Predictors of course in obsessive compulsive disorder

Systematic studies of course of illness in obsessive compulsive disorder (OCD) using standardized diagnostic criteria are relatively rare. In the present study, 100 patients diagnosed with OCD were prospectively followed for up to 5 years. Other comorbid conditions included anxiety disorders (76%), major depressive disorder (33%), and at least one personality disorder (33%), mainly in the anxious cluster. Approximately 20% of patients had full remission and 50% had partial remission during follow-up. Significant predictors of partial remission included being married and having lower global severity scores at intake; the presence of major depression was marginally predictive of poorer course. Adequate serotonergic medication was associated with worse course, but findings are likely spurious. Only marital status and global severity were retained as predictors in a final regression model. Findings are discussed with regard to sample characteristics and similarity to other reports on predictors of course and of treatment outcome.     

Evidence for successful implementation of exposure and response prevention in a naturalistic group format for pediatric OCD

Background: Although exposure and response prevention (ERP) is an effective treatment for youth with obsessive–compulsive disorder (OCD), the majority of studies, randomized clinical trials of individual therapy, find variability in treatment response. We evaluated the potential role of individual differences in OCD presentation, comorbid disorders, age, and gender on treatment effects. Moreover, we examined these potential effects in a group format in a naturalistic, clinic‐based sample of patients. Methods: Pediatric patients with a DSM‐IV diagnosis of OCD ( n =41) were treated with ERP in an intensive outpatient community‐based program. OCD, mood, and anxiety symptom severity was measured at baseline, during treatment, and at discharge. Trajectories and predictors of treatment outcome were measured using linear growth models. Results: We found that group‐based ERP was effective in reducing pediatric OCD symptom severity in a naturalistic treatment setting irrespective of age or gender. Furthermore, ERP was found to be effective at reducing depressive symptoms but not other anxiety symptoms. We also found inter‐individual variability in the discharge levels of contamination, symmetry, and intrusive sexual thoughts and in the rate of severity reduction of intrusive sexual thoughts. Conclusion: Group‐based ERP is an effective treatment for children and adolescents with OCD. Several factors, including symptom dimensions and comorbid psychopathology, are associated with treatment response and outcome in this pediatric population. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

The DRD4 gene and severity of tics and comorbid symptoms: Main effects and interactions with delivery complications

In this study, we investigated the role of the dopamine receptor D4 (DRD4) 48‐base pairs (bp) variable number of tandem repeats (VNTR) and perinatal adversities regarding severity of tics and comorbid symptoms in children with tic disorders. We genotyped 110 children with tics with regard to the 48‐bp VNTR and assessed presence of prenatal smoking exposure, and pregnancy and delivery complications by parent questionnaires. We examined associations between 2, 3, 4, and 7 repeat (R) alleles and severity of tics and comorbid obsessive‐compulsive, depressive, anxious, and autistic symptoms. Through linear regressions, we investigated whether perinatal adversities and the 2R, 3R, 4R, and 7R alleles would interact with severity ratings of tics or comorbid symptoms as outcome. Presence of a 2R allele was related to more severe obsessive–compulsive symptoms, and presence of a 3R allele to increased severity of autistic features. Pregnancy complications were associated with decreased obsessive–compulsive symptom severity, and prenatal smoking exposure to more severe depressive and autistic symptoms. In children without a 3R allele delivery complications were associated with more severe tics, but in children with a 3R variant an inverse relation between delivery complications and tic severity was found. Moreover, the relation between delivery complications and internalizing symptom severity appeared to be most pronounced in children with a 2R allele. In conclusion, this study provides evidence for a role of the 48‐bp VNTR in the etiology of tic and associated disorders, and for interactions with delivery complications regarding severity of tics and co‐occurring internalizing symptoms. © 2010 Movement Disorder Society     

Prospective Relationship Between Obsessive–Compulsive and Depressive Symptoms During Multimodal Treatment in Pediatric Obsessive–Compulsive Disorder

The present study examined the prospective relationship between obsessive–compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive–compulsive disorder (OCD). Participants included fifty-six youth, aged 7–17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive–compulsive severity was measured using the Children’s Yale-Brown Obsessive–Compulsive Scale, and depressive symptoms were rated using the Children’s Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive–compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive–compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.     

