Obsessive-compulsive Disorder Spectrum Disorders Research Articles

Obsessions and Delusions: The Clinical Overlap and Differential Diagnosis of Obsessive-Compulsive and Psychotic Disorders

Obsessive-compulsive symptoms (OCS) are commonly observed in the pre-illness, prodromal, first-episode, and chronic stages of schizophrenia. Similarly, patients with obsessive-compulsive disorder (OCD) can present with delusional levels of conviction that border on psychosis. Transitions between OCD and schizophrenia spectrum disorders are also common. The phenomenological overlap between obsessions and delusions can be challenging for accurate diagnosis and treatment planning. Clinicians may struggle to differ entiate obsessions from delusions in severe OCD and similarly may not know if the emerging obsessive symptoms in schizophrenia require specialized OCD treatment. This review summarizes the current literature on comorbid obsessive-compulsive and psychotic disorders, transitions between these two disorders, the impact on prognosis, and the clinical strategies in differential diagnosis as well as treatment planning. [ Psychiatr Ann . 2023;53(5):199–203.]

Subjective impact of COVID-19 pandemic on youth with tic and OCD spectrum disorders

ObjectivesThis study investigated the perceived impact of the COVID-19 pandemic on youth with chronic tic disorders (CTD) and/or obsessive–compulsive disorder (OCD) based on subjective reports, objective measures, and parental feedback. This study also sought to investigate whether and how these reported experiences differed based on the presence of underlying tic and/or OCD spectrum diagnoses. MethodsChildren with CTD, OCD, and Tics + OCD and their parents were recruited to complete an online survey from July 2020 through April 2021. Forty-eight responses were received; child respondents had a median age of 12 years. ResultsOn average, youth reported that the pandemic negatively impacted them in several domains, particularly after-school activities, relationships with friends, and social/community gatherings. Despite the small sample size, youth with OCD appeared to experience a greater negative impact compared to other subgroups. Median screen use in this sample was 3–8 hours a day, and youth who reported > 8 hours on weekends trended towards increased depressive symptoms. ConclusionConsistent with the physician-authors’ clinical experiences, youth with CTD, OCD, and Tics + OCD and their parents reported a subjective negative impact of the pandemic on various symptoms and psychosocial domains. Going forward, if another lockdown loomed, it would be valuable to stay attuned to these vulnerable youth, particularly those with OCD symptoms, and consider providing support in specific psychosocial domains, such as relationship with peers and home life.

Zwangsstörung

Obsessive-compulsive disorder (OCD) and OCD spectrum disorders are frequent diseases with a complex, biopsychosocial etiology and pathogenesis. An OCD is characterized by repetitive thoughts, impulses and behavior, which occur intrusively against inner resistance, and are recognized as exaggerated and unreasonable by the patient. The symptoms are experienced as burdening and torturous. In contrast to former estimates the disorder can be treated successfully so that with treatment according to the guidelines a substantial reduction of symptoms can be achieved. This article discusses the classification of the disorders in the International Statistical Classification of Diseases and Related Health Problems 11th revision (ICD-11) and the essential innovations in the current revision of the S3 guidelines on OCD.

Digging Signatures in 13-Month-Old 3xTg-AD Mice for Alzheimer's Disease and Its Disruption by Isolation Despite Social Life Since They Were Born.

The severity of this pandemic's scenarios will leave significant psychological traces in low resistant and resilient individuals. Increased incidence of depression, anxiety, obsessive-compulsive disorder (OCD), and post-traumatic stress disorder has already been reported. The loss of human lives and the implementation of physical distance measures in the pandemic and post-COVID scenarios may have a greater impact on the elderly, mostly in those with dementia, as OCD and other neuropsychiatric symptoms (NPS) are quite prevalent in this population. Modeling NPS in animals relies in neuroethological perspectives since the response to new situations and traumatic events, critical for survival and adaptation to the environment, is strongly preserved in the phylogeny. In the laboratory, mice dig vigorously in deep bedding to bury food pellets or small objects they may find. This behavior, initially used to screen anxiolytic activity, was later proposed to model better meaningless repetitive and perseverative behaviors characteristic of OCD or autism spectrum disorders. Other authors found that digging can also be understood as part of the expression of the animals' general activity. In the present brief report, we studied the digging ethograms in 13-month-old non-transgenic and 3xTg-AD mice modeling normal aging and advanced Alzheimer's disease (AD), respectively. This genetic model presents AD-like cognitive dysfunction and NPS-like phenotype, with high mortality rates at this age, mostly in males. This allowed us to observe the digging pattern's disruption in a subgroup of 3xTg-AD mice that survived to their cage mates. Two digging paradigms involving different anxiogenic and contextual situations were used to investigate their behavior. The temporal course and intensity of digging were found to increase in those 3xTg-AD mice that had lost their “room partners” despite having lived in social structures since they were born. However, when tested under neophobia conditions, this behavior's incidence was low (delayed), and the temporal pattern was disrupted, suggesting worsening of this NPS-like profile. The outcomes showed that this combined behavioral paradigm unveiled distinct features of digging signatures that can be useful to study these perseverative behaviors and their interplay with anxiety states already present in the AD scenario and their worsening by naturalistic/forced isolation.

