Comorbid Obsessive-compulsive Disorder Research Articles

2711 – Trajectory of comorbidity in obsessive-compulsive disorder

Obsessive-compulsive (OC) symptoms may begin at any point of the life span. Comorbid psychiatric disorders in OCD is more a rule than an exception and can contribute to the OCD-related burden. The goal of this study is to understand the trajectory of comorbid disorders in OCD according to the first manifested psychiatric disorder and their impact in the clinical manifestation of OCD and. 1001 consecutive OCD outpatients from the Brazilian Obsessive-Compulsive Disorder Consortium were evaluated. Inclusion criterion: OCD as the main psychiatric diagnosis (DSM-IV). Exclusion criteria: comorbid schizophrenia and mental retardation. The instruments applied were: SCID-I; Y-BOCS; DY-BOCS, YGTSS (significant level =5%). To investigate the age at comorbidities onset Bayesian approach was performed. Those distributions contain all the information obtained by the data for the mean age at onset. OCD patients that presented separation anxiety disorder (N=175, age of onset SAD 5.35) as first diagnosis had higher frequency of social phobia, simples phobia, generalized anxiety disorder and panic disorder (78.3%; p=0.05), somatoform disorders (13.1%; p=0.05) and post-traumatic stress disorder (30.3% p=0.003). OCD patients that presented ADHD (N=50, age of onset ADHD 6.42; age of onset OCD 13.08) as first diagnosis had higher frequency of substance abuse (16.0%; p=0.00001). OCD patients that presented tic disorders (N=44, age of onset tic disorder 6.86; age of onset OCD 16.18) as first diagnosis had higher frequency of OC spectrum disorders (50.0%; p=0.03). First psychopathological manifestation in OCD patients is associated with distinct long-term trajectory of comorbid psychiatric disorders.

Co-morbid disorders in Tourette syndrome.

Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support.

Co-Morbid Disorders in Tourette Syndrome

Tourette syndrome (TS) is often accompanied by other symptoms and syndromes. The two best-known co-morbidities are Attention Deficit Hyperactivity Disorder (ADHD) and Obsessive Compulsive Disorder (OCD), but also other conditions like rage-attacks, depression, and sleeping disturbances are frequent in persons with TS. Both in clinical cohorts and in population-based cohorts the prevalence of co-morbidities is high. The presence of co-morbid ADHD and/or OCD has an impact on psychosocial, educational, and neuropsychological consequences of TS and it is associated with higher rates of other co-morbid disorders, like rage, anxiety, and conduct disorders. The symptoms of a co-morbid disorder might appear prior to the time that tics reach clinical attention. The TS phenotype probably changes during the course of the disease. The exact aetiology of the co-occurrence of co-morbid disorders and TS is not known, but they probably all are neurotransmitter disorders. European guidelines recommend first-choice pharmacological treatment, but randomised double-blinded trials are needed. Professionals need to be aware of the close relationship between TS and co-morbidities in order to give the patients the right treatment and support.

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.

Exploring Maternal and Child Effects of Comorbid Anxiety Disorders among African American Mothers with Depression

Comorbid depression and anxiety disorders are commonly experienced in mothers. Both maternal depression and anxiety as well as their comorbidity has been shown to increase psychopathology in children, however, there is limited research focusing on African American families. The aim of this study is to examine whether comorbid anxiety disorders are associated with maternal depression severity, kinship support, and child behavioral problems in a sample of African American mothers with depression. African American mothers (n = 77) with a past year diagnosis of a depressive disorder and a child between the ages of ages 8-14 were administered a clinician interview and measures of maternal depression severity, kinship support, and child behavior problems (internalizing and externalizing) in a cross-sectional design. Results showed that more than half (58%) of the mothers had a comorbid anxiety disorder and a third had Posttraumatic Stress Disorder (PTSD). Regression analyses showed that comorbid PTSD and Social Phobia were positively associated with maternal depression severity. Maternal comorbid Obsessive Compulsive Disorder (OCD) was associated with child internalizing symptoms. The findings are consistent with other research demonstrating negative outcomes with maternal comorbidity of depression and anxiety, however, there is limited research focused on maternal depression and OCD or PTSD. The study suggests that it is important to consider comorbid anxiety and cultural issues when conceptualizing, studying, and treating mothers with depression and their families.

