Early-onset Obsessive-compulsive Disorder Research Articles

Early-onset obsessive-compulsive disorder: Sociodemographic and clinical characterization of a large outpatient cohort

IntroductionObsessive-compulsive disorder (OCD) is a prevalent and disabling condition characterized by a wide variety of phenotypic expressions. Several studies have reinforced the hypothesis of OCD heterogeneity by proposing subtypes based on predominant symptomatology, course, and comorbidities. Early-onset OCD (EO) could be considered a neurodevelopmental subtype of OCD, with evidence of distinct neurocircuits supporting disease progression. To deepen the heterogeneous nature of the disorder, we analyzed sociodemographic and clinical differences between the EO and late-onset (LO) subtypes in a large outpatient cohort. MethodsTwo hundred and eighty-four patients diagnosed with OCD were consecutively recruited from the OCD Tertiary Clinic at Luigi Sacco University Hospital in Milan. Sociodemographic and clinical variables were analyzed for the entire sample and compared between the two subgroups (EO, age <18 years [n = 117,41.2 %]; LO: late-onset, age ≥18 years [n = 167, 58.8 %]). ResultsThe EO group showed a higher frequency of male gender (65 % vs 42.5 %, p < .001), and a higher prevalence of Tic and Tourette disorders (9.4 % vs 0 %, p < .001) compared to the LO group. Additionally, in the EO subgroup, a longer duration of untreated illness was observed (9.01 ± 9.88 vs 4.81 ± 7.12; p < .001), along with a lower presence of insight (13.8 % vs. 7.5 %, p < .05). ConclusionsThe early-onset OCD subtype highlights a more severe clinical profile compared to the LO group. Exploring distinct manifestations and developmental trajectories of OCD can contribute to a better definition of homogeneous subtypes, useful for defining targeted therapeutic strategies for treatment.

5.40 Exploring the Genetic Architecture of Early-Onset OCD: Effect of Autoimmune and Inflammatory Polygenic Risk Scores

5.40 Exploring the Genetic Architecture of Early-Onset OCD: Effect of Autoimmune and Inflammatory Polygenic Risk Scores

Microbiome analysis of circulating bacterial extracellular vesicles in obsessive-compulsive disorder.

The present study examined the microbiome abundance and composition of drug-naïve or drug-free patients with obsessive-compulsive disorder (OCD) compared to healthy controls. In addition, in the OCD group, the microbiome composition was compared between early-onset and late-onset OCD. Serum samples were collected from 89 patients with OCD and 107 age- and sex-matched healthy controls. Bacterial DNA was isolated from bacteria-derived extracellular vesicles in serum and then amplified and quantified using primers specific to the V3-V4 hypervariable region of the 16S rDNA gene. The 16S rRNA gene amplicon sequencing was performed. The pooled estimate showed that alpha diversity was significantly reduced in patients with OCD compared to that in healthy controls (pShannon = 0.00015). In addition, a statistically significant difference was observed in beta diversity between patients with OCD and healthy controls at the order (p = 0.012), family (p = 0.003), genus (p < 0.001), and species (p = 0.005) levels. In the microbiome composition, Pseudomonas, Caulobacteraceae(f), Streptococcus, Novosphingobium, and Enhydrobacter at the genus level were significantly less prevalent in patients with OCD than in controls. In addition, among patients with OCD, the microbial composition in the early-onset versus late-onset types was significantly different with respect to the genera Corynebacterium and Pelomonas. The present study showed an aberrant microbiome in patients with OCD, suggesting a role of the microbiota-brain interaction in the pathophysiology of OCD. Further longitudinal studies with larger sample sizes adjusting for various confounders are warranted. This article is protected by copyright. All rights reserved.

Performance Monitoring: A Transdiagnostic Biomarker of Adaptive Behavior in Mental Disorders