418 - Digging signatures modeling anxiety and OCD disorders in very old age and end-of-life Alzheimer’s disease and the effect of social isolation: A translational neuroscience approach in times of coronavirus pandemic (COVID-19)

The severity of the current scenarios in this pandemic will leave important psychological traces. In fact, the first clinical reports available already refer to increased incidence of depression and anxiety disorders such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder. At the translational level, modelling of such neuropsychiatric alterations in animal models relays in neuroethological perspectives since response to fearful situations and traumatic events, critical for survival and adaptation to the environment, are strongly preserved in phylogeny. In the wild, mice dig as a ‘defensive behavior’ which is considered to reflect the anxiety state of animals. In the laboratory, mice dig vigorously in deep bedding to bury food pellets or small objects they may find. Thus this behavior, initially used to screen anxiolytic activity was later proposed to better model meaningless repetitive and perseverative behaviors characteristic of OCD or autism spectrum disorders. In the present work, we have studied the digging ethograms in normal and advanced AD-related pathological aging using wildtype and the 3xTg-AD mice, a genetic model of Alzheimer’s disease that presents AD-cognitive dysfunction but also a conspicuous BPSD-like phenotype. We also studied the effects of isolation in this respect, using very old (18 month-old) 3xTg-AD mice that survived to their cage mates, as mortality rates in this animal model are high after 13 months of age. Two digging paradigms, involving different anxiogenic and contextual situations were used to investigate the digging patterns in these very old males with normal and AD-pathological aging, as well as the effects of isolation. The temporal course and intensity of this behavior was found increased in those 3xTg-AD mice that had lost their ‘room partner’ and lived isolated. However, when they were tested under neophobia conditions, incidence of this behavior was smaller and the pattern of digging was disrupted. The results show that this combined paradigm unveils distinct features of digging signatures that can be useful to provide an animal model for these perseverative behaviors and their interplay with anxiety states, which represent an important part of BPSD or can now emerge as a result of the enhancement of obsessive-convulsive behaviors by social-isolation.

Prevalence of obsessive compulsive spectrum disorder in patients seeking dermatological consultation

Background Previous studies have reported the relation between some dermatological presentations and obsessive compulsive disorder (OCD). The aim of this study is to estimate the prevalence of OCD in patients with dermatological disorders attending Mansoura University Hospital, as well as describe the different dermatological presentation of the OCD and possible association between dermatological lesions and the severity OCD. Patients and methods The study was conducted on 500 patients at the Dermatology Outpatient Clinic of Mansoura University. The patients were assessed by Diagnostic and statistical manual of mental disorder V OCD criteria and the Yale Brown Obsessive Compulsive Scale, Arabic version for assessment the severity. Results Among 500 patients, 55 (10.6%) were diagnosed as having OCD spectrum, comprising two (3.8%) with skin excoriations, 14 (26.4%) with trichotillomania, two (3.8%) with body dysmorphic disorder, 0 (0.0) with hoarding disorder, and 37 (69.9) with OCD. Conclusion There was an increased prevalence of OCD spectrum disorders among patients with dermatological disorders. Detection and diagnosis of comorbid psychiatric problems with skin disease is critical to the optimal management of psychodermatological disorders.

