Family History Of Obsessive-compulsive Disorder Research Articles

Towards the correlates of stressful life events as precipitants of obsessive-compulsive disorder: a systematic review and metanalysis.

Obsessive-compulsive disorder (OCD) is a prevalent condition with multifactorial etiology involving genetic and environmental factors. The present study aims to summarize the correlates of stressful life events (SLEs) in OCD by reviewing studies comparing OCD associated or not with SLEs before its onset. To do so, a systematic review was performed by searching PubMed, Web of Science, Scopus, and PsycINFO databases for studies published between the database's inception and November 27, 2023. Studies including individuals whose OCD was precipitated or not by SLEs (SLEs OCD and NSLEs OCD, respectively) were assessed. Effect sizes or odds ratios were then calculated to identify the strength of association between SLEs and clinical characteristics, such as gender, age of onset, family history of OCD, severity of OCD symptoms, depressive symptoms, and mood comorbidities among patients with OCD. Out of the 4083 records initially identified, 5 studies met the inclusion criteria and 3 were comparable through a meta-analysis. Notably, the analyses were limited by the small number of studies available in the literature. The meta-analysis demonstrated SLEs OCD to be associated with female gender, later OCD onset, and increased comorbidity rates with mood disorders. Despite the cross-sectional nature of the reviewed studies, women may be more vulnerable to develop a later onset of OCD following SLEs, which may also lead to mood disorders. Caution is needed to avoid prematurely classifying this presentation as a distinct subtype of OCD.

Assessing suicide risk in patients with obsessive-compulsive disorder: a dimensional approach.

Although an association has been found recently between obsessive-compulsive disorder and an increased risk of suicide, the prevalence of both suicidal ideation and attempts vary considerably and are generally assessed categorically. Our aims were to evaluate the prevalence of suicidal ideation and behaviors using a dimensional approach. The sample included 129 patients with obsessive-compulsive disorder. Suicidality was assessed by administering the Columbia-Suicide Severity Rating Scale. Logistic and linear regressions were used to examine predictors of suicidal ideation, severe suicidal ideation, and suicidal behavior. The lifetime prevalence of suicidal ideation and behaviors were 64.3% and 16.3%, respectively. Lifetime suicidal ideation was associated with the number of stressful life events, duration of illness, Hamilton Rating Scale for Depression scores, and family history of mood disorders. A family history of obsessive-compulsive disorder was associated with a lower probability of lifetime suicidal ideation. Severe suicidal ideation was related to greater severity of the most stressful life event, Hamilton Rating Scale for Depression scores, and longer duration of untreated illness. The probability of lifetime suicidal behavior was related to Hamilton Rating Scale for Anxiety scores, symmetry obsessions, and washing and checking compulsions. The probability of lifetime non-suicidal self-injurious behaviors was related to Hamilton Rating Scale for Anxiety scores. Recognizing predictors of suicidal ideation/behavior is crucial to identifying patients at greater risk.

Familial risk of psychosis in obsessive-compulsive disorder: Impact on clinical characteristics, comorbidity and treatment response

BackgroundFamily studies in obsessive-compulsive disorder (OCD) indicate higher rates of psychosis among their first-degree relatives (FDRs). However, the etiological and clinical relationships between the two disorders remain unclear. We compared the clinical characteristics and pharmacological treatment response in patients diagnosed with OCD with a family history of psychosis (OCD-FHP), with a family history of OCD (OCD-FHO) and those with sporadic OCD (OCD-S). MethodsA total of 226 patients who met DSM-IV criteria for OCD (OCD-FHP = 59, OCD-FHO = 112, OCD-S = 55) were included for analysis. All patients were evaluated using the Mini International Neuropsychiatric Interview (MINI 6.0.0), Yale-Brown Obsessive-Compulsive Scale (YBOCS), and the Family Interview for Genetic Studies (FIGS). Treatment response was characterized over naturalistic follow-up. ResultsThe three groups did not differ across any demographic or clinical variables other than treatment response. Patients in the OCD-FHP group were found to have received a greater number of trials with serotonin reuptake inhibitors (SRI) [F (2,223) = 7.99, p < 0.001], were more likely to have failed ≥2 trials of SRIs (χ2 = 8.45, p = 0.014), and less likely to have attained remission (χ2 = 6.57, p = 0.037) ConclusionsWe observed that having a relative with psychosis may predispose to treatment resistance in OCD. Further research on the influence of genetic liability to psychosis on treatment response in OCD may offer novel translational leads.