Experiential avoidance and emotion regulation difficulties in hoarding disorder

Experiential avoidance can be defined as the tendency to avoid contact with unwanted internal experiences. Current conceptualizations of pathological hoarding appear broadly consistent with an experiential avoidant model. Eighty participants in four groups, namely hoarding disorder (HD) without comorbid obsessive–compulsive disorder (OCD), HD with comorbid OCD, non-hoarding OCD, and healthy controls, were administered measures of experiential avoidance and emotion regulation difficulties. Hoarding individuals reported higher levels of experiential avoidance and difficulties in emotion regulation compared to healthy but not to OCD participants. Both experiential avoidance and emotion regulation difficulties were significantly more prominent when HD was comorbid with OCD than when HD occurred without comorbid OCD. Correlation analyses further showed that both experiential avoidance and emotion regulation were moderately but significantly associated with obsessive–compulsive but not hoarding symptoms. Thus, experiential avoidance and emotion regulation difficulties are not specifically relevant to HD but to a broad range of psychopathologies. However, despite the lack of specificity, the findings raise some potentially useful clinical implications for the treatment of HD.     

Clinical correlates of quality of life in Tourette syndrome

Tourette syndrome (TS) is a neurodevelopmental disorder involving tics, which is frequently accompanied by comorbid obsessive compulsive (OCD) or attention deficit hyperactivity disorder (ADHD). Individuals with TS often report poor quality of life (QoL) in comparison with the general population. This study investigated the clinical correlates of QoL in young people with TS using a self‐report multidimensional QoL measure, and a range of clinical scales used to assess tic severity and the symptoms of anxiety, depression, OCD, ADHD and other emotional and behavioral symptoms. Symptoms of depression, OCD, and ADHD appeared to have a widespread negative impact on QoL, but poorer QoL was not associated with increased tic severity. Greater emotional and behavioral difficulties, including symptoms of OCD, were among the best predictors of poor QoL in young people with TS. © 2010 Movement Disorder Society     

Obsessive compulsive symptoms are related to lower quality of life in patients with Schizophrenia

Background. The aim of this study is to investigate the effects of obsessive–compulsive symptoms (OCS) on quality of life (QoL) and to identify the OCS with a particular effect on QoL, and whether there are any such symptoms for patients with schizophrenia. Methods. We studied three groups of patients with schizophrenia. One group of patients (n = 45) without OCS or obsessive–compulsive disorder (OCD), one group with OCS, not fulfilling the diagnostic criteria for OCD (n = 31), and one group with OCD as a comorbid condition (n = 24). Severity of clinical symptoms was evaluated with the Positive and Negative Symptom Scale and OCS was examined using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Symptom Checklist. We also administered the Y-BOCS. The patients’ QoL was assessed using the Quality of Life Scale (QLS). Results. QLS interpersonal relationships subscale scores of those with OCS were lower than those without OCS. There was no difference among OCS, non-OCS, and OCD groups in terms of QoL. There was no relationship between QLS scores and symmetry, contamination and causing harm obsessions, but those with cleaning and repeating compulsions had lower QoL. Conclusions. Questioning of comorbid OCS and treatment with specific medication in schizophrenia patients may increase QoL.     

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.     

Olfactory identification and discrimination in obsessive-compulsive disorder

Background: Neuroimaging and neuropsychological data from patients with an obsessive‐compulsive disorder (OCD) indicate the dysfunction of the orbitofrontal cortex (OFC). Olfactory processing has been associated with OFC function, although results from OCD studies regarding this sensory modality have been inconclusive. No previous study has analyzed both odor discrimination and identification capacity in OCD patients using “Sniffin' Sticks” tests. The aim of our study was to assess odor threshold, identification, discrimination, and nonverbal memory in OCD patients, in order to determine whether these functions were affected. Methods: Olfactory function was measured in 29 OCD patients and 29 healthy volunteers (HV) using the “Sniffin' Sticks” test and their nonverbal memory was scored with the Rey–Osterrieth Complex Figure Test. Results: OCD patients showed significant impairment in their odor performance and in their execution of the nonverbal memory task compared to HV. No statistical associations were found between the deficits in the two areas. The severity of depressive and obsessive‐compulsive symptoms did correlate with olfactory identification. Conclusion: Our findings support the hypothesis that olfactory and memory dysfunctions in OCD reflect different neurobiological alterations of the disorder, and point to the modulation effect of depressive and obsessive‐compulsive symptoms on odor performance. Depression and Anxiety, 2011. © 2011 Wiley‐Liss, Inc.     