Volumetric MRI study of orbito-frontal cortex and thalamus in obsessive-compulsive personality disorder

ObjectivesObsessive compulsive personality disorder (OCPD) is currently thought to bear a close relationship with obsessive-compulsive disorder (OCD), and other compulsive disorders such as eating disorder and autistic spectrum disorder, as well as with the personality disorders, focusing on some important dimensions like phenomenology, heritability, environmental risk factors, comorbidity, course of illness, neurocognitive endophenotypes, and treatment response. In the present study, when we have taken into consideration the knowledge aforementioned, we aimed to examine OFC and thalamus volumes in patients with OCPD. MethodsWe comparatively measured orbito-frontal cortex (OFC) and thalamus volumes of patients with OCPD and healthy control subjects. ResultsPatients with OCPD had considerably smaller left and right OFC volumes compared to those of healthy control subjects. We also found that thalamus volumes of patients were statistically significantly greater than those of healthy comparisons for both sides of region of interest. ConclusionsWe consider that volumetric alterations determined in the present study may be involved in the pathophysiology of the OCPD, considering that OCPD might be related to OCD spectrum disorders neuroanatomically.

Corticostriatal circuit defects in Hoxb8 mutant mice

Hoxb8 mutant mice exhibit compulsive grooming and hair removal dysfunction similar to humans with the obsessive-compulsive disorder (OCD)-spectrum disorder, trichotillomania. As, in the mouse brain, the only detectable cells that label with Hoxb8 cell lineage appear to be microglia, we suggested that defective microglia cause the neuropsychiatric disorder. Does the Hoxb8 mutation in microglia lead to neural circuit dysfunctions? We demonstrate that Hoxb8 mutants contain corticostriatal circuit defects. Golgi staining, ultra-structural and electrophysiological studies of mutants reveal excess dendritic spines, pre- and postsynaptic structural defects, long-term potentiation and miniature postsynaptic current defects. Hoxb8 mutants also exhibit hyperanxiety and social behavioral deficits similar to mice with neuronal mutations in Sapap3, Slitrk5 and Shank3, reported models of OCD and autism spectrum disorders (ASDs). Long-term treatment of Hoxb8 mutants with fluoxetine, a serotonin reuptake inhibitor, reduces excessive grooming, hyperanxiety and social behavioral impairments. These studies provide linkage between the neuronal defects induced by defective Hoxb8-microglia and neuronal dysfunctions directly generated by mutations in synaptic components that result in mice, which display similar pathological grooming, hyperanxiety and social impairment deficits. Our results shed light on Hoxb8 microglia-driven circuit-specific defects and therapeutic approaches that will become essential to developing novel therapies for neuropsychiatric diseases such as OCD and ASDs with Hoxb8-microglia being the central target.

Autism Spectrum Symptoms in Children and Adolescents with Obsessive Compulsive Disorder and Their Mothers.

Obsessive-compulsive disorder (OCD) affects 1-3% of children and adolescents. Although a close relation between OCD and autism spectrum disorder (ASD) has been pointed out, the relation between maternal ASD symptoms and subclinical ASD symptoms in OCD have not been evaluated adequately. In this study, children and adolescents with OCD diagnosis, and OSB indications in their mothers were investigated. The relationship between the clinical severity of these indications in children and adolescents with OCD, and maternal OSB indications will be examined. The study group consisted of 38 cases (8-18 years old) diagnosed with OCD. The control group (n=39) comprised patients of other clinics at hospital, and was matched for gender and age to the OCD patients. The Kiddie Schedule for Affective Disorders and Schizophrenia for School Aged Children - Present and Lifetime Version (K-SADS-PL) was used to diagnose OCD and accompanying comorbidities. Social Communication Questionnaire (SCQ) was used to evaluate children's ASD symptoms while Autism Spectrum Quotient (ASQ) was used to evaluate maternal broad autism phenotype. OCD symptoms in children were evaluated with Children Yale-Brown Obsessive Compulsive Scale-(C-Y-BOCS), and OCD symptoms in mothers were evaluated with Yale-Brown Obsessive Compulsive Scale-(Y-BOCS). There was no significant difference between sociodemographic data of two groups. When cases and controls were compared with SCQ; all subscales' scores and total score of SCQ were statistically significant higher in OCD group and also mothers of OCD group had statistically significant higher scores in total score of ASQ and subscales except "imagination". Also in comparing the groups with Y-BOCS and C-Y-BOCS; OCD group had statistically significant higher scores in these scales. ASD symptoms are prevalent in cases diagnosed with OCD and ASD symptoms increases with OCD severity. Further studies are needed to examine genetic and environmental common risk factors between OCD and ASD.

Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder with and without Autism Spectrum Disorder: Gray Matter Differences Associated with Poor Outcome.

