Late-onset Obsessive-compulsive Disorder Research Articles

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.

Late-Onset Obsessive-Compulsive Disorder With Religious Obsessions

Late-Onset Obsessive-Compulsive Disorder With Religious Obsessions

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.

GDNF rs2910702, rs3096140, and rs3812047 polymorphisms in obsessive compulsive disorder: Preliminary study

The neurobiology of obsessive-compulsive disorder (OCD) is evidenced by a strong demonstration of malfunctions in the serotonergic and dopaminergic system. Recently, glial cell line-derived neurotrophic factor (GDNF) gene polymorphisms have been emphasized in psychiatric diseases and treatment strategies that have been tried to be developed in this regard. In the literature, there are several studies investigating the relationship between GDNF gene polymorphisms and psychiatric diseases excluding OCD. Therefore, this study aimed to compare the symptomatology and GDNF gene polymorphisms in early and late-onset OCD patients. For this purpose, patients diagnosed with OCD according to DSM-V diagnostic criteria in structured clinical interviews were grouped as early and late-onset based on the age of initiation. DNA was isolated from blood samples collected from 140 subjects (70 OCD and 70 healthy controls) in EDTA tubes, and rs2910702, rs3096140, and rs3812047 polymorphisms in GDNF gene were examined by Real-Time PCR. No significant correlation was detected between GDNF and the rs2910702, rs3096140, and rs3812047 polymorphisms in early and late-onset OCD subjects (P&gt;0.05). Failure to detect correlations between OCD and GDNF gene polymorphisms might be due to the variable expression pattern of the GDNF gene in different tissues and pathologies. Therefore, future studies might be improved by including a larger group of patients and examining a wider range of tissues for the expression pattern of GDNF.

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.

Predicting Response to vALIC Deep Brain Stimulation for Refractory Obsessive-Compulsive Disorder.

Background: Deep brain stimulation (DBS) for treatment-refractory obsessive-compulsive disorder (OCD) is effective in half of patients, but also is invasive and labor-intensive.Objective: Selecting probable responders beforehand would more optimally allocate treatment resources and prevent patients' disappointment. Some centers use clinical and demographic predictors to exclude patients from DBS treatment, but the evidence base remains uncertain.Methods: This observational cohort study examined the association of baseline demographic and disease characteristics with a 1-year prospective course of OCD and depressive symptoms in a cohort of 70 consecutive patients who received DBS of the ventral anterior limb of the internal capsule (vALIC-DBS) for OCD according to DSM-IV or DSM-5 criteria between April 2005 and October 2017. Baseline characteristics and symptom decrease were analyzed using Fisher exact tests and binary logistic regression to examine whether they could predict individual response (> 35% reduction in Yale-Brown Obsessive Compulsive Scale score and 50% reduction in Hamilton Depression Rating Scale score, respectively).Results: Insight into illness was the only significant predictor of individual response, with a positive predictive value of 84.4%, while the negative predictive value was 44.0% (b = 0.247, χ21 = 5.259, P = .022). Late-onset OCD was associated with more symptom decrease (β = -0.29; 95% CI, -0.53 to -0.04; P = .023) and comorbid personality disorder with less symptom decrease over time (β = 0.88; 95% CI -0.29 to 1.47; P = .004), but they could not significantly predict vALIC-DBS response. A later age at onset, comorbid personality disorder, and insight into illness were associated with clinical outcomes after vALIC-DBS, but predictive values were not large enough to facilitate clinical patient selection.Conclusions: Clinical and demographic factors cannot yet predict outcome and should not be used to exclude patients from treatment with vALIC-DBS. These first individual prediction analyses for vALIC-DBS response in OCD are important, given that some centers up until now still exclude patients based on clinical characteristics such as comorbid personality disorders.