Adherence to exposure and response prevention as a predictor of improvement in obsessive-compulsive symptom dimensions

Exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD); yet, improvement rates vary and it is therefore important to examine potential predictors of outcome. The present study examined adherence with ERP homework as a predictor of (a) treatment response across OCD symptom dimensions and (b) reductions in psychological factors implicated in the maintenance of OCD. Fifty adults with OCD received manualized twice-weekly ERP as part of a treatment trial. Results indicated that treatment was effective for all OCD symptom dimensions and that greater adherence with ERP homework predicted post-treatment (but not follow-up) improvements in OCD symptoms pertaining to responsibility for harm, unacceptable obsessional thoughts, and symmetry. Adherence did not predict outcomes for contamination symptoms, however. Adherence also predicted improvement in psychological maintenance factors such as obsessive beliefs and experiential avoidance. Implications of the findings include the importance of emphasizing adherence to homework instructions, as well as the importance of considering OCD symptoms dimensionally as opposed to globally in examining predictors of treatment response.     

Emotional burden in caregivers of patients with obsessive-compulsive disorder

Background: The objective of this study was to evaluate the emotional burden, psychological morbidity, and level of family accommodation in caregivers of obsessive‐compulsive disorder (OCD) patients, according to sociodemographic and clinical factors. Methods: Fifty Brazilian DSM‐IV OCD patients and their caregivers were evaluated using the Family Accommodation Scale, the Zarit Burden Interview (ZBI), the Self‐Report Questionnaire (caregivers), the Yale‐Brown Obsessive‐Compulsive Scale, and the Beck Depression Inventory (patients). Most caregivers (80%) were aged between 30 and 59 years and lived with the patient (88%). Results: Forty‐two percent presented a common mental disorder and their mean ZBI score was 28.9. Family accommodation was moderate in 26% and severe or very severe in 24%. Caregivers' levels of psychological morbidity, accommodation, and emotional burden were associated with each other and with the severity of patient obsessive‐compulsive and depressive symptoms. Conclusions: The results suggest that caregivers of OCD patients have important levels of burden and psychological morbidity and should receive orientation and support to minimize this emotional impact. Depression and Anxiety, 2008. © 2008 Wiley‐Liss, Inc.     

Comorbid Personality Disorders in Obsessive–Compulsive Disorder and Its Symptom Dimensions

The current paper was aimed at: (1) investigating the comorbidity between obsessive–compulsive disorder (OCD) and personality disorders (PDs) using an OCD sample and clinician-administered structured interviews; (2) exploring the associations of different cluster comorbid PDs with the specific symptom dimensions of OCD; (3) analyzing the variables which could play a significant role in the probability of having at least one comorbid PD, controlling for confounding variables. The SCID-II and Y-BOCS, together with a series of self-report measures of OCD, depression and anxiety symptoms were administered to a clinical sample of 159 patients with a primary diagnosis of OCD. 20.8 % of the participants suffered from at least one comorbid PD; the most common was obsessive–compulsive PD (9.4 %), followed by narcissistic PD (6.3 %). In OCD patients with comorbid cluster C PDs, the percentage of responsibility for harm, injury, or bad luck symptoms was significantly greater than other OCD symptom dimensions (p < .005). Logistic regression found some evidence supporting the association between severity of OCD symptoms and comorbid PDs. PDs are prevalent among Italian people with OCD and should be routinely assessed, as comorbidity may affect help-seeking behaviour and response to treatment.     

Prevalence and clinical correlates of obsessive–compulsive disorder in schizophrenia