Cognitive behavioral therapy (CBT) is an effective treatment for obsessive–compulsive disorder (OCD) and is also applicable to patients with both OCD and autism spectrum disorder (ASD). However, previous studies have reported that CBT for patients with both OCD and ASD might be less effective than for patients with OCD alone. In addition, there is no evidence as to why autistic traits might be risk factors. Therefore, we investigated whether comorbidity between ASD and OCD may significantly affect treatment outcome and discovered predictors of CBT outcomes using structural magnetic resonance imaging (MRI) data. A total of 39 patients, who were diagnosed with OCD, were enrolled in this study. Of these, except for 2 dropout cases, 15 patients were diagnosed with ASD, and 22 patients were diagnosed with OCD without ASD. Both groups took CBT for 11–20 sessions. First, to examine the effectiveness of CBT for OCD patients with and without ASD, we compared CBT outcomes between the two groups. Second, to investigate how the structural abnormality profile of the brain at pretreatment influenced CBT outcomes, we performed a structural MRI comparison focusing on the gray matter volume of the whole brain in both patients with only OCD, and those with both OCD and ASD. In order to discover neurostructural predictors of CBT outcomes besides autistic traits, we divided our samples again into two groups of those who did and those who did not remit after CBT, and repeated the analysis taking autistic traits into account. The results showed that OCD patients with ASD responded significantly less well to CBT. The OCD patients with ASD had much less gray matter volume in the left occipital lobe than OCD patients without ASD. The non-remission group had a significantly smaller volume of gray matter in the left dorsolateral prefrontal cortex (DLPFC) compared with the remission group, after having partialed out autistic traits. These results indicate that the abnormalities in DLPFC negatively affect the CBT outcome, regardless of the severity of the autistic traits.

A Case Report of Intensive Exposure-Based Cognitive Behavioral Therapy for a Child With Comorbid Autism Spectrum Disorder and Obsessive-Compulsive Disorder

Cognitive behavioral therapy (CBT) with exposure and response prevention (ERP) has proven to be an effective treatment modality for children with obsessive-compulsive disorder (OCD). Less research exists demonstrating efficacy for this treatment modality among children with comorbid diagnoses of OCD and autism spectrum disorder (ASD), and virtually, nothing has been reported examining intensive interventions for the most severe cases. As such, this article discusses the treatment of an adolescent male with severe OCD comorbid with ASD, attention deficit hyperactivity disorder (ADHD), generalized anxiety disorder (GAD), and chronic tic disorder using a cognitive behavioral approach and ERP. We conclude with recommendations for continued clinical research to understand approaches to help nonresponders to standard therapeutic approaches with this challenging population.

Acceptance and Commitment Therapy for Obsessive Compulsive Disorder and Obsessive Compulsive Spectrum Disorders: A Review

This paper reviews Acceptance and Commitment Therapy (ACT) for Obsessive Compulsive Disorder (OCD) and Obsessive Compulsive (OC) spectrum disorders (e.g., trichotillomania and chronic skin picking). It reviews the philosophy of science that underlies ACT: functional contextualism; the basic research that informs it: learning theory, rule governed behavior and relational frame theory; ACT’s model: psychological flexibility; and the research to date that supports ACT for OCD and OC spectrum disorders. Limitations to this research and future directions are discussed. Keywords: Acceptance and commitment therapy, obsessive compulsive disorder.

Obsessive-compulsive disorder as a risk factor for schizophrenia: a nationwide study.

Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians, researchers, and those with the disorders. To assess whether patients with OCD experience an enhanced risk of developing schizophrenia and schizophrenia spectrum disorders and to determine whether a family history of OCD constitutes a risk factor for schizophrenia and schizophrenia spectrum disorders. Using individual data from longitudinal nationwide Danish registers, we conducted a prospective cohort study with 45 million person-years of follow-up. All survival analyses were adjusted for sex, age, calendar year, parental age, and place of residence at the time of birth. A total of 3 million people born between January 1, 1955, and November 30, 2006, were followed up from January 1, 1995, through December 31, 2012. During this period, 30 556 people developed schizophrenia or schizophrenia spectrum disorders. The presence of a prior diagnosis of OCD and the risk of a first lifetime diagnosis of schizophrenia and a schizophrenia spectrum disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals are used as measures of relative risk. The presence of prior diagnosis of OCD was associated with an increased risk of developing schizophrenia (IRR = 6.90; 95% CI, 6.25-7.60) and schizophrenia spectrum disorders (IRR = 5.77; 95% CI, 5.33-6.22) later in life. Similarly, offspring of parents diagnosed as having OCD had an increased risk of schizophrenia (IRR = 4.31; 95% CI, 2.72-6.43) and schizophrenia spectrum disorders (IRR = 3.10; 95% CI, 2.17-4.27). The results remained significant after adjusting for family history of psychiatric disorders and the patient's psychiatric history. A diagnosis of OCD was associated with higher rates of schizophrenia and schizophrenia spectrum disorders. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway.