Late-Onset Obsessive-Compulsive Disorder With Comorbid Narcolepsy After Perfect Blend of Thalamo-Striatal Stroke and Post-Streptococcal Infection

Late-Onset Obsessive-Compulsive Disorder With Comorbid Narcolepsy After Perfect Blend of Thalamo-Striatal Stroke and Post-Streptococcal Infection

The Effects of Comorbid Obsessive-Compulsive Disorder and Attention-Deficit Hyperactivity Disorder on Quality of Life in Tourette Syndrome

Tourette syndrome (TS) is a complex neuropsychiatric disorder affecting patients' quality of life (QoL). The authors compared QoL measures in young patients with "pure" TS (without comorbid conditions) versus those with TS+OCD (obsessive-compulsive disorder), TS+ADHD (attention-deficit hyperactivity disorder), or TS+OCD+ADHD. Age and scores on scales assessing tic severity, depression, anxiety, and behavioral problems were included as covariates. Young patients with both comorbidities exhibited significantly lower Total and Relationship Domain QoL scores, versus patients with pure TS. Across the whole sample, high ADHD-symptom scores were related to poorer QoL within the Self and Relationship domains, whereas high OCD symptom scores were associated with more widespread difficulties across the Self, Relationship, Environment, and General domains. Significant differences in QoL may be most likely when both comorbidities are present, and features of OCD and ADHD may have different impacts on QoL across individual domains.

A controlled study of personality and affect in Tourette syndrome

ObjectiveTourette syndrome (TS) can increase the likelihood of social and emotional difficulties which may shape an individual's personality and self-perception. We investigated personality and affect in patients with TS. MethodsTwenty-five adults with TS (2 with co-morbid obsessive compulsive disorder, 4 with co-morbid attention-deficit hyperactivity disorder and 4 with both co-morbidities), who were not clinically depressed, and 25 matched controls participated in the study. They completed the Ten-Item Personality Index, the Positive and Negative Affect Scale and the Beck Depression Inventory. ResultsAdults with TS exhibited no differences from controls in reported emotional experience or depressive symptoms but did differ for four of the five assessed personality dimensions; extraversion, conscientiousness, openness and emotional stability. Individuals with pure TS (who had no co-morbid conditions) exhibited reduced extraversion and emotional stability compared to controls. Personality scores were not related to tic severity, yet lower emotional stability scores were associated with higher ratings of negative affect. ConclusionsThis study is limited by a restricted sample in terms of size and source. However, our findings indicate that in the absence of depression and common co-morbidities, people with TS differ from controls in indices of personality, which are linked to negative affectivity.

Trajectory in obsessive-compulsive disorder comorbidities

The main goal of this study is to contribute to the understanding of the trajectory of comorbid disorders associated with obsessive-compulsive disorder (OCD) according to the first manifested psychiatric disorder and its impact in the clinical course of OCD and subsequent psychiatric comorbidities. One thousand and one OCD patients were evaluated at a single time point. Standardized instruments were used to determine the current and lifetime psychiatric diagnoses (Structured Clinical Interview for DSM-IV Axis I and for impulse-control disorders) as well as to establish current obsessive-compulsive, depressive and anxiety symptom severity (Yale-Brown Obsessive-Compulsive Scale; Dimensional Yale-Brown Obsessive-Compulsive Scale, Beck Depression and Anxiety Inventories and the OCD Natural History Questionnaire). To analyze the distribution of comorbidities according to age at onset Bayesian approach was used. Five hundred eight patients had the first OC symptom onset till the age of 10 years old. The first comorbidity to appear in the majority of the sample was separation anxiety disorder (17.5%, n=175), followed by ADHD (5.0%, n=50) and tic disorders (4.4%, n=44). OCD patients that presented with separation anxiety disorder as first diagnosis had higher lifetime frequency of post-traumatic stress disorder (p=0.003), higher scores in the Sexual/Religious dimension (p=0.04), Beck Anxiety (p<0.001) and Depression (p=0.005) Inventories. OCD patients that initially presented with ADHD had higher lifetime frequencies of substance abuse and dependence (p<0.001) and worsening OCD course (p=0.03). OCD patients that presented with tic disorders as first diagnosis had higher lifetime frequencies of OC spectrum disorders (p=0.03). OCD is a heterogeneous disorder and that the presence of specific comorbid diagnoses that predate the onset of OCD may influence its clinical presentation and course over the lifetime.

