obsessive–compulsive and related disorders. Relevant literature was accessed using the Cochrane database, embase and PubMed on 29 October 2013. Prospective studies examining the efficacy of anticonvulsants in obsessive–compulsive and related disorders were included. Case reports, case series, and retrospective studies were excluded. A total of 10 studies were included in this review. The studies of obsessive–compulsive disorder, except for two negative studies, showed favorable efficacy results of anticonvulsants. In one study on body dysmorphic disorder, levetiracetam showed favorable efficacy. In two lamotrigine studies for pathologic skin‐picking, the efficacy findings were inconsistent. In one trichotillomania study, topiramate had reduced hair‐pulling symptoms. Despite limited evidence, our review suggests that anticonvulsants have a potential role in the treatment of obsessive–compulsive and related disorders.     

Neurobiological model of obsessive–compulsive disorder: Evidence from recent neuropsychological and neuroimaging findings

Obsessive–compulsive disorder (OCD) was previously considered refractory to most types of therapeutic intervention. There is now, however, ample evidence that selective serotonin reuptake inhibitors and behavior therapy are highly effective methods for treatment of OCD. Furthermore, recent neurobiological studies of OCD have found a close correlation between clinical symptoms, cognitive function, and brain function. A large number of previous neuroimaging studies using positron emission tomography, single‐photon emission computed tomography or functional magnetic resonance imaging (fMRI) have identified abnormally high activities throughout the frontal cortex and subcortical structures in patients with OCD. Most studies reported excessive activation of these areas during symptom provocation. Furthermore, these hyperactivities were decreased after successful treatment using either selective serotonin reuptake inhibitors or behavioral therapy. Based on these findings, an orbitofronto‐striatal model has been postulated as an abnormal neural circuit that mediates symptomatic expression of OCD. On the other hand, previous neuropsychological studies of OCD have reported cognitive dysfunction in executive function, attention, nonverbal memory, and visuospatial skills. Moreover, recent fMRI studies have revealed a correlation between neuropsychological dysfunction and clinical symptoms in OCD by using neuropsychological tasks during fMRI. The evidence from fMRI studies suggests that broader regions, including dorsolateral prefrontal and posterior regions, might be involved in the pathophysiology of OCD. Further, we should consider that OCD is heterogeneous and might have several different neural systems related to clinical factors, such as symptom dimensions. This review outlines recent neuropsychological and neuroimaging studies of OCD. We will also describe several neurobiological models that have been developed recently. Advanced findings in these fields will update the conventional biological model of OCD.     

Abnormalities of hippocampal shape and subfield volumes in medication‐free patients with obsessive–compulsive disorder

In this study, we sought to identify alterations of hippocampal shape and subfield volumes in a relatively large sample of medication‐free obsessive–compulsive disorder (OCD) patients without comorbid depression. 3D T1‐weighted Magnetic Resonance Imaging scans were collected from 81 medication‐free OCD patients and 95 age‐ and sex‐matched healthy controls (HC). Total hippocampal volume and volume of eight bilateral subfields were measured using FreeSurfer software. Subregional shape deformity was examined via FSL software. Volumetric and shape differences between groups and correlations with OCD symptoms were examined. The volume of right hippocampus was significantly reduced in OCD patients (p = .001, η² = 0.065). Follow‐up analysis of right hemisphere subfields showed reduced volume in right subiculum (p < .001, η² = 0.081), presubiculum (p < .001, η² = 0.125), CA2/3 (p = .001, η² = 0.06), and hippocampal tail (p < 0.001, η² = 0.105), while the volume of right fimbria was increased (p = .001, η² = 0.058). Shape analysis revealed a bilateral outward bending in the hippocampal body related to a lateral displacement of hippocampus from the body to the tail. Symptom severity was correlated with volumes of presubiculum (with compulsions, r = ?0.25, p = .024) and fimbria (with obsessions, r = ?0.28, p = .012), and with the lateral shift of middle and posterior hippocampus (with obsessions). Alterations across hippocampal subfields and overall shape may contribute to the distinctive cognitive and affective abnormalities associated with OCD.