Characterization of SLITRK1 Variation in Obsessive-Compulsive Disorder

Obsessive compulsive disorder (OCD) is a syndrome characterized by recurrent and intrusive thoughts and ritualistic behaviors or mental acts that a person feels compelled to perform. Twin studies, family studies, and segregation analyses provide compelling evidence that OCD has a strong genetic component. The SLITRK1 gene encodes a developmentally regulated stimulator of neurite outgrowth and previous studies have implicated rare variants in this gene in disorders in the OC spectrum, specifically Tourette syndrome (TS) and trichotillomania (TTM). The objective of the current study was to evaluate rare genetic variation in SLITRK1 in risk for OCD and to functionally characterize associated coding variants. We sequenced SLITRK1 coding exons in 381 individuals with OCD as well as in 356 control samples and identified three novel variants in seven individuals. We found that the combined mutation load in OCD relative to controls was significant (p = 0.036). We identified a missense N400I change in an individual with OCD, which was not found in more than 1000 control samples (P<0.05). In addition, we showed the the N400I variant failed to enhance neurite outgrowth in primary neuronal cultures, in contrast to wildtype SLITRK1, which enhanced neurite outgrowth in this assay. These important functional differences in the N400I variant, as compared to the wildtype SLITRK1 sequence, may contribute to OCD and OC spectrum symptoms. A synonymous L63L change identified in an individual with OCD and an additional missense change, T418S, was found in four individuals with OCD and in one individual without an OCD spectrum disorder. Examination of additional samples will help assess the role of rare SLITRK1 variation in OCD and in related psychiatric illness.

1337 – Obsessive-compulsive disorder and hypochondriasis in schizophrenic patients treated with clozapine vs other atypical antipsychotics

Introduction Despite the growing literature on the co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, there is a lack of studies addressing the co-occurrence of OCD spectrum disorders, such as hypochondriasis, and schizophrenia. Objectives and aims The aim of the study was to investigate the prevalence rates of OCD and Hypochondriasis in schizophrenic patients treated with clozapine versus other atypical antipsychotics (AAPs). Methods We enrolled 24 consecutive schizophrenic patients treated with clozapine attending the ‘Clozapine Clinic’ of the University of Florence and 24 consecutive schizophrenic patients treated with other AAPs. Patient’s assessment was performed with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS), the Hypochondriasis Y-BOCS (HY-BOCS) and the Global Assessment of Functioning Scale (GAF). Results Considering the whole group (n = 48), we found an OCD prevalence rate of 29.2% (n = 14) and a hypochondriasis prevalence rate of 22.9% (n = 11). We found a significant correlation between Y-BOCS and HY-BOCS scores (p = .007) suggesting an association between OCD and hypochondriasis in these patients. We also found a significant negative correlation between H-YBOCS scores and GAF scores (p = .006). Clozapine-treated patients had a higher rate of OCD (37.5% vs 20.8%). and hypochondriasis (37.5% vs 8.3%) than other AAP-treated patients. Conclusions We found a higher prevalence rate of OCD and hypochondriasis comorbidity in schizophrenic patients than in general population. The prevalence rate of OCD and hypochondriasis was higher in clozapine-treated patients versus other AAP-treated patients. Furthermore, the severity of hypochondriasis symptoms was correlated to a lower level of global functioning.

Common limbic and frontal-striatal disturbances in patients with obsessive compulsive disorder, panic disorder and hypochondriasis