Late-onset obsessive-compulsive disorder as the initial manifestation of possible behavioural variant Alzheimer’s disease

ABSTRACT Introduction A late-onset obsessive-compulsive disorder (OCD) might be a challenging diagnostic issue because of the overlapping with the dementia conditions more related to frontal lobe pathology. We aim to describe and investigate how this condition might represent the isolated long-lasting symptomatology of a frontal Alzheimer’s disease (AD). Methods An elderly woman with normal cognitive status showed a subacute onset of OCD with contamination obsession and washing compulsion. We conducted neuropsychological assessments and neuroimaging examinations at the onset and at 3-years follow-up. Results At 3-years follow-up, the patient developed cognitive deterioration, frontal behavioural disorders and improvement of OCD. Cognitive assessment showed impairments of executive functions, episodic memory, and constructional apraxia, according to the involvement of fronto-mesial, temporal and parietal regions at neuroimaging. A clinical diagnosis of possible behavioural variant AD was assigned. Conclusion A typical OCD might be the long-lasting initial manifestation of a possible behavioural variant AD due to dysfunctions of the anterior cingulate network.

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.

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.

Neural bases of the clinical and neurocognitive differences between earlyand late-onset obsessive–compulsive disorder

Using biological evidence to define subtypes within the heterogeneous population with obsessive–compulsive disorder (OCD) is important for improving treatment response. Based on age at onset, OCD can be clustered into 2 groups, each of which is more homogeneous with respect to clinical and cognitive phenotype. However, the neural bases for these phenotypic differences need to be established to construct evidence-based homogeneous groups. We compared brain volumes, clinical symptoms, and neurocognitive function for 49 people with early-onset OCD and 52 with late-onset OCD (participants in both groups were unmedicated or drug-naïve), and 103 healthy controls. We performed regression analyses to examine group × volume interaction effects on clinical outcomes or neurocognitive function in people with OCD. We observed larger volumes in the precentral, orbitofrontal, middle frontal, and middle temporal gyri in people with early-onset OCD compared to those with late-onset OCD. Poorer visuospatial construction in early-onset OCD was correlated with a larger left middle frontal gyrus volume. Impaired visuospatial memory in people with early-onset OCD and cognitive inflexibility in people with late-onset OCD were correlated with increased and decreased volume in the left middle frontal gyrus, respectively. We found group × volume interactions for obsessive–compulsive symptom scores in the left middle temporal gyrus of people with OCD. Although we divided the subtypes using the commonly adopted criterion of age at onset, this criterion is still somewhat controversial. We provided the neural bases for clinical and neurocognitive differences to demonstrate that biological evidence underlies the distinctions between early- and late-onset OCD. This study suggests that different treatment options should be considered for the OCD subtypes, because their neurobiology differs and is related to distinct phenotypic profiles.

“SOMETHING BAD CAN HAPPEN”. THE CASE OF A 73 YEAR OLD MAN WITH OBSESSIVE COMPULSIVE DISORDER DUE TO RIGHT HEMISPHERIC INFARCTS

Introduction Obsessive Compulsive Disorder (OCD) following Cerebrovascular Accidents (CVA) is rare but people with CVA are at a higher risk of having OCD than the general population. Here, we present the case of a man who developed OCD after finding lacunar infarcts of the right hemisphere.This is one of the few case reports as this topic is in the early stages of research. Methods Patient was assessed and followed in outpatient psychiatry clinic.The case was reviewed and compared with relevant literature. Results This is a case report of a 73 year old man with history of Type 2 Diabetes and hypertension, no reported psychiatric history or developmental issues, who was referred to our psychiatry clinic after reporting a two year history of repeated daily checks and rituals in his home which were becoming more distressing and disruptive to his daily activities.On interview the patient reported frequently checking outlets, faucets, lights, and even his own clothes for dirt, and excessive hand washing. Patient reported that these checks took up to four hours per day causing him to frequently miss prior engagements and even awakens him at night. During the interview he cleaned the chair before sitting and asked the interviewer to check for stains on his coat. He described related nonspecific obsessive and intrusive thoughts that “something bad can happen” and was worried about contamination. He expressed relief of tension when performing these compulsions. Neurological examination was unremarkable and MMSE 28. CT scan of the brain without contrast, done two years prior to presentation, showed that the patient suffered from a lacunar infarct in the anterior limb of the internal capsule, extending into the putamen (basal ganglia). A diagnosis of Obsessive-Compulsive and Related Disorder due to Cerebral Infarction was made and he was started on an ongoing trial of Sertraline. Conclusions This case shows the rare development of OCD post cerebrovascular infarct in the right basal ganglia. Organic causes for late onset OCD should be considered when symptoms occur above age 50. Literature review suggests orbitofrontal cortex, basal ganglia and anterior cingulate cortex are most consistently implicated but not definitive. Review of cases shows that SSRI appear to be most effective in treating this rare disorder. Further studies on this topic is needed to provide additional details of the clinical features and structural/functional imaging finding. This research was funded by: NA

