Abstract
There appear to be two peaks of incidence of Obsessive Compulsive Disorder (OCD), one with a pre-adolescent onset and another in early adulthood. As new cases are added, the cumulative prevalence of OCD increases, but the great majority of cases have an onset in youth. The notion that early onset OCD represents a unique developmental subtype of the disorder has been considered by many researchers based on several specific age-related factors. Ascertainment and early intervention in affected youth is critical to abbreviate the functional impairments associated with untreated illness. In this paper we review the clinical, familial and translational biomarker correlates seen in early onset OCD that support the notion of a developmental subtype and discuss implications for research and treatment aimed at this cohort. The importance of cognitive, academic and social development tasks of childhood and adolescence, illness-specific and familial factors, and immune-mediated inflammatory factors are discussed, with their implications for management.
Highlights
Clinical research has posited a developmental subtype of Obsessive Compulsive Disorder (OCD) that affects youth, and which may be distinct in important ways from the adultonset form
We have detailed the many differences between pediatric or pediatric OCD and OCD that onsets in adults
Keeping in mind that development throughout the pediatric years is rapid and that accompanying neuronal maturation occurs with similar rapid synchrony, these factors may greatly affect the presentation and research findings in affected youth and adults
Summary
Clinical research has posited a developmental subtype of Obsessive Compulsive Disorder (OCD) that affects youth, and which may be distinct in important ways from the adultonset form. There was a positive correlation between these adverse labor events and earlier age at onset of OCD, greater symptom severity, and presence of concurrent disorders including chronic tics, anxiety, depression and ADHD These early clinical observations were supported by a large epidemiological study of more than 2.4 million singleton births using the Swedish birth registry over a 24 year period that identified over 17,000 cases of OCD. Limited- only 63% have good or excellent insight Up to 80%- Mood and anxiety conditions, ADHD, Tic disorders, ODD, DMDD, ASD (∼5%) Greater family involvement leads to worse OCD symptoms and greater functional impairment 26% risk of OCD in a first degree relative Increased rates, especially in boys with OCD. Evidence is accumulating incrementally that a subset of cases of pediatric OCD are triggered by infections and mediated by immune and inflammatory processes [123]
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