Aripiprazol and Hypersexuality: when partial is to much

IntroductionA growing number of published cases has showed that hypersexual behavior may arise with treatment with second-generation antipsychotics, including aripiprazole and olanzapine. Aripiprazole is a second-generation antipsychotic commonly used to treat schizophrenia and bipolar disorder. It has a unique pharmacologic profile acting as a partial agonist of the dopamine D2 receptor, as a partial agonist at the 5-HT1A receptor, and as an antagonist at the 5-HT2A receptor. Literature shows that medication with partial dopaminergic agonistic activity can cause compulsive behaviors, such as pathological gambling, compulsive eating, compulsive shopping, and hypersexuality. Although it is difficult to predict who would develop these behaviors, the literature suggests that patients at a higher risk of developing impulsive behaviors include those with a personal or family history of obsessive-compulsive disorder, impulse control disorder, bipolar disorder, impulsive personality, alcoholism, drug abuse, or other addictive behaviors.ObjectivesHere, we present a case of a 32-year-old male who developed hypersexuality symptoms after receiving aripiprazole as treatment for bipolar disorder.MethodsWe have done a literature review using the MeSH terms Aripiprazole and hypersexuality in the “PubMed”.ResultsAfter switching Aripiprazole to Risperidone the hypersexuality symptoms started to decrease and got almost complete relief after 2 weeks.ConclusionsThis case highlights the rare hypersexuality side effect that can arise in patients receiving aripiprazole for bipolar disorder treatment. Clinicians should be aware of the increased risk of hypersexuality and other impulsive behaviors as they can significantly impair a patient’s daily functioning.DisclosureNo significant relationships.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: Preliminary Findings From a Study in the United Arab Emirates.

Objective: To investigate the prevalence of obsessive-compulsive disorder (OCD) during the coronavirus disease 2019 (COVID-19) pandemic among the general population of the United Arab Emirates. Methods: An online survey of a convenience sample was conducted between October 2020 and January 2021. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was used to assess symptoms of OCD. The rate of OCD symptoms in those who had positive COVID-19 test results was compared with those who had no previous COVID-19 diagnosis. Results: The total number of participants was 702, including 371 males and 325 females (6 skipped the question regarding sex). Most participants reported no previous psychiatric history (84.3%). Previous psychiatric diagnoses were reported by 15.7% of participants (n = 110) and included generalized anxiety (27.3%), phobia (1.8%), depression (19.1%), bipolar mood disorder (1.8%), OCD (6.3%), and panic attacks (8.2%). There were 39 (5.6%) participants who had past psychiatric history but were unsure of the exact diagnosis. Presence of history of OCD for the total sample was reported by 7 (1%) participants. A family history of OCD was reported by 34 (4.8%) participants. A total of 218 (31.1%) participants scored mild, moderate, severe, or extreme OCD symptoms. Clinically significant OCD symptoms were reported by 75 participants (10.7% of the total sample). The mean (SD) score of the Y-BOCS was 6.63 (7.13) for the COVID-positive group and 4.9 (6.34) for the COVID-negative group, which was statistically significant (P = .0008). Conclusions: The study findings indicate an increased prevalence of OCD during the COVID-19 pandemic, which is significantly higher among people with positive COVID-19 infection compared to those with negative COVID-19 test results.

Preschool-onset OCD: A review of literature and clinical experience.

Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2-3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those treated adequately.

Did psychopathology in Indian psychiatric patients change following the COVID-19 pandemic?