Association study of the PDE4D gene and obsessive-compulsive disorder in a Chinese Han population.

Multiple evidence suggests an involvement of the PDE4D in mental disorders. Therefore we investigate the association between obsessive-compulsive disorder and a polymorphism of the single nucleotide polymorphisms of PDE4D gene in the Chinese Han population. We genotyped and performed a case-control association analysis of the PDE4D polymorphism rs1838733 in 400 obsessive-compulsive disorder patients and 459 healthy control subjects. The site conformed to Hardy-Weinberg (P > 0.05), three genotypes (AA, AG, GG) of PDE4D gene rs1838733 were detected. We demonstrated three principal results. First, there were no significant differences between the case and health controls in the genotype and allele at rs1838733 (P > 0.05). Second, there were no significant differences in the allele and genotype frequency between different genders obsessive-compulsive disorder (P > 0.05). Third, the genotype of single nucleotide polymorphism rs1838733 was associated with late-onset obsessive-compulsive disorder and female late-onset obsessive-compulsive disorder (P < 0.05). The present study is the first to verify the associations of single nucleotide polymorphisms rs1838733 of the PDE4D gene with obsessive-compulsive disorder in a Chinese Han population. We found the genotype of single nucleotide polymorphism rs1838733 was associated with the occurrence of late-onset obsessive-compulsive disorder and female late-onset obsessive-compulsive disorder. Therefore, PDE4D may play a role in the pathogenesis of obsessive-compulsive disorder and may become a potential target for obsessive-compulsive disorder treatment in future research. Further studies should verify the current findings.

T63GENETIC AND ENVIRONMENTAL FACTORS AND RISK OF OBSESSIVE-COMPULSIVE DISORDER

Genetic risk factors that contribute to obsessive-compulsive disorder (OCD) have yet to be elucidated. Historically, serotonergic dysfunction has been implicated. Evidence from the literature points towards the serotonin receptor 2A gene (HTR2A) as a primary candidate. Our meta-analysis investigated whether polymorphisms in HTR2A are associated with OCD or its subtypes, based on sex and age of onset.Studies employing case-control or family-based designs were systematically searched, and those meeting eligibility underwent quality assessment, resulting in 18 studies. A random-effects meta-analysis using standard inverse-variance weighting to compute odds ratio (OR) was conducted. To examine sensitivity, results were also obtained using a more conservative statistical method.Three HTR2A variants were identified: T102C, G-1438A, and C516T. T102C and G-1438A were analyzed together due to strong linkage disequilibrium, where the 102T allele co-occurs with -1438A allele. Results reported as OR [95%CI] showed that the T/A allele were significantly associated with OCD, 1.14 [1.01, 1.29]. After stratification, results remained significant for females, 1.20 [1.00, 1.45], and early-onset OCD, 1.27 [1.02, 1.58], but not males, 1.06 [0.91, 1.23]. No associations were found for late-onset OCD, 0.98 [0.70, 1.37], or C516T, 1.22 [0.14, 10.37], but conclusions cannot be drawn from two studies.Associations no longer reached significance with the conservative statistical approach. HTR2A alone cannot explain OCD complexity and limited samples reporting genetic data according to subtypes.These results suggest a possible association of HTR2A polymorphisms with OCD, but further investigations considering sex and age of onset with larger samples is needed.

Roles of 5,10-methylenetetrahydrofolate reductase C677T and A1298C polymorphisms in early- and late-onset obsessive-compulsive disorder.