Direct comparisons of brain function between obsessive compulsive disorder (OCD) and other anxiety or OCD spectrum disorders are rare. This study aimed to investigate the specificity of altered frontal-striatal and limbic activations during planning in OCD, a prototypical anxiety disorder (panic disorder) and a putative OCD spectrum disorder (hypochondriasis). The Tower of London task, a 'frontal-striatal' task, was used during functional magnetic resonance imaging measurements in 50 unmedicated patients, diagnosed with OCD (n=22), panic disorder (n=14) or hypochondriasis (n=14), and in 22 healthy subjects. Blood oxygen level-dependent (BOLD) signal changes were calculated for contrasts of interest (planning versus baseline and task load effects). Moreover, correlations between BOLD responses and both task performance and state anxiety were analysed. Overall, patients showed a decreased recruitment of the precuneus, caudate nucleus, globus pallidus and thalamus, compared with healthy controls. There were no statistically significant differences in brain activation between the three patient groups. State anxiety was negatively correlated with dorsal frontal-striatal activation. Task performance was positively correlated with dorsal frontal-striatal recruitment and negatively correlated with limbic and ventral frontal-striatal recruitment. Multiple regression models showed that adequate task performance was best explained by independent contributions from dorsolateral prefrontal cortex (positive correlation) and amygdala (negative correlation), even after controlling for state anxiety. Patients with OCD, panic disorder and hypochondriasis share similar alterations in frontal-striatal brain regions during a planning task, presumably partly related to increased limbic activation.

Obsessive-compulsive disorder and its related disorders: a reappraisal of obsessive-compulsive spectrum concepts

Obsessive-compulsive disorder (OCD) is a clinical syndrome whose hallmarks are excessive, anxiety-evoking thoughts and compulsive behaviors that are generally recognized as unreasonable, but which cause significant distress and impairment. When these are the exclusive symptoms, they constitute uncomplicated OCD. OCD may also occur in the context of other neuropsychiatric disorders, most commonly other anxiety and mood disorders. The question remains as to whether these combinations of disorders should be regarded as independent, cooccurring disorders or as different manifestations of an incompletely understood constellation of OCD spectrum disorders with a common etiology. Additional considerations are given here to two potential etiology-based subgroups: (i) an environmentally based group in which OCD occurs following apparent causal events such as streptococcal infections, brain injury, or atypical neuroleptic treatment; and (ii) a genomically based group in which OCD is related to chromosomal anomalies or specific genes. Considering the status of current research, the concept of OCD and OCD-related spectrum conditions seems fluid in 2010, and in need of ongoing reappraisal.

Obsessive–compulsive disorder and cyclothymic temperament: An exploration of clinical features

Background: Bipolar disorder comorbidity in obsessive–compulsive disorder (OCD) has relevant implications on the symptomatological expression, complications and pharmacologic treatment of the disorder. Relatively few data exist on OCD comorbid with soft-bipolar forms. The aims of the study are to evaluate affective temperaments in patients with OCD and to analyze differences in socio-demographic and clinical characteristics according to the presence or absence of cyclothymic temperament. Methods: The sample consisted of 167 patients with a principal diagnosis of OCD (DSM-IV-TR). Affective temperaments have been evaluated through the Italian semistructured interview version of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS-I). Results: A total of 90 patients (53.9%) were diagnosed with a dominant affective temperament. Cyclothymic affective temperament (CT) was the most represented in the sample of OCD patients (19.2%). Patients with CT showed significant lower mean age at onset, higher scores at the HAM-A, more repeating compulsions, higher rates of eating disorder comorbidity, OCD spectrum disorder comorbidity and higher rates of Axis II comorbidity (particularly Cluster A). Limitations: Recruitment of OCD patients from a tertiary center. Absence of an investigation about treatment implications associated with cyclothymic temperament. Conclusions: Patients with OCD and CT could be more severe and complicated compared to patients without CT. Moreover, individuals with OCD spectrum disorders may be vulnerable to bipolarity. Systematic assessment of affective temperament is necessary to detect OCD with such a soft-bipolar comorbidity.

New-onset obsessive–compulsive disorder following neurosurgery for medication-refractory seizure disorder

A 31-year-old man with medication-refractory seizures in the context of right mesial temporal lobe sclerosis and right occipital encephalomalacia is described. He experienced the onset of obsessive-compulsive symptoms following resection of the right hippocampus and right occipital pole. Semistructured psychiatric evaluation was conducted 16 months after surgery. Results indicated that he fulfilled diagnostic criteria for obsessive-compulsive disorder (OCD) and that he was not depressed at the time of the evaluation. Total score on the Yale-Brown Obsessive Compulsive Scale was 24, indicating moderate symptom severity, and he had prominent symptoms related to contamination, washing, checking, repeating rituals, and ordering. He also reported significant problems with "not just right" experiences. Treatment with sertraline resulted in apathy. To our knowledge, the present case is only the fourth reported of de novo onset OCD following neurosurgery for seizure disorder, and the first in a patient without either preexisting obsessive traits or an OCD spectrum disorder.

Multiple rare SAPAP3 missense variants in trichotillomania and OCD

Multiple rare SAPAP3 missense variants in trichotillomania and OCD