Onset Of Obsessive-compulsive Disorder Research Articles

Journal Digest: Riluzole, and Hyperarousal; Children, OCD, and Pandemic; Apathy, Dementia, and Older Adults; Cannabis, and Opioids; COVID, Xenophobia, and Mental Health

Journal Digest: Riluzole, and Hyperarousal; Children, OCD, and Pandemic; Apathy, Dementia, and Older Adults; Cannabis, and Opioids; COVID, Xenophobia, and Mental Health

Impacts of Stressful Life Events and Traumatic Experiences on Onset of Obsessive-Compulsive Disorder.

Not a few patients with obsessive-compulsive disorder (OCD) have experienced events that affected the onset. The onset of OCD is not limited to the original meaning of trauma; rather, traumatic experiences such as unexpected exposure to contaminants or various stressful life events often cause the onset of OCD. It would be useful to understand the experiences surrounding the onset, including stressful life events and traumatic experiences, for comprehension of the pathophysiology of OCD. In the present study, we investigated the onset conditions of 281 patients with OCD and compared clinical characteristics among groups with or without stressful life events including traumatic experiences. As a result, 172 (61.2%) participants had experienced various stressful life events, and 98 (34%) participants had had traumatic experiences before the onset. Furthermore, the participants who had had stressful life events showed more contamination/fear symptoms compared with those without such life events. Meanwhile, the patients who had had specific traumatic experiences showed a tendency toward hoarding obsessions. To comprehend the pathophysiology of OCD, it is important to understand the stressful life events that precede its onset.

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

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

Are anxiety disorders a pathway to obsessive-compulsive disorder? Different trajectories of OCD and the role of death anxiety

Objectives A body of research has demonstrated high rates of comorbidity among individuals with obsessive-compulsive disorder (OCD). Further, recent empirical evidence has demonstrated the relevance of death anxiety in OCD. Given that the trajectory towards OCD remains unclear, the current study aimed to examine which disorders individuals typically experience prior to the onset of this disorder. Further, the study aimed to explore the role of death anxiety in the developmental pathways to the disorder. Methods The present study involved administering a measure of death anxiety and conducting structured diagnostic interviews among a treatment-seeking sample of 98 individuals with OCD. Results First, the findings revealed a number of anxiety-related disorders commonly experienced prior to the development of OCD, the most frequent of which were separation anxiety disorder, specific phobias, and generalised anxiety disorder. Second, consistent with hypotheses, individuals with higher death anxiety experienced more disorders prior to the onset of OCD. Conversely, those with lower fears of death were significantly more likely to develop OCD as their first disorder. Conclusions These findings support the argument that death anxiety may influence the trajectory towards OCD, and the comorbidity among anxiety-related disorders. However, further research is needed to clarify whether death anxiety plays a causal role in this trajectory.

Quality of Life in Families With a Young Child With Pediatric Autoimmune Neuropsychiatric Disorder Associated With Streptococcal Infections (PANDAS)

Abstract Date Presented 03/29/20 PANDAS is the sudden onset of obsessive-compulsive disorder or tics following streptococcal infection in a previously healthy child. We will discuss our qualitative phenomenology study of six families with a child with PANDAS whose symptoms developed prior to beginning school and consider how symptoms affected families. We will discuss implications of results for OT practitioners. Primary Author and Speaker: Barbara Demchick Additional Authors and Speakers: Julia Ehler, Alison Mills

Obsessive compulsive disorder in very young children \u2013 a case series from a specialized outpatient clinic

BackgroundPaediatric obsessive-compulsive disorder (OCD) is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is 10.3 years; however, reports on young children with OCD show that the disorder can manifest itself at an earlier age. Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment. The objective of this study is to enhance knowledge about the clinical presentation, diagnosis and possible treatment of OCD in very young children.Case presentationWe describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old). At the moment of first presentation, all children were so severely impaired that attendance of compulsory Kindergarten was uncertain. Parents were deeply involved in accommodating their child’s rituals. Because of the children’s young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. Parents were asked to bring video tapes of critical situations that were watched together. They were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level / class.ConclusionsDisseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD.

Pediatric Acute-Onset Neuropsychiatric Syndrome: A Data Mining Approach to a Very Specific Constellation of Clinical Variables.