Background:The C677T and A1298C mutations of 5,10-methylenetetrahydrofolate reductase (MTHFR) have been linked with conditions such as depression, bipolar disorder, and schizophrenia, but there are not clear the relationship between MTHFR polymorphisms and obsessive-compulsive disorder (OCD).Aim:The current study was planned to investigate the link between the MTHFR polymorphisms and OCD in patients to reveal any potential correlations that may be used as a novel marker in diagnosis of people who are in high-risk group of developing OCD.Materials and Methods:Blood samples from 64 highly characterized symptomatic cases and 64 gender- and age-matched control participants were analyzed for MTHFR C677T and A1298C gene variants. The MTHFR gene polymorphisms were detected through real-time polymerase chain reaction, followed by melting curve analysis. The results were tested with analysis of variance test and the differences with P < 0.05 were reported as statistically significant.Results:A statistically significant difference in age, education level, and marital status was found in the comparison of all groups in sociodemographic findings (P = 0.004, P = 0.001, and P = 0.001, respectively). A statistically significant difference was found in the comparison of the tic story of early- and late-onset OCD patients (P = 0.002). There was no significant difference in the genotype frequencies and allele distributions of MTHFR polymorphisms between the patients and controls (P > 0.05).Conclusion:The results suggest that MTHFR polymorphisms are unlikely to play a major role in the pathogenesis of OCD. Further studies are needed in biochemical data on folate metabolism to clarify the effect of the MTHFR polymorphisms in OCD pathophysiology.

Variation in obsessive-compulsive symptoms between children and adults

The complexity and diversity of clinical manifestations of obsessive-compulsive disorder have intrigued psychiatrists for a long time. Various differences have been noted in the presentation of obsessive-compulsive disorder of different age group. It was aimed to assess the variations of presentation of symptoms in children and adults in a tertiary level hospital. This study was done in an outpatient department from May 2015 to April 2017. Four hundred patients were included in the study consecutively after considering the inclusion and exclusion criteria. Respondents were interviewed with a semi-structured questionnaire which includes demographic variables, psychiatric diagnoses (DSM-IV-TR) and Y-BOCS symptom checklist. Obsessive-compulsive disorder started before adulthood in 41.5% of patients and onset after 18 years was found to be 58.5%. In this study, cases of obsessions, dirt and contamination was seen to predominate in both early- and late-onset obsessive compulsive disorder (68.3 and 71.4% respectively) and among the cases of compulsions, cleaning variety was found to be highest in both early- and late-onset (65.8 and 73.3% respectively). Age should be taken into account when evaluating obsessive compulsive disorder patients. The results suggest that more studies are necessary to determine whether in fact, it defines a homogeneous and particular group in obsessive-compulsive disorder.

Higher serotonin transporter availability in early-onset obsessive-compulsive disorder patients undergoing escitalopram treatment: A [11 C]DASB PET study.

Early-onset obsessive-compulsive disorder (EOCD) and late-onset obsessive-compulsive disorder (LOCD) are distinct subtypes of obsessive-compulsive disorder (OCD). OCD patients are treated with serotonin reuptake inhibitors, but the difference in serotonin transporter (SERT) availability between medicated EOCD and LOCD is unexplored yet. Six EOCD and 6 LOCD patients were enrolled. They underwent serial [11 C]DASB positron emission tomography scans during maintenance therapy with escitalopram, and their plasma concentration of escitalopram was measured simultaneously with the scan. Then, the drug-free binding potential of SERT was calculated by pharmacokinetic-pharmacodynamic modelling. In comparison with LOCD patients, SERT availability was significantly higher in the putamen of EOCD patients (U=4, p=.026), but not in the caudate nucleus (U=14, p=.589), thalamus (U=16, p=.818), and dorsal raphe nucleus (U=7, p=.093). Binding potential of putamen showed a negative correlation (r=-.580, p=.048) with age of onset of the disease, but not with the Yale-Brown Obsessive Compulsive Scale scores. These findings indicate that the earlier the age of onset of OCD, the less serotonergic pathology there is and that this difference remains even after long-term serotonin reuptake inhibitor treatment. Clinically, it might suggest that nonserotonergic treatments would be a better option for EOCD patients.