Neurological soft signs in obsessive–compulsive disorder: The effect of co-morbid psychosis and evidence for familiality

Patients with obsessive-compulsive disorder (OCD) have increased rates of neurological soft signs (NSS) when compared to healthy controls. However, previous findings have been confounded by the presence of co-morbidity with disorders themselves associated with increased NSS, such as schizophrenia. Moreover, it remains unclear whether NSS in OCD reflect a vulnerability to this disorder. This study aimed to examine: 1) the severity of NSS in patients with OCD alone, in patients with OCD and co-morbid psychosis (schizophrenia or bipolar disorders), and in healthy controls; and b) whether unaffected first-degree relatives of patients with OCD also demonstrate a higher prevalence rate of NSS than healthy controls. NSS were assessed with the Cambridge Neurological Inventory (CNI) in 100 patients with OCD, 38 patients with OCD and psychosis (22 with bipolar disorders and 16 with schizophrenia), and 101 healthy controls. Forty-seven unaffected first-degree relatives of patients with OCD only were also administered the CNI. Patients with OCD showed significantly higher scores in motor coordination and total NSS than controls, and patients with OCD co-morbid with psychosis also showed significantly higher scores in motor coordination and total NSS than controls. Although there were no differences in NSS between patients with OCD only and OCD and psychosis as a whole, patients with OCD co-morbid with schizophrenia showed significantly higher scores in motor coordination than patients with OCD, patients with OCD and bipolar disorder, and healthy controls. Unaffected first-degree relatives only showed a higher prevalence rate than healthy controls in specific motor coordination signs, such as Opposition and Extinction. These findings suggest that patients with OCD exhibit more NSS than healthy controls, and that motor coordination signs may be even more extensive when OCD is co-morbid with psychosis. Some of these abnormalities may be indicative of a vulnerability to these disorders, as indicated by their presence in un-affected first-degree relatives.

Outlining new frontiers for the comprehension of obsessive-compulsive disorder: a review of its relationship with fear and anxiety

Anxiety is an important component of the psychopathology of the obsessive-compulsive disorder (OCD). So far, most interventions that have proven to be effective for treating OCD are similar to those developed for other anxiety disorders. However, neurobiological studies of OCD came to conclusions that are not always compatible with those previously associated with other anxiety disorders. The aim of this study is to review the degree of overlap between OCD and other anxiety disorders phenomenology and pathophysiology to support the rationale that guides research in this field. Clues about the neurocircuits involved in the manifestation of anxiety disorders have been obtained through the study of animal anxiety models, and structural and functional neuroimaging in humans. These investigations suggest that in OCD, in addition to dysfunction in cortico-striatal pathways, the functioning of an alternative neurocircuitry, which involves amygdalo-cortical interactions and participates in fear conditioning and extinction processes, may be impaired. It is likely that anxiety is a relevant dimension of OCD that impacts on other features of this disorder. Therefore, future studies may benefit from the investigation of the expression of fear and anxiety by OCD patients according to their type of obsessions and compulsions, age of OCD onset, comorbidities, and patterns of treatment response.

Obsessive–compulsive aspects as predictors of poor response to treatments in patients with chronic migraine and medication overuse

Patients with chronic migraine (CM) and medication overuse (MO) have a high frequency of psychiatric comorbidity or psychopathological traits, the presence of which may have important implications for the course of the CM and the MO, both for response to treatment and possible relapses. Overuse of symptomatic drugs is regarded as one of the most important risk factor for the transformation of episodic migraine into CM and drug-seeking tendency due to fear of headache in chronic migraine patients shares with obsessive-compulsive disorder (OCD) the compulsive quality of the behavior. Aim of this study was to review the clinical history of a sample of CM patients with MO in which an obsessive-compulsive trait was identified, performing a comparison with a sample of patients without obsessive-compulsive trait. We selected 14 patients with positivity to Spectrum Project OBS (obsessive-compulsive disorder) questionnaire and other 14 patients with negativity to the same tool from among a sample of patients who were enrolled in a previous study on the psychopathological profile of patients suffering from CM with MO. According to data obtained from the clinical records referring to the previous 5 years, patients with OBS questionnaire positivity showed a worse clinical course and a tendency to early relapse in MO after symptomatic medication withdrawal. Our results show that the comorbidity of OCD should be always evaluated in patients with CM and MO as it may play a relevant role--particularly if not treated--among the risk factors favoring the progression of episodic migraine to the chronic form, and/or the tendency to a pathological behavior that prompts the overuse of symptomatic medications.

Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder

Chronic tic disorders (TD) are consistently found to have high rates of comorbidity with obsessive-compulsive disorder (OCD) and attention deficit hyperactivity disorder (ADHD). The purpose of this study is to compare the severity of TD only to TD with comorbid OCD or ADHD based on severity of tics, measures of psychopathology and additional comorbid diagnoses. Baseline data from 158 youth with a chronic TD who participated in two longitudinal studies were examined. Fifty-three percent (N = 85) of the youth also met criteria for a diagnosis of OCD, 38.6 % (n = 61) met criteria for ADHD and 24.1 % (N = 38) met criteria for both. Measures of interest addressed severity of tics, symptoms of anxiety, depression, ADHD, psychosocial stress, global functioning and the presence of comorbid diagnoses. Youth with comorbid TD and OCD were characterized by more severe tics, increased levels of depressive and anxious symptoms, heightened psychosocial stress and poorer global functioning. Youth with comorbid TD and ADHD did not differ from those with TD alone on measures of tic severity, but experienced greater psychosocial stress and poorer global functioning. Subjects with comorbid TD and OCD had more internalizing disorders than those without OCD, while those with comorbid ADHD were more likely to meet criteria for oppositional defiant disorder. TD with OCD is a more severe subtype of TD than TD without OCD. TD with ADHD is associated with higher psychosocial stress and more externalizing behaviors. Further research is needed into the underlying relationships between these closely associated conditions.

CLINICAL FEATURES OF BIPOLAR DISORDER COMORBID WITH ANXIETY DISORDERS DIFFER BETWEEN MEN AND WOMEN

Anxiety disorders are commonly comorbid with bipolar disorder (BP) and may worsen course of illness, but differential impact of specific anxiety disorders in men and women remains unknown. We measured the impact of comorbid panic disorder (PD), social phobia, specific phobia, and obsessive-compulsive disorder (OCD) in 460 women and 276 men with Bipolar I Disorder (BPI) or schizoaffective disorder, bipolar type from the National Institute of Mental Health Bipolar Genetics Initiative. We compared clinical characteristics in BP with and without each anxiety disorder in men and women separately correcting for family relatedness. Comorbid PD, OCD, and specific phobia were more common in women with BP than men. Comorbid social phobia correlated with increased risk of alcohol abuse in BP women, but not men. Women with comorbid PD attended fewer years of school. Comorbidity with OCD was associated with earlier age at the onset of BP for both genders. Comorbid PD, OCD, and specific phobia were associated with more antidepressant trials in BP, across both genders, compared to BP patients without these anxiety disorders. In BP, comorbid anxiety disorders are associated with increased risk for functional impairment, and women had differently associated risks than men. Clinicians should be aware of an increased risk for comorbid PD, OCD, and specific phobia in women with BP, and an increased risk of alcohol abuse in women with BD and comorbid social phobia.

Aripiprazole in Children with Tourette's Disorder and Co-morbid Attention-Deficit/Hyperactivity Disorder: A 12-Week, Open-Label, Preliminary Study

Tourette's disorder (TD) in children and adolescents is frequently co-morbid with attention-deficit/hyperactivity disorder (ADHD). Dopamine-blockers are the first line treatment for TD, whereas dopamine-agonists, such as stimulants, are the gold-standard in the treatment of ADHD. These contrasting effects supported concerns about the risk that stimulants for treating ADHD may trigger or worsen co-morbid tics. Aripiprazole, a partial dopamine agonist, acts as an antagonist at dopamine D2 receptors in hyperdopaminergic conditions and displays agonist properties under hypodopaminergic conditions. The present study describes the use of aripiprazole (10.0 ± 4.8 mg/day) in a consecutive group of 28 patients with a primary diagnosis of TD and co-morbid ADHD, combined subtype. The Yale Global Tic Severity Scale (YGTSS) and the ADHD-Rating Scale (ADHD-RS-IV) were used as primary outcome measures and both significantly improved (p<0.001) after the treatment. Global measures of severity (Clinical Global Impressions-Severity) and of functional impairment (Children's Global Assessment Scale) also significantly improved during the treatment (p<0.001). At the YGTSS there was a reduction of 42.5%, in motor tics, of 47.9% in phonic tics (44.7% for the combined scores), and of 32.3% in tic impairment. Nineteen patients (67.9%) had a reduction of at least 50% of the YGTSS score (motor+phonic tics). The improvement at the ADHD-RS-IV score was 22.5%, 12 patients (42.8%) presented an improvement of 30%, but only 2 (7.1%) an improvement greater than 50%. Using a logistic regression model, a reduction of at least 30% in ADHD-RS-IV score was more likely to occur in the obsessive-compulsive disorder co-morbid group. Aripiprazole was well tolerated and none of the patients discontinued medication because of side effects. In summary, aripiprazole resulted in an effective treatment for TD, but it was only moderately effective on co-occurring ADHD symptomatology. Our preliminary data suggest that aripiprazole may represent a possible therapeutic option, among other possible monotherapies addressing both tics and ADHD.