Obsessive-compulsive disorder (OCD) is a severe and heterogeneous disorder with a considerable rate of treatment nonresponders. It is important to understand the neural underpinnings of the disorder so that they can inform and improve treatments. A well-established target candidate for the underlying psychopathology in OCD is the error-related negativity (ERN) as measured in performance monitoring ( 1 Endrass T. Ullsperger M. Specificity of performance monitoring changes in obsessive-compulsive disorder. Neurosci Biobehav Rev. 2014; 46: 124-138 Crossref PubMed Scopus (99) Google Scholar ). The ERN is important for the adaptation of behavior (e.g., affect/motivation) and subsequent actions. Many studies have observed an increased ERN and discussed this phenomenon as a potential biomarker or endophenotype for OCD. However, despite the need to identify qualified endophenotypes early in the course of the disorder—or even before a clinical threshold is reached, assuming it might be easier to treat at this early stage—evidence from pediatric samples and early-onset OCD is scarce. The study by Suzuki et al. ( 2 Suzuki T. Gu P. Grove T.B. Hammond T. Collins K.M. Pamidighantam P. et al. Abnormally enhanced midfrontal theta activity during response monitoring in youths with obsessive-compulsive disorder. Biol Psychiatry. 2023; 93: 1031-1040 Abstract Full Text Full Text PDF Google Scholar ) in the current issue of Biological Psychiatry provides evidence for an increased ERN and theta band power in a group of children and adolescents with early-onset OCD compared with an unaffected control group. Consistent with previous studies, the authors observed increased amplitudes and theta power in OCD not only following errors but also following correct responses. In addition, they analyzed intertrial phase coherence in the theta range—a measure for the synchronization of the phase of the signal between trials independent of amplitude ( 3 McLoughlin G. Gyurkovics M. Palmer J. Makeig S. Midfrontal theta activity in psychiatric illness: An index of cognitive vulnerabilities across disorders. Biol Psychiatry. 2022; 91: 173-182 Abstract Full Text Full Text PDF PubMed Scopus (9) Google Scholar )—but group effects were not observed. Enhanced ERN and theta power have been suggested as biomarkers or endophenotypes for OCD. Although there is substantial evidence supporting the notion of performance monitoring abnormalities in OCD, we will discuss the following aspects: 1) the function of ERN and theta power for adaptive behavior and in mental disorders; 2) performance monitoring as a specific versus transdiagnostic biomarker; and 3) functional role and sensitivity to interventions. SEE CORRESPONDING ARTICLE ON PAGE 1031 SEE CORRESPONDING ARTICLE ON PAGE 1031 Abnormally Enhanced Midfrontal Theta Activity During Response Monitoring in Youths With Obsessive-Compulsive DisorderBiological PsychiatryVol. 93Issue 11PreviewResponse monitoring, as reflected in electroencephalogram recordings after commission of errors, has been consistently shown to be abnormally enhanced in individuals with obsessive-compulsive disorder (OCD). This has traditionally been quantified as error-related negativity (ERN) and may reflect abnormal neurophysiological mechanisms underlying OCD. However, the ERN reflects the increase in phase-locked activities, particularly in the theta-band (4–8 Hz), and does not reflect non–phase-locked activities. Full-Text PDF

A clinical investigation of psychotic vulnerability in early-onset Obsessive-Compulsive Disorder through Cognitive-Perceptive basic symptoms.

Childhood-onset Obsessive-Compulsive Disorder (OCD) shows distinct comorbidity patterns and developmental pathways, as well as an increased risk of psychosis with respect to adult-onset forms. Nevertheless, little is known about the prodromal symptoms of psychosis in children and adolescents with a primary diagnosis of OCD. The present study was aimed at evaluating the occurrence of Cognitive-Perceptual basic symptoms (COPER) and high- risk criterion Cognitive Disturbances (COGDIS) in pediatric and adults OCD patients, verifying if they might vary according to the age of onset of OCD. The study included 90 outpatients with a primary diagnosis of obsessive-compulsive disorder. The study sample was collapsed into three groups according to the age at onset: 1) very early onset group (< 10years); 2) early onset group (11-18years); 3) adult-onset group (> 18years). All patients were administered the Yale-Brown Obsessive- Compulsive Scale (Y-BOCS) and its Child version (CY-BOCS), the Schizophrenia Proneness Instrument-Adult (SPIA) and its Child and Adolescent version (SPI-CY) and the Social and Occupational Functioning Assessment Scale (SOFAS). COPER and COGDIS symptoms were positively associated with OCD severity and detectable, respectively, in 28.9 and 26.7% of our study sample. The very early onset group significantly had higher COPER and COGDIS symptoms than the adult-onset group. Our data suggest that COPER and COGDIS symptoms are frequent in obsessive patients, in particular in those with earlier onset; therefore, their detection in childhood-onset OCD may represent an early and specific indicator of psychotic vulnerability.