Objectives: Pediatric acute onset neuropsychiatric syndrome (PANS) is a clinically heterogeneous disorder presenting with: unusually abrupt onset of obsessive compulsive disorder (OCD) or severe eating restrictions, with at least two concomitant cognitive, behavioral, or affective symptoms such as anxiety, obsessive-compulsive behavior, and irritability/depression. This study describes the clinical and laboratory variables of 39 children (13 female and 26 male) with a mean age at recruitment of 8.6 years (standard deviation 3.1). Methods: Using a mathematical approach based on Artificial Neural Networks, the putative associations between PANS working criteria, as defined at the NIH in July 2010 (Swedo et al. 2012), were explored by the Auto Contractive Map (Auto-CM) system, a mapping method able to compute the multidimensional association of strength of each variable with all other variables in predefined dataset. Results: The PANS symptoms were strictly linked to one another on the semantic connectivity map, shaping a central "diamond" encompassing anxiety, irritability/oppositional defiant disorder symptoms, obsessive-compulsive symptoms, behavioral regression, sensory motor abnormalities, school performance deterioration, sleep disturbances, and emotional lability/depression. The semantic connectivity map also showed the aggregation between PANS symptoms and laboratory and clinical variables. In particular, the emotional lability/depression resulted as a highly connected hub linked to autoimmune disease in pregnancy, allergic and atopic disorders, and low Natural Killer percentage. Also anxiety symptoms were shown to be strongly related with recurrent infectious disease remarking the possible role of infections as a risk factor for PANS. Conclusion: Our data mining approach shows a very specific constellation of symptoms having strong links to laboratory and clinical variables consistent with PANS feature.

‘Hiccups of the mind’: psychotherapy with a young boy with obsessive-compulsive disorder

ABSTRACT This paper presents a case study of a six-year-old boy who, unusually, had intensive psychoanalytic psychotherapy as a form of treatment for OCD. Obsessive-compulsive disorder (OCD) can be clinically diagnosed as a psychiatric condition from the age of four or five. The standard treatment for OCD in the NHS tends to be a combination of cognitive and behavioural therapies. This little boy suffered classic symptoms of OCD, which included repetitive intrusive thoughts, compulsions, and ritualistic behaviour. After just over two years of psychoanalytic treatment, his distressing symptoms were alleviated, and in the follow-up sixteen months later, the symptoms had not re-emerged. This paper highlights the psychoanalytic approach used in this case, focusing on the meanings and possible aetiology of paediatric OCD. Using the qualitative research approach of thematic analysis, three main themes that emerged in this work are discussed, by referring to clinical examples from the child’s therapy. Based on the findings, I suggest that the contribution and maintenance of early onset OCD in this boy, to some extent camouflaged infantile relationship struggles, particularly in relation to oedipal difficulties. I will describe a ‘turning point’ in the therapy, to further illustrate my formulation, as well the demonstrating the complexity of the process of change in child psychotherapy, as evidenced in this case.

Obsessive compulsive-disorder and reproductive life events.

We explored the association between reproductive life events and the onset or exacerbation of obsessive-compulsive disorder (OCD) among women in comparison with men with OCD. We chose men because there is some evidence of increased occurrence of OCD in expectant fathers as well. We recruited 150 eligible outpatients (58 men and 92 women) with OCD, who attended a specialty OCD Clinic over a period of one year. Occurrence of any life event including reproductive life events in the year before the onset of OCD was assessed using the Interview of Recent Life Events (IRLE). Reproductive life events in the year prior to onset of OCD were overrepresented in women compared to men. Postpartum onset and worsening of OCD was reported in 14 % and 11 % of women respectively. Menarche and menopause as life events were infrequently reported (3% and 1%). Symmetry obsessions and ordering compulsions were more common in women with post-partum onset of OCD than those without. Post-partum period seems to be associated with onset and exacerbation of OCD; therefore, routine screening for OCD during this period is necessary.

Parental emotional warmth interacts with traumatic life events in predicting the onset of obsessive-compulsive disorder

Adverse life events increase the risk of obsessive-compulsive disorder (OCD). Parental rearing may serve as a protective factor in the face of adversity. We investigated whether parental rearing moderates the association between adverse life events and the subsequent first onset of OCD. A representative sample of individuals (aged 14–24 years) was followed for over 10 years (N = 2210). OCD and any adverse life event, that is, any separation event or any traumatic life event, were assessed using the Munich-Composite International Diagnostic Interview. Parental rearing was assessed by self-report, using the Questionnaire of Recalled Parental Rearing Behavior. Both maternal (risk ratio, RR = 0.08, 95% confidence interval, CI [0.02, 0.31]) and paternal (RR = 0.16, 95% CI [0.03, 0.89]) emotional warmth moderated the association between any adverse