Lateral frontal cortex volume reduction in Tourette syndrome revealed by VBM

BackgroundStructural changes have been found predominantly in the frontal cortex and in the striatum in children and adolescents with Gilles de la Tourette syndrome (GTS). The influence of comorbid symptomatology is unclear. Here we sought to address the question of gray matter abnormalities in GTS patients with co-morbid obsessive-compulsive disorder (OCD) and/or attention deficit hyperactivity disorder (ADHD) using voxel-based morphometry (VBM) in twenty-nine adult actually unmedicated GTS patients and twenty-five healthy control subjects.ResultsIn GTS we detected a cluster of decreased gray matter volume in the left inferior frontal gyrus (IFG), but no regions demonstrating volume increases. By comparing subgroups of GTS with comorbid ADHD to the subgroup with comorbid OCD, we found a left-sided amygdalar volume increase.ConclusionsFrom our results it is suggested that the left IFG may constitute a common underlying structural correlate of GTS with co-morbid OCD/ADHD. A volume reduction in this brain region that has been previously identified as a key region in OCD and was associated with the active inhibition of attentional processes may reflect the failure to control behavior. Amygdala volume increase is discussed on the background of a linkage of this structure with ADHD symptomatology. Correlations with clinical data revealed gray matter volume changes in specific brain areas that have been described in these conditions each.

P-807 - Co-morbidity of obsessive compulsive disorder and bipolar affective disorder in a bedford community psychiatry team

We carried out a study of the prevalence and impact of co-existing bipolar affective disorder on patients with OCD, and the effect on their management within a community psychiatric team. Patients with this co-morbidity appeared to be challenging to treat. We found that 16% of patients who visited psychiatric outpatients with a diagnosis of OCD had co-existing bipolar affective disorder. Of these the majority had bipolar affective disorder II (67%). Compared to the control group the patients with co-morbid bipolar affective disorder had a greater number of hospital admissions,required a greater number of outpatients appointments, were more likely to have been allocated a care coordinator and to have received psychological input.

Atypical presentation of tuberous sclerosis and obsessive compulsive disorder in an adult male

Tuberous Sclerosis (TSC) is clinically marked by a triad of adenoma sebaceum, epilepsy and mental retardation. It can however manifest as various neuropsychiatric disorders. We report a patient who presented with TSC and co-morbid Obsessive Compulsive Disorder.

Depression mediates the relationship between obsessive–compulsive symptoms and eating disorder symptoms in an inpatient sample

Although a significant association between eating disorder symptoms and obsessive–compulsive disorder (OCD) symptoms has been consistently reported in the literature, there remains a paucity of studies aimed at better understanding processes that may account for this association. The present study employed structural equation modeling to examine the extent to which depression explains the relationship between eating disorder symptoms and OCD symptoms in an inpatient sample of individuals with eating disorders. A measurement model specifying significant associations between the three symptom domains provided a good fit to the data. Consistent with predictions, the present study found that the association between latent OCD symptoms and latent eating disorder symptoms was mediated by depression symptoms. Subsequent analysis also revealed structural invariance of the mediated effect between eating disorder patients with and without a comorbid OCD diagnosis. Implications of these findings for better understanding the phenomenological and functional relationship between eating disorders and OCD are discussed.

Aripiprazole Improved Obsessive Compulsive Symptoms in Asperger's Disorder

There are many comorbid disorders associated with autism spectrum disorders in child and adolescent population. Although obsessive compulsive disorder and autism spectrum disorders (ASD) comorbidity has common in clinical practice, there are few reports about psychopharmacological treatment for obsessive compulsive symptoms in children with ASD in the literacy. We report a successful treatment case with aripiprazole in Asperger's Disorder with obsessive compulsive symptoms. The Yale Brown Obsessive Compulsive Scale was performed to assess symptom variety. This case report supports the effectiveness of aripiprazole in treatment of obsessive compulsive symptoms in Asperger's Disorder or ASDs. Aripiprazole may be beneficial to obsessive compulsive disorder comorbid autism spectrum disorders in child and adolescent age group.