Obsessive compulsive symptoms frequently occur in a substantial proportion of patients with schizophrenia. The term schizoobsessive has been proposed to delineate this subgroup of schizophrenia patients who present with obsessive–compulsive symptoms/disorder. However, whether this co-occurrence is more than just co-morbidity and represents a distinct subgroup remains controversial. A striking variation is noted across studies examining prevalence of obsessive–compulsive symptoms/disorder in schizophrenia patients and their impact on clinical profile of schizophrenia. Hence, in this study, we examined the prevalence of obsessive–compulsive symptoms/disorder in a large sample of consecutively hospitalized schizophrenia patients and compared the clinical and functional characteristics of schizophrenia patients with and without obsessive–compulsive symptoms/disorder. We evaluated 200 consecutive subjects with the DSM-IV diagnosis of schizophrenia using the Structured Clinical Interview for DSM-IV Axis I disorders, Positive and Negative Syndrome Scale, Yale–Brown Obsessive–Compulsive Scale, Brown Assessment of Beliefs Scale, Clinical Global Impression-Severity scale, Global Assessment of Functioning Scale, Family Interview for Genetic Studies and World Health Organization Quality of Life scale. The prevalence of obsessive–compulsive symptoms in patients with schizophrenia was 24% (n = 48); 37 of them had obsessive–compulsive disorder (OCD) and 11 had obsessive–compulsive symptoms not amounting to a clinical diagnosis of OCD (OCS). Schizophrenia patients with OCS/OCD had an earlier age at onset of schizophrenia symptoms, lower positive symptoms score, higher co-morbidity with Axis II disorders, higher occurrence of OCD in family and better quality of life. Findings of the study indicate a higher prevalence of OCS/OCD in schizophrenia. Schizophrenia patients with and without OCS/OCD have comparable clinical profile with few exceptions. High rates of OCD in first degree relatives suggest possible genetic contributions and differences in neurobiology. Finally, evidence to consider schizoobsessive as a distinct diagnostic entity is inconclusive and warrants further studies.     

Response of Obsessive Compulsive Disorder to Carbamazepine in Two Patients with Comorbid Epilepsy

An association between epilepsy and obsessive compulsive disorder (OCD) has been noted. The response of two patients with OCD and comorbid epilepsy to carbamazepine is reported. It is hypothesized that obsessive compulsive symptoms may be a variant of epileptiform forced thinking in a subgroup of patients, and may be preferentially responsive to anticonvulsant therapy.     

Can obsessions drive you mad? Longitudinal evidence that obsessive‐compulsive symptoms worsen the outcome of early psychotic experiences

Van Dael F, van Os J, de Graaf R, ten Have M, Krabbendam L, Myin‐Germeys I. Can obsessions drive you mad? Longitudinal evidence that obsessive‐compulsive symptoms worsen the outcome of early psychotic experiences. Objective: Although there is substantial comorbidity between psychotic disorder and obsessive‐compulsive disorder (OCD), little is known about how these clinical phenotypes, and their subclinical extended phenotypes, covary and impact on each other over time. This study examined cross‐sectional and longitudinal associations between both (extended) phenotypes in the general population. Method: Data were obtained from the three waves of the NEMESIS‐study. A representative population sample of 7076 participants were assessed using the composite international diagnostic interview (CIDI) at baseline (T₀), 1 year later at T₁ and again 2 years later at T₂. Results: At T₀, a lifetime diagnosis of psychotic disorder was present in 1.5% of the entire sample, in 11.5% of the people with any OC symptom and in 23.0% of individuals diagnosed with OCD. OC symptoms at T₀ predicted incident psychotic symptoms at T₂. Similarly, T₀ psychotic symptoms predicted T₂ OC symptoms. The likelihood of persistence of psychotic symptoms or transition to psychotic disorder was higher if early psychosis was accompanied by co‐occurring OC symptoms, but not the other way around. Conclusion: OCD and the psychosis phenotype cluster together and predict each other at (sub)clinical level. The co‐occurrence of subclinical OC and psychosis may facilitate the formation of a more ‘toxic’ form of persistent psychosis.     

Variations in Symptom Prevalence and Clinical Correlates in Younger Versus Older Youth with Obsessive–Compulsive Disorder

Few studies have examined the phenomenology of obsessive–compulsive disorder (OCD) in younger children. A sample of 292 treatment seeking youth with a primary diagnosis of OCD was divided into the young child (3–9 years old) and older child (10–18 years old) groups. Overall OCD severity did not differ between groups. However, older youth demonstrated stronger intensity of obsessive and compulsive symptoms, while younger children were rated as having less resistance and control of compulsions. Older youth exhibited increased occurrence of comorbid depression, and an increased occurrence of sexual, magical thinking, and somatic obsessions, as well as, checking, counting and magical thinking compulsions. Conversely, the group of younger children exhibited significantly poorer insight, increased incidence of hoarding compulsions, higher rates of comorbid attention deficit/hyperactivity disorder, disruptive behavior, and parent-rated anxiety, and more frequently exhibited hoarding compulsions. These differences suggest domains to consider when screening for OCD among younger/older pediatric cohorts.     