Oxytocin receptor gene polymorphisms exert a modulating effect on the onset age in patients with obsessive-compulsive disorder

The oxytocin receptor (OXTR) is a potential candidate in the pathophysiology of obsessive-compulsive disorder (OCD). The present study investigated the association between common single-nucleotide polymorphism (SNPs) of the OXTR gene and the affected status of OCD or distinct clinical subtypes of OCD including the age at onset and symptom dimensions. Ten SNPs of OXTR were examined in 615 patients with OCD and 581 healthy controls. Single-marker and haplotype-based association analyses were conducted. While OXTR variants were not associated with the affected status of OCD or its clinical symptom dimensions, rs2268493 (p=0.00185) and rs13316193 (p=0.00461) of the OXTR gene were associated with the age at onset in patients with OCD. In addition, in haplotype-based association analyses, there was a significant association between the OXTR gene and the onset age in patients with OCD. In particular, the G-C-G haplotype of rs2268493-rs2254298-rs11316193 and the T-G-A haplotype of rs237887-rs2268490-rs4686301 were positively associated with late-onset OCD. Our results suggest that common variants of OXTR may exert a modulating effect on the onset age in OCD pathophysiology. The potential involvement of the oxytocin system in the development and expression of OCD warrants further longitudinal research.

Morphologic and clinical differences between Early- and Late-onset obsessive-compulsive disorder: Voxel-based Morphometric study

• We found significantly increased left thalamic gray matter volume in OCD patients compared to healthy controls.

About a case suicide attempt as a trigger of remission in obsessive and compulsive disorder

IntroductionThis is the case of a 73 year old woman with a late onset, severe and refractory obsessive-compulsive disorder who experimented a sudden remission after a frustrated suicide attempt.ObjectiveOur target is to make a reflection about the relation between traumatic closeness to own death and neurosis spontaneous remission.MethodPatient has been interviewed and her medical record studied.ResultsPatient's psychiatric history shows major depressive disorder, recurrent (ICD 10 CM-F33). Patient is a housewife with primary education. In her psychobiography distinguish a conflictive relationship which probably acted as a trigger for obsessive-compulsive symptoms. These symptoms include obsessive thoughts of contamination, ritual hand washing and avoid contact with others people. In the course of the last 10 years, since the OCD (ICD 10 CM-F42.2) diagnose, the patient has been through a wide therapeutic arsenal, from cognitive-behavioural psychotherapeutic interventions to psychopharmacological treatment, resulting with limited effectiveness. The last treatment was fluoxetine 200 mg (0–0–1) and pregabalin 300 mg (1–0–1). Subsequently, the patient underwent a failed suicide attempt by hanging. After physical recovery, all OCD symptoms had subsided.ConclusionsTraditionally, literature and philosophy considered catharsis as a purifying experience, and Breuer and Freud introduced this concept in modern psychology as a therapeutic method. More recent authors as Yalom have correlated the closeness to death as a stress factor with radical change in life's perspective and attitude. Although current research presents contradicting data about healing effectiveness through a catharsis processes, this case exposes a clear example of positive outcomes in this assumption.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Age at symptom onset is not associated with reduced action cancelation in adults with obsessive-compulsive disorder

The aim of the current study was to examine the association between age at symptom onset and action cancelation in adults with obsessive-compulsive disorder (OCD). Performance on the stop-signal task was compared among adult patients with early-onset OCD (n=63, onset age ≤19), late-onset OCD (n=33, onset age ≥20), and healthy controls (n=51). Stop-signal reaction time (SSRT) was significantly longer in both OCD groups compared to the control group. However, no significant differences were found between the two OCD groups. In addition, age at symptom onset was not associated with response inhibition performance in adults with OCD. The study findings support the existence of reduced performance on action cancelation in patients with OCD compared to healthy controls with no difference between early- and late-onset OCD subtypes.