Did psychopathology in Indian psychiatric patients change following the COVID-19 pandemic?

Moderators and predictors of response to deep transcranial magnetic stimulation for obsessive-compulsive disorder

Deep transcranial magnetic stimulation (dTMS) has emerged as a treatment option for adults with obsessive-compulsive disorder (OCD) who continue to exhibit impairing symptoms following an adequate response to first line interventions. Currently, little is known about the predictors or moderators of dTMS outcome for OCD. This paper examined if several theoretically relevant variables may predict and moderate treatment effects including OCD symptom severity, functional impairment, co-occurring depressive symptoms, age, gender, age of OCD onset, and family history of OCD. As part of a previously reported study, 100 patients received 29 dTMS or sham stimulation treatments over 6 weeks. dTMS was administered using a Magstim Rapid2 TMS (The Magstim Co. Ltd., Whitland, Carmarthenshire, United Kingdom) stimulator equipped with a H shaped coil design, which was specifically designed to stimulate the dorsal mPFC-ACC bilaterally. Findings suggest older participants and those with lower OCD severity and disability respond faster to both dTMS and sham stimulation. dTMS of the dorsal mPFC/ACC appeared to have larger benefits for individuals with greater OCD severity, whereas the difference between treatment arms was minimal in those with lower severity. Implications of these findings for treatment of OCD are discussed.

Clinico-epidemiological Profile of Obsessive Compulsive Patients in a Tertiary Care Hospital in Mangalore, India: A Retrospective Study

Introduction: Obsessive-compulsive disorder (OCD) is the fourth most common mental illness. It is associated with a wide range of functional impairments and therefore adversely affects the quality of life of patients. Objectives: To assess the risk factors, clinical features and management practices of OCD based on findings were stated in medical records. Methodology: The secondary data from the medical records of 9 OCD patients admitted in a tertiary care hospital over the past 10 years were recorded in a semi-structured proforma. Severity of OCD was assessed using Yale Brown Obsessive Compulsive Scale scores. Results: Mean age of onset among all patients (n=9) was 27.9±15.2 years. Family history of OCD was reported among 3(33.3%) patients. Six had predominant obsessions while the rest 3 had mixed type. The most common type of obsession was of sexual type reported among 3 patients. The most common compulsion reported was the checking type which was present among 2 patients. Reduced concentration, suicidal ideation and anhedonia were present each among 5(55.6%) patients. Depression was the most common co-morbidity reported among 5(55.6%) patients. Severity of OCD was mild among 5(55.6%). Fluvoxamine was the most common drug [5(55.6%)] used to treat OCD. Outcome of treatment was reported poor among 3(33.3%) patients. It was good/moderate among 1(25%) patient residing in urban area in comparison to 5(100%) from rural areas (p=0.048). Conclusion: Mean age of onset was found to be delayed among patients probably due to delay in identification of OCD. Hence awareness generation and early screening need to be initiated for early identification of OCD. The majority of OCD patients had positive history of suicide ideation and depression as co-morbidity, indicating the need of screening patients for these conditions.

Error-related brain activity as a transdiagnostic endophenotype for obsessive-compulsive disorder, anxiety and substance use disorder.

Increased neural error-signals have been observed in obsessive-compulsive disorder (OCD), anxiety disorders, and inconsistently in depression. Reduced neural error-signals have been observed in substance use disorders (SUD). Thus, alterations in error-monitoring are proposed as a transdiagnostic endophenotype. To strengthen this notion, data from unaffected individuals with a family history for the respective disorders are needed. The error-related negativity (ERN) as a neural indicator of error-monitoring was measured during a flanker task from 117 OCD patients, 50 unaffected first-degree relatives of OCD patients, and 130 healthy comparison participants. Family history information indicated, that 76 healthy controls were free of a family history for psychopathology, whereas the remaining had first-degree relatives with depression (n = 28), anxiety (n = 27), and/or SUD (n = 27). Increased ERN amplitudes were found in OCD patients and unaffected first-degree relatives of OCD patients. In addition, unaffected first-degree relatives of individuals with anxiety disorders were also characterized by increased ERN amplitudes, whereas relatives of individuals with SUD showed reduced amplitudes. Alterations in neural error-signals in unaffected first-degree relatives with a family history of OCD, anxiety, or SUD support the utility of the ERN as a transdiagnostic endophenotype. Reduced neural error-signals may indicate vulnerability for under-controlled behavior and risk for substance use, whereas a harm- or error-avoidant response style and vulnerability for OCD and anxiety appears to be associated with increased ERN. This adds to findings suggesting a common neurobiological substrate across psychiatric disorders involving the anterior cingulate cortex and deficits in cognitive control.

SU71 - BDNF GENE AND OBSESSIVE COMPULSIVE DISORDER – DO SYMPTOM DIMENSIONS HAVE SPECIFIC GENETIC CORRELATES?

Background Obsessive Compulsive Disorder (OCD) is a common neuropsychiatric disorder with a worldwide 12-month prevalence ranging from 1% to 2% across studies (Weissman et al., 1995; Ruscio et al., 2010). Characterized by repetitive intrusive thoughts, images and impulses (obsessions) and repetitive behaviors or mental acts (compulsions), the clinical phenotype of OCD appears to be complex. Genetic etiology of Obsessive Compulsive Disorder (OCD) has been investigated extensively, with mixed results across candidate gene studies. In this study, we perform a case control analysis of association of a single nucleotide polymorphism rs6265(Val66Met) in Brain Derived Neurotrophic Factor gene, that has been previously implicated in a variety of psychiatric syndromes, and examine its association with symptom dimensions of OCD. Methods Patients (n=377) diagnosed with OCD by DSM IV – TR were recruited from a specialty OCD clinic at the NIMHANS, Bengaluru, INDIA. Patients were assessed on socio-demographic data, detailed history of illness, presence of common co-morbid disorders, family history of OCD and major psychiatric disorders, and treatment details. Patients were additionally assessed on Yale Brown Obsessive Compulsive Scale (YBOCS), Mini International Neuropsychiatric Interview plus (MINI plus) Clinical Global Impression scale (CGI). Control population (n=449) consisted of healthy individuals also of south Indian origin. MINI plus was administered to screen and rule out psychiatric diagnosis in this group. DNA samples were genotyped for polymorphism rs6265 (Val66Met) using Quantitative Real time PCR. Results Factor analysis yielded five factor solutions as the best fit for the data explaining 65% of the variance as follows - Factor-1 with robust loading on hoarding obsession (0.891) & collecting compulsions (0.913). Factor-2 with Obsessions of need for symmetry (0.821) & ordering compulsions (0.864). Factor-3 with Pathological doubts obsessions (0.824) & checking compulsions (0.819). Factor-4 with Sexual (0.680), religious (0.655) &aggressive obsessions (0.554), mental rituals compulsions (0.630) and Factor-5 with Contamination obsessions (0.919) & washing compulsions (0.893). The allele ‘A’ frequency was found to be significantly higher in the controls, as compared to cases suggesting a protective effect. Among the clinical variables tested in univariate analysis by genotype, factor-5 (contamination obsessions with washing compulsions) and factor 1 (hoarding), dimension scores was significantly lower in ‘A’ carriers in subjects with OCD compared to homozygous G carriers (GG). Discussion Our findings suggest a protective effect of the rarer Met allele in OCD. The lower factor-5 scores in Met carrier patients and its confirmation after controlling for the confounders further suggests a probable specific protective effect in contamination-washing dimension of OCD. This dimension, which is one of the most commonly observed clinical phenotype, may represent a more homogenous group, with specific biological underpinnings. Functional imaging studies show that the same sub-group of OCD patients demonstrate specific regional activation in ventromedial prefrontal regions in symptom provocation paradigm (Mataix-Cols et al., 2004). The Met allele of rs6265 has also been associated with volumetric reduction in the same region (Yu et al., 2009). These findings suggest a need for future imaging and genetic studies in specific symptom dimensions of OCD.

D-Cycloserine augmentation of cognitive behavior therapy for pediatric OCD: Predictors and moderators of outcome

BackgroundOver half of children receiving cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) do not fully remit. To improve response rates and enhance extinction learning, d-cycloserine (DCS) has been examined as an augmenting agent of CBT. To direct children with OCD towards treatments with the highest likelihood of success, the current study evaluated the conditions under which DCS augmentation works best (i.e., moderators) and the baseline characteristics associated with outcome, irrespective of treatment type (i.e., predictors). MethodsData came from a two-site randomized controlled trial (N = 142) in which children received either DCS + CBT (n = 70) or placebo + CBT. ResultsNo baseline variables moderated the effects of DCS augmentation on CBT outcome. However, several predictor variables were associated with a decreased likelihood of achieving remission status, including higher family accommodation scores, higher impairment scores, higher depression scores, and higher externalizing scores. Furthermore, better insight at pre-treatment was associated with more improvement longitudinally on a clinician-rated summary measure of illness severity. LimitationsThe current study did not examine all variables that had previously been shown to moderate or predict treatment outcome (e.g., family history of OCD or cognitive profile). ConclusionsThe absence of significant moderators suggests that baseline factors cannot yet be used to determine who benefits most from DCS. To maximize treatment benefits for children presenting with identified predictors of worse treatment outcome, clinicians might need to adapt existing CBT protocols and administer additional interventions that address patients’ specific problem areas.

Obsessive-compulsive symptoms in children with first degree relatives diagnosed with obsessive-compulsive disorder

Objective:A first-degree relative affected by obsessive-compulsive disorder (OCD) and obsessive-compulsive symptoms (OCS) in childhood is an important risk factor for developing the disorder in adulthood. The relationship between a family history of OCD and the presence of OCS and its correlates in childhood is not well established.Methods:A total of 66 children whose parents or siblings have been diagnosed with OCD were assessed for the presence of OCS and clinical correlates.Results:Three children (4.5%) were reported to have received an OCD diagnosis and another 26 (39.4%) were identified as having OCS. Children with OCS had higher rates of coercive behavior and came from families with lower socioeconomic status. Contamination/cleaning dimension symptoms in the proband were associated with OCS in the assessed children.Conclusion:OCS are frequent among family members of individuals with OCD and are associated with socioeconomic status, coercive behaviors and proband contamination/cleaning symptoms. Future longitudinal studies should test the risk of developing OCD in association with these characteristics.

Clinical profile and outcome in a large sample of children and adolescents with obsessive–compulsive disorder: A chart review from a tertiary care center in India

Background:Obsessive–compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Till date, the sample sizes in the Indian studies have been relatively small.Methodology:The present study is a retrospective chart review of a large sample of children and adolescents diagnosed with OCD in a tertiary care centerObjectives:The objectives of this study were to characterize the clinical profile and to evaluate outcome of OCD in children and adolescentsResults:Fear of contamination and washing/cleaning compulsions were the most common presenting symptoms. Most of the patients were male with two-thirds having a comorbid disorder. Major depressive disorder was the most common comorbid disorder. The rates of attention deficit hyperactivity disorder, disruptive behavioral disorders, and tic disorders were low when compared to Western studies. One-third of the patients received adequate trial of serotonin reuptake inhibitors and 36% received cognitive behavior therapy. Fifty-four percent of patients had a poor outcome with hospitalization, longer duration of illness, earlier onset of OC symptoms, and family history of OCD being the predictors of poor outcome.Conclusion:The present study of a large sample of patients with juvenile OCD highlights the low rate of comorbid disruptive behavior disorders as reported in the earlier Indian studies and a favorable short-term outcome in approximately 56% of the patients.

Volitional saccade performance in a large sample of patients with obsessive-compulsive disorder and unaffected first-degree relatives.

Recent evidence indicates that patients with obsessive-compulsive disorder (OCD) as well as their unaffected first-degree relatives show deficits in the volitional control of saccades, suggesting that volitional saccade performance may constitute an endophenotype of OCD. Here, we aimed to replicate and extend these findings in a large, independent sample. One hundred and fifteen patients with OCD, 103 healthy comparison subjects without a family history of OCD, and 31 unaffected first-degree relatives of OCD patients were examined using structured clinical interviews and performed a volitional saccade task as well as a prosaccade task. In contrast to previous reports, neither patients nor relatives showed impairments in the performance of volitional saccades compared to healthy controls. Notably, medicated patients did not differ from nonmedicated patients, and there was no effect of depressive comorbidity. Additional analyses investigating correlations between saccade performance and OCD symptom dimensions yielded no significant associations. In conclusion, the present results do not support the notion that volitional saccade execution constitutes an endophenotype of OCD. Possible explanations for inconsistencies with previous studies are discussed.

Familial occurrence of tic disorder, anxiety and depression is associated with the clinical presentation of obsessive compulsive disorder (OCD) in children and adolescents

Obsessive compulsive disorder (OCD) is a neuropsychiatric entity. The aim was to explore the association of familial OCD, tics, anxiety, and depression with the presentation of OCD in offspring. To our knowledge, this is the first study examining the association of other familial psychiatric disorders with OCD in offspring.A total of 198 families recruited to a Scandinavian multicenter treatment study participated. Characteristics of the child were assessed with standard measures. Family psychiatric disorders were assessed with two methods: a parent interview with open questions and a parent interview with specific questions concerning tics, depression, anxiety, and OCD.A family history of OCD was described in 6% of the probands. No differences were observed between children who had relatives with OCD and children without familial occurrence of OCD. Familial tic disorder was associated with comorbid tics, externalizing disorders, repeating compulsions, and hoarding in the child proband. Familial anxiety was associated with internalizing disorders and comorbid tics, whereas familial depression was associated with somatic obsessions and hoarding in the proband.Our study shows that familial occurrence of other psychiatric disorders is associated with differences in the clinical presentation. Identifying subtypes may have implications for our understanding of the etiology of OCD.

Illness perception, help-seeking attitudes, and knowledge related to obsessive-compulsive disorder across different ethnic groups: a community survey.

Despite similar prevalence rates across ethnicities, ethnic minorities with obsessive-compulsive disorder (OCD) are under-represented in research and clinical settings. The reasons for this disproportion have been sparsely studied. We explored potential differences in illness perception, help-seeking attitudes, illness knowledge, and causal attributions that could help explain the lower uptake of treatment for OCD amongst ethnic minorities. Two-hundred and ninety-three parents (139 White British, 61 Black African, 46 Black Caribbean, and 47 Indian) were recruited from the general population in South-East London, UK. Using a text vignette methodology, participants completed a survey including questions on illness perception, help-seeking attitudes, OCD knowledge, and causal attributions. The groups did not differ in socio-demographic characteristics and family history of OCD. White British parents perceived that the OCD difficulties would have more negative impact on their children and that treatment would be more helpful, compared to the ethnic minorities; the largest differences were observed between White British and Indian parents. Ethnic minorities were more prone to say that would seek help from their religious communities. Black African parents were more in favor of not seeking help for the described difficulties and, in general, perceived more treatment barriers. White British parents seemed to be better informed about OCD than ethnic minority parents. The results offer some plausible explanations for the large inequalities in access to services amongst ethnic minorities with OCD. Clinicians and policy-makers need to be aware of these socio-cultural factors when designing strategies to encourage help-seeking behaviors in these populations.

Heredity in comorbid bipolar disorder and obsessive-compulsive disorder patients.

SummaryPartly due to the overlap of symptom groupings in DSM, psychiatric comorbidity is extremely common. One of the most common and difficult to manage comorbid conditions is the co-occurrence of bipolar disorder (BD) and obsessive compulsive disorder (OCD). However, the key nosological question about this condition – whether they are two distinct disorders or a subtype of one of the disorders – remains unresolved. In order to help address this unanswered question, we updated our recent systematic review, searching the electronic databases MEDLINE, Embase, and PsycINFO to specifically investigate the heredity in BD-OCD patients. We identified a total of 8 relevant papers, the majority of which found that, compared to non-BD-OCD patients, BD-OCD patients were more likely to have a family history for mood disorders and less likely to have a family history for OCD. These results support the view that the majority of cases of comorbid BD-OCD are, in fact, BD cases. If confirmed in larger, more focused studies, this conclusion would have important nosological and clinical implications.

Is late-onset OCD a distinct phenotype? Findings from a comparative analysis of "age at onset" groups.

Significant differences in clinical profile and comorbidity patterns have been observed between "juvenile-onset" and "adult-onset" obsessive-compulsive disorder (OCD). There is little systematic research on onset of OCD after the fourth decade. The current study aims to compare the demographic, clinical, and comorbidity patterns of patients with "juvenile-onset" (<18 years), "adult-onset" (18-39 years), and "late-onset" (≥40 years) OCD. Eight hundred two consecutive patients who consulted a specialty OCD clinic at a tertiary care hospital in India were evaluated with the Mini International Neuropsychiatric Interview, the Yale-Brown Obsessive-Compulsive Scale, and the Clinical Global Impression scale. 37.4%, 57.4%, and 5.2% of patients had juvenile-, adult-, and late-onset OCD, respectively. Late-onset OCD was associated with female gender (χ2=42, p<0.001); negative family history of OCD in first-degree relatives (χ2=20.4, p<0.001); and less aggressive obsessions (χ2=18.16, p<0.001), sexual obsessions (χ2=26.68, p<0.001), pathological doubts (χ2=19.41; p<0.001), and repeating rituals (χ2=44.28; p<0.001). On multinomial logistic regression, late-onset OCD was significantly associated with female gender, collecting compulsions, and less aggressive obsessions, in comparison with adult-onset OCD. In comparison with juvenile-onset, late-onset OCD was significantly associated with female gender, presence of precipitating factors, and less aggressive obsessions, sexual obsessions, and repeating compulsions. Late-onset OCD is characterized by female gender, lesser familial loading for OCD, and presence of precipitating factors, suggesting that it may have a distinct pathophysiology compared to juvenile- and adult-onset OCD. Systematic research is required to understand the family-genetic, neuropsychological, and neurobiological correlates of late-onset OCD.

Dissociation of decision making under ambiguity and decision making under risk: a neurocognitive endophenotype candidate for obsessive-compulsive disorder.

Evidence in the literature suggests that executive dysfunction is regarded as an endophenotype candidate for obsessive-compulsive disorder (OCD). Decision making is an important domain of executive function. However, few studies that have investigated whether decision making is a potential endophenotype for OCD have produced inconsistent results. Differences in the findings across these studies may be attributed to several factors: different study materials, comorbidity, medication, etc. There are at least two types of decision making that differ mainly in the degree of uncertainty and how much useful information about consequences and their probabilities are provided to the decision maker: decision making under ambiguity and decision making under risk. The aim of the present study was to simultaneously examine decision making under ambiguity as assessed by the Iowa Gambling Task (IGT) and decision making under risk as measured by the Game of Dice Task (GDT) in OCD patients and their unaffected first-degree relative (UFDR) for the first time. The study analyzed 55 medication-naïve, non-depressed OCD patient probands, 55 UFDRs of the OCD patients and 55 healthy matched comparison subjects (CS) without a family history of OCD with the IGT, the GDT and a neuropsychological test battery. While the OCD patients and the UFDRs performed worse than the CS on the IGT, they were unimpaired on the GDT. Our study supports the claim that decision making under ambiguity differs from decision making under risk and suggests that dissociation of decision making under ambiguity and decision making under risk may qualify to be a neurocognitive endophenotypes for OCD.