Cortical gyrification differences between early- and late-onset obsessive-compulsive disorder: neurobiological evidence for neurodevelopmentally distinct subtypes.

Identifying more homogenous subtypes of patients with obsessive-compulsive disorder (OCD) using biological evidence is critical for understanding complexities of the disorder in this heterogeneous population. Age of onset serves as a useful subtyping scheme for distinguishing OCD into two subgroups that aligns with neurodevelopmental perspectives. The underlying neurobiological markers for these distinct neurodevelopmental differences can be identified by investigating gyrification changes to establish biological evidence-based homogeneous subtypes. We compared whole-brain cortical gyrification in 84 patients with early-onset OCD, 84 patients with late-onset OCD, and 152 healthy controls (HCs) to identify potential markers for early neurodevelopmental deficits using the local gyrification index (lGI). Then, the relationships between lGI in clusters showing significant differences and performance in visuospatial memory and verbal fluency, which are considered trait-related neurocognitive impairments in OCD, were further examined in early-onset OCD patients. The early-onset OCD patients exhibited significantly greater gyrification than those with late-onset OCD patients and HCs in frontoparietal and cingulate regions, including the bilateral precentral, postcentral, precuneus, paracentral, posterior cingulate, superior frontal, and caudal anterior cingulate gyri. Moreover, impaired neurocognitive functions in early-onset OCD patients were correlated with increased gyrification. Our findings provide a neurobiological marker to distinguish the OCD population into more neurodevelopmentally homogeneous subtypes, which may contribute to the understanding of the neurodevelopmental underpinnings of an etiology in early-onset OCD consistent with the accumulated phenotypic evidence of greater neurodevelopmental deficits in early-onset OCD than in late-onset OCD.

White matter alterations in drug-naïve children with Tourette syndrome and obsessive-compulsive disorder.

Tourette syndrome (TS) and early-onset obsessive-compulsive disorder (OCD) are frequently associated and conceptualized as distinct phenotypes of a common disease spectrum. However, the nature of their relationship is still largely unknown on a pathophysiological level. In this study, early structural white matter (WM) changes investigated through diffusion tensor imaging (DTI) were compared across four groups of drug-naïve children: TS-pure (n = 16), TS+OCD (n = 14), OCD (n = 10), and 11 age-matched controls. We analyzed five WM tracts of interest, i.e., cortico-spinal tract (CST), anterior thalamic radiations (ATR), inferior longitudinal fasciculus (ILF), corpus callosum (CC), and cingulum and evaluated correlations of DTI changes to symptom severity. Compared to controls, TS-pure and TS+OCD showed a comparable pattern of increased fractional anisotropy (FA) in CST, ATR, ILF and CC, with FA changes displaying negative correlation to tic severity. Conversely, in OCD, FA decreased in all WM tracts (except for the cingulum) compared to controls and negatively correlated to symptoms. We demonstrate different early WM microstructural alterations in children with TS-pure/TS+OCD as opposed to OCD. Our findings support the conceptualization of TS+OCD as a subtype of TS while suggesting that OCD is characterized by independent pathophysiological mechanisms affecting WM development.

Genetic Susceptibility of Obsessive-Compulsive Disorder in The Paediatric Population

Obsessive-compulsive disorder (OCD) is a psychiatric disorder involving recurring, unwanted thoughts followed by eliciting ritualistic behaviours to alleviate feelings of distress. Two onsets of OCD exist: early and late. Early-onset (also known as paediatric or childhood) OCD shows greater rates of comorbidities and symptom severity, as well as stronger links to genetics, which are a developing field in OCD etiopathogenesis. An extensive number of twin and family studies have demonstrated heritability of OCD and clustering in families. Although genome-wide association studies (GWAS) are a relatively new addition to the progression of OCD genomics, they have provided initial results on specific candidate genes involved. Currently, the serotonergic, early glutamatergic, and dopaminergic systems possess the main genes implicated in OCD. An epigenetic contribution has also been recently considered in paediatric populations. This review of existing literature primarily focuses on the genetic factors of OCD, particularly its early-onset form.