Clinical characteristics of comorbid obsessive‐compulsive disorder and bipolar disorder in children and adolescents

Joshi G, Wozniak J, Petty C, Vivas F, Yorks D, Biederman J, Geller D. Clinical characteristics of comorbid obsessive‐compulsive disorder and bipolar disorder in children and adolescents.
Bipolar Disord 2010: 12: 185–195.
© 2010 The Authors. Journal compilation © 2010 John Wiley & Sons A/S. Objective: To explore bidirectional comorbidity between bipolar disorder (BPD) and obsessive‐compulsive disorder (OCD) in youth and to examine the symptom profile and clinical correlates of both disorders in the context of reciprocal comorbidity and ascertainment status. Methods: Two samples of consecutively referred youth (ages 6–17 years) ascertained contemporaneously for respective studies of BPD and OCD were compared using clinical and scalar assessment and structured diagnostic interviews. Results: A total of 21% (17/82) of the BPD subjects and 15% (19/125) of the OCD subjects met DSM‐III‐R diagnostic criteria for both disorders. In the presence of BPD, youth with OCD more frequently experienced hoarding/saving obsessions and compulsions along with a clinical profile of greater comorbidity, poorer global functioning, and higher rate of hospitalization that is characteristic of BPD. Multiple anxiety disorders (≥ 3), especially generalized anxiety disorder and social phobia, were present at a higher frequency when OCD and BPD were comorbid than otherwise. In subjects with comorbid OCD and BPD, the primary disorder of ascertainment was associated with an earlier onset and more severe impairment. Conclusions: An unexpectedly high rate of comorbidity between BPD and OCD was observed in youth irrespective of primary ascertainment diagnosis. In youth with comorbid OCD and BPD, the clinical characteristics of each disorder run true and are analogues to their clinical presentation in youth without reciprocal comorbidity, with the exception of increased risk for obsessions and compulsions of hoarding/saving and comorbidity with other anxiety disorders.     

Obsessive-compulsive disorder with and without bipolar disorder

Aim: Bipolar disorder (BD) is often comorbid with obsessive–compulsive disorder (OCD). In this study, we compared clinical profile and course of subjects with a primary diagnosis of OCD with and without BD. Methods: We compared 34 subjects with primary diagnosis of OCD with BD and 57 subjects with a diagnosis of OCD without BD. Structured interview schedules, clinical rating scales, and information from clinical charts were utilized to assess patients. Results: OCD with BD was characterized by: (i) an episodic course; (ii) a higher number of depressive episodes, greater suicidality and a higher rate of hospitalization; (iii) fewer pathological doubts and more miscellaneous compulsions; and (iv) poorer insight into obsessive–compulsive symptoms. Conclusions: Episodic course appears to be typical of OCD with BD. Bipolarity has a pathoplastic effect on OCD and it is possible that some forms of OCD and BD are pathophysiologically related. Bipolar OCD is associated with a higher rate of depressive episodes, higher suicidality and more frequent hospitalizations, suggesting greater morbidity. Long‐term prospective follow‐up studies and studies addressing pathophysiology and genetic basis are needed to understand the complexity of such comorbidity.     

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.     

Why are religious individuals more obsessional? The role of mental control beliefs and guilt in Muslims and Christians

Background and objectives

The cognitive-behavioural perspective on obsessions recognizes that certain cultural experiences such as adherence to religious beliefs about the importance of maintaining strict mental control might increase the propensity for obsessional symptoms via the adoption of faulty appraisals and beliefs about the unacceptability and control of unwanted intrusive thoughts. Few studies have directly investigated this proposition, especially in a non-Western Muslim sample.

Method

In the present study high religious, low religious and religious school Canadian Christian and Turkish Muslim students were compared on measures of OCD symptoms, obsessive beliefs, guilt, religiosity, and negative affect.

Results

Analysis revealed that religiosity had a specific relationship with obsessional but not anxious or depressive symptoms in both samples, although the highly religious Muslim students reported more compulsive symptoms than highly religious Christians. In both samples the relationship between religiosity and obsessionality was mediated by importance/control of thoughts and responsibility/threat beliefs as well as generalized guilt.

Limitations

The sample composition was limited to non-clinical undergraduates and only two major religions were considered without recognition of denominational differences.

Conclusions

These findings indicate that the tendency for highly religious Christians and Muslims to experience greater obsessionality is related to their heightened sense of personal guilt and beliefs that they are responsible for controlling unwanted, threatening intrusive thoughts.