The relationship between homework adherence and outcome in family-based cognitive-behavioral therapy for early-onset obsessive compulsive disorder

Family-based cognitive behavioral therapy (CBT) is an effective treatment for obsessive compulsive disorder (OCD), but not all children respond. Children with early-onset OCD may exhibit poorer outcomes, possibly due to developmental factors that affect treatment engagement and distress tolerance, which may ultimately affect treatment dose. Homework adherence between sessions can increase treatment dose and predict improved outcome. However, no studies have specifically examined the effect of homework adherence on treatment outcome for early-onset OCD. This study examined homework adherence during family-based CBT for young children (N = 63) with early-onset OCD. Caregiver and child homework adherence were rated weekly by clinicians and symptom change was assessed at multiple timepoints across treatment. Caregivers and children were both rated as highly adherent with homework, although caregivers were rated as more adherent than children. Structural equation modeling indicated that early homework adherence predicted later homework adherence, which predicted improved treatment outcome.

Gene expression study in monocytes: evidence of inflammatory dysregulation in early-onset obsessive-compulsive disorder

Obsessive-compulsive disorder (OCD) has a complex etiology that seems to include immune dysfunction and alterations in circulating monocytes. To investigate the immune basis and the functional dysregulation of monocytes in this disease, we analyzed gene expression in the peripheral monocytes of pediatric patients with OCD (N = 102) compared to controls (N = 47). We examined gene expression in primary cultures of peripheral monocytes from participants, under basal conditions and under exposure to lipopolysaccharide (LPS) to stimulate immune response. Whole-genome expression was assessed in 8 patients and 8 controls. Differentially expressed genes were identified followed by protein-protein interaction network construction and functional annotation analysis to identify the genes and biological processes that are altered in the monocytes of OCD patients. We also explored the expression levels of selected genes in monocytes from the other participants using qPCR. Several changes in gene expression were observed in the monocytes of OCD patients, with several immune processes involved under basal conditions (antigen processing and presentation, regulation of immune system and leukocyte cell adhesion) and after LPS stimulation (immune and inflammatory response, cytokine production and leukocyte activation). Despite the qPCR analysis provided no significant differences between patients and controls, high correlations were observed between the expression levels of some of the genes and inflammatory markers (i.e., T helper 17 and regulatory T cell levels, total monocyte and proinflammatory monocyte subset levels, and the cytokine production by resting and stimulated monocytes) of the study participants. Our findings provide more evidence of the involvement of monocyte dysregulation in early-onset OCD, indicating a proinflammatory predisposition and an enhanced immune response to environmental triggers.

Association of Environmental Uncertainty With Altered Decision-making and Learning Mechanisms in Youths With Obsessive-Compulsive Disorder

Adults with obsessive-compulsive disorder (OCD) display perseverative behavior in stable environments but exhibit vacillating choice when payoffs are uncertain. These findings may be associated with intolerance of uncertainty and compulsive behaviors; however, little is known about the mechanisms underlying learning and decision-making in youths with OCD because research into this population has been limited. To investigate cognitive mechanisms associated with decision-making in youths with OCD by using executive functioning tasks and computational modeling. In this cross-sectional study, 50 youths with OCD (patients) and 53 healthy participants (controls) completed a probabilistic reversal learning (PRL) task between January 2014 and March 2020. A separate sample of 27 patients and 46 controls completed the Wisconsin Card Sorting Task (WCST) between January 2018 and November 2020. The study took place at the University of Cambridge in the UK. Decision-making mechanisms were studied by fitting hierarchical bayesian reinforcement learning models to the 2 data sets and comparing model parameters between participant groups. Model parameters included reward and punishment learning rates (feedback sensitivity), reinforcement sensitivity and decision consistency (exploitation), and stickiness (perseveration). Associations of receipt of serotonergic medication with performance were assessed. In total, 50 patients (29 female patients [58%]; median age, 16.6 years [IQR, 15.3-18.0 years]) and 53 controls (30 female participants [57%]; median age, 16.4 years [IQR, 14.8-18.0 years]) completed the PRL task. A total of 27 patients (18 female patients [67%]; median age, 16.1 years [IQR, 15.2-17.2 years]) and 46 controls (28 female participants [61%]; median age, 17.2 [IQR, 16.3-17.6 years]) completed the WCST. During the reversal phase of the PRL task, patients made fewer correct responses (mean [SD] proportion: 0.83 [0.16] for controls and 0.61 [0.31] for patients; 95% CI, -1.31 to -0.64) and switched choices more often following false-negative feedback (mean [SD] proportion: 0.09 [0.16] for controls vs 0.27 [0.34] for patients; 95% CI, 0.60-1.26) and true-positive feedback (mean [SD] proportion: 0.93 [0.17] for controls vs 0.73 [0.34] for patients; 95% CI, -2.17 to -1.31). Computational modeling revealed that patients displayed enhanced reward learning rates (mean difference [MD], 0.21; 95% highest density interval [HDI], 0.04-0.38) but decreased punishment learning rates (MD, -0.29; 95% HDI, -0.39 to -0.18), reinforcement sensitivity (MD, -4.91; 95% HDI, -9.38 to -1.12), and stickiness (MD, -0.35; 95% HDI, -0.57 to -0.11) compared with controls. There were no group differences on standard WCST measures and computational model parameters. However, patients who received serotonergic medication showed slower response times (mean [SD], 1420.49 [279.71] milliseconds for controls, 1471.42 [212.81] milliseconds for patients who were unmedicated, and 1738.25 [349.23] milliseconds for patients who were medicated) (control vs medicated MD, -320.26 [95% CI, -547.00 to -88.68]) and increased unique errors (mean [SD] proportion: 0.001 [0.004] for controls, 0.002 [0.004] for patients who were unmedicated, and 0.008 [0.01] for patients who were medicated) (control vs medicated MD, -0.007 [95% CI, -3.14 to -0.36]) on the WCST. The results of this cross-sectional study indicated that youths with OCD showed atypical probabilistic reversal learning but were generally unimpaired on the deterministic WCST, although unexpected results were observed for patients receiving serotonergic medication. These findings have implications for reframing the understanding of early-onset OCD as a disorder in which decision-making is associated with uncertainty in the environment, a potential target for therapeutic treatment. These results provide continuity with findings in adults with OCD.

Distinct alterations of amygdala subregional functional connectivity in early- and late-onset obsessive-compulsive disorder

BackgroundAge of onset may be an important feature associated with distinct subtypes of obsessive-compulsive disorder (OCD). The amygdala joined neurocircuitry models of OCD for its role in mediating fear and regulating anxiety. The present study aims to identify the underlying pathophysiological specifics in OCD with different onset times by assessing amygdala subregional functional connectivity (FC) alterations in early-onset OCD (EO-OCD) and late-onset OCD (LO-OCD). MethodsResting-state functional magnetic resonance imaging data were acquired from 88 medication-free OCD patients (including 30 EO-OCD and 58 LO-OCD) and age- and sex-matched healthy controls (HC) for each patient group. Onset-by-diagnosis interactions were examined and comparisons between each OCD group and the corresponding HC group were performed regarding the FC of amygdala subregions including the basolateral amygdala (BLA), centromedial amygdala (CMA), superficial amygdala (SFA) and amygdalostriatal transition area (Astr). ResultsSignificant onset-by-diagnosis interactions were found in FC between bilateral SFA, right CMA, left Astr and the cerebellum. EO-OCD patients showed abnormally increased BLA/SFA-cerebellum, BLA-precuneus and BLA/SFA-fusiform connectivity in addition to decreased BLA/SFA-orbitofrontal cortex connectivity. In contrast, LO-OCD patients exhibited increased CMA/Astr-precentral/postcentral gyrus and CMA-cuneus connectivity as well as decreased CMA/Astr-cerebellum and BLA-striatum connectivity. LimitationsThe exclusion of comorbidity may reduce the generalizability of our results. ConclusionsThese findings emphasized the different patterns of amygdala subregional connectivity alterations associated with EO-OCD and LO-OCD patients. These results provide unique insights into constructing evidence-based distinct OCD subtypes based on brain intrinsic connectivity and point to the need of specified management for EO-OCD and LO-OCD in clinical setting.

Very early-onset Obsessive-Compulsive Disorder in pre-schoolers: A prospective case series

Normative Obsessive-compulsive (OC) like behaviors can be common in early childhood. Very young children rarely can present with significantly impairing OC phenomenon associated with severe accommodative behaviors, which may warrant interventions. We describe three pre-schoolers with an onset of impairing OC symptoms at 28-, 21-, and 36-months of ages. An eclectic psychosocial approach based on Behaviorism, Attachment, Sensitive Parenting, Developmental, and Family systems was used. The children were followed-up for one to three years. The cases highlight the pattern of Obsessive-Compulsive Disorders (OCD) in very young children and emphasize the utility of non-pharmacological intervention in this age group.

Trajectory of Change in Parental Accommodation and Its Relation to Symptom Severity and Impairment in Pediatric OCD.

Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 youth receiving a family-based intervention for early-onset OCD. FA, symptom severity and functional impairment were assessed at baseline, week 5, week 9, and post-treatment (week 14). Results suggested that changes in FA in the beginning stages of treatment preceded global symptom improvement (but not OCD specific improvement) whereas changes in functional impairment preceded changes in FA. In the latter half of treatment, changes in FA preceded improvement in global and OCD specific symptom severity as well as functional impairment. These findings highlight the importance of reducing FA, especially in the later stages of treatment, in order to optimize treatment outcomes in early-onset OCD.

A-67 Measuring Regional Cerebral Blood Flow with Single-Photon Emission Computed Tomography (SPECT) in Obsessive–Compulsive Disorder

Abstract Objective To identify regional cerebral blood flow (rCBF) differences between individuals with Obsessive–Compulsive Disorder (OCD) and healthy controls. Mehtods: Healthy controls (n = 81, Mage = 41.9, 53.0% female, 42.0% Caucasian) and persons diagnosed by psychiatric examination with OCD (n = 1020, Mage = 34.8, 33.6% female, 66.3% Caucasian) were selected from a deidentified adult clinical outpatient database. Those with comorbid diagnoses were included. Significant differences (alpha = 0.001) were found for age [t(1099) = −4.4], gender [χ2(2) = 25.7], and race [χ2(12) = 30.1] between groups and therefore were controlled for. Significant rCBF differences were noted in the cerebellum [left:F(1,1096) = 21.6; right:F(1,1096) = 18.3], limbic system [left:F(1,1096) = 12.2; right:F(1,1096) = 10.4], and basal ganglia [left:F(1,1096) = 18.6; right:F(1,1096) = 18.3]. Results Group means comparisons indicated higher perfusion in the cerebellum for the OCD group. Lower perfusion was found in the limbic system and basal ganglia in the OCD group. This study found higher perfusion in the cerebellum among the OCD group. Previous research found increased rCBF in the left cerebellum in OCD before pharmacotherapy. In the right cerebellum, increased rCBF was found among participants with early-onset OCD. Conclusion Overall, there is limited research on the cerebellum because of its use as a reference point. No research was found regarding the limbic system in OCD using SPECT; however, other neuroimaging found increased amygdala reactivity to emotional face stimuli. This study found lower perfusion in the basal ganglia among the OCD group. Previous research found hypoperfusion in the right; however, hypoperfusion in the left was not significant. Updated OCD and rCBF research with SPECT are needed. Limitations included the inclusion of comorbidities and use of DSM-IV-TR rather than DSM-5 diagnosis criteria.

Developmental Considerations in Obsessive Compulsive Disorder: Comparing Pediatric and Adult-Onset Cases.

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.

Obsessive compulsive disorder: a case of extreme obsessional slowness in an 18-year-old presenting to the national OCD unit

ObjectiveObsessional slowness in OCD is a rare phenomenon on which there is minimal published literature. This is a particularly severe and atypical case of early onset OCD with extreme obsessional slowness and mutism. To the best of our knowledge, there have been no reports of similar severity published in this age group. This report seeks to provide discussion of important organic causes that may need to be considered as well as information on treatment approach.Case reportAn 18-year-old male was admitted to the National OCD Unit, Springfield Hospital with a history of autism and normal development until the age of 14, after which symptoms of OCD with fear of contamination emerged, followed by progressive motor slowness and mutism.Due to the severity of OCD and self-neglect he had two previous admissions to CAMHS wards and required a course of ECT to treat catatonic symptoms age 17.Pharmacological treatment has included Aripiprazole 5 mg and Fluoxetine 60 mg, which the patient was taking at admission. The latter was subsequently switched to Sertraline 250 mg and Aripiprazole increased. As it was hypothesized that his obsessional slowness stemmed from severe levels of anxiety, Buspirone was also added.Therapy has been intensive, although communication difficulties have made targeting specific fears challenging as the exact nature of the intrusive thoughts remains unclear.DiscussionFollowing combined neurology and neuropsychiatry review, the patient spent four weeks in a general hospital for further investigation as it was initially felt an organic cause was likely. Initial differentials included Juvenile Onset Parkinson's or Wilson's disease. Both were subsequently ruled out and despite multiple investigations, no obvious organic cause was found. A markedly abnormal FDG PET scan showed findings usually seen in advanced dementia, but not necessarily clinically correlating to his current presentation.The OCD unit have continued to provide intensive input and tailored treatment programme, encouraging actions against any rules he has in place. Prompting and pacing, verbal exercises and regular stretching exercises due to stooped posture which he attributed to needing to obey certain rules have been used.ConclusionIt is important for clinicians to be aware of obsessional slowness in OCD and this report highlights a particularly rare and severe example in a young adult who has been difficult to treat. Organic causes may need to be considered and MDT approach to treatment is essential.

Olfactory identification impairment in early-and late-onset obsessive-compulsive disorder.

Early-onset obsessive-compulsive disorder (EOCD) is a comparatively severe subtype of obsessive-compulsive disorder (OCD). Olfactory dysfunction is a common symptom of OCD, but all previous studies have focused on late-onset OCD (LOCD). The current study compared olfactory identification ability in EOCD patients and age-matched and sex-matched LOCD patients and healthy controls. Thirty patients with EOCD, 30 patients with LOCD and 30 healthy controls were included in the study. Olfactory function was measured using the University of Pennsylvania Smell Identification Test. The Logical Memory and Visual Reproduction components of the Revised Wechsler Memory Scale were used to evaluate verbal and visual memory. There were significant differences in olfactory identification ability between the three groups. EOCD patients were comparable to LOCD patients, while both patients' group showing worse olfactory identification ability than controls. Olfactory identification ability was not significantly correlated with verbal and visual memory or clinical symptoms in the EOCD group or the LOCD group. The results of the present study suggest that olfactory identification ability may be a relatively stable indicator of OCD, independent of age, duration of illness, verbal and visual memory, and severity of clinical symptoms.

Early onset obsessive-compulsive disorder: the biological and clinical phenotype.

Moving from a behavioral-based to a biological-based classification of mental disorders is a crucial step toward a precision-medicine approach in psychiatry. In the last decade, a big effort has been made in order to stratify genetic, immunological, neurobiological, cognitive, and clinical profiles of patients. Making the case of obsessive-compulsive disorder (OCD), a lot have been made in this direction. Indeed, while the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of OCD aimed to delineate a homogeneous group of patients, it is now clear that OCD is instead an heterogeneous disorders both in terms of neural networks, immunological, genetic, and clinical profiles. In this view, a convergent amount of literature, in the last years, indicated that OCD patients with an early age at onset seem to have a specific clinical and biological profile, suggesting it as a neurodevelopmental disorder. Also, these patients tend to have a worse outcome respect to adult-onset patients and there is growing evidence that early-interventions could potentially improve their prognosis. Therefore, the aim of the present paper is to review the current available genetic, immunological, neurobiological, cognitive, and clinical data in favor of a more biologically precise subtype of OCD: the early-onset subtype. We also briefly resume current available recommendations for the clinical management of this specific population.

Association Between the SLC1A1 Glutamate Transporter Gene and Obsessive-Compulsive Disorder in the Chinese Han Population.

BackgroundObsessive-compulsive disorder (OCD) is a common, serious and genetically related mental illness; the etiology of OCD has not yet reached a definitive conclusion. Multiple evidence suggests that the glutamatergic system plays a major role in the pathophysiology of OCD. However, subsequent studies on the glutamate transporter gene are not consistent. OCD is a heterogeneous disease. To resolve the complex genetic basis of OCD, division the disorder into different subphenotypes is an effective method for studying the pathogenesis of OCD.MethodsWe recruited 438 OCD patients and 465 age- and sex-matched controls from a Chinese Han population. rs10491734, rs3780412, rs301434 and rs3087879 SNPs were genotyped by real-time TaqMan polymerase chain reaction, and the chi-squared test was used to compare allele and genotype frequencies of variants between the two groups.ResultsThe genotype of rs301434 was statistically significant in total patients with OCD and the controls. After grouping by age and gender, the genotype of rs301434 was statistically significant in early-onset OCD, late-onset OCD as well as male OCD, the allele and genotype of rs3780412 was associated with late-onset OCD. Haplotype analysis showed that four loci haplotypes (G-A-A-G and G-G-A-G) were associated with total OCD, (G-G-A-G) was associated with female OCD, (G-A-G-G) was associated with male OCD, (G-A-A-G and G-G-A-G) were associated with late-onset OCD.ConclusionThis study provides suggestive evidence that SLC1A1 may be involved in the development of OCD in the Han population. However, these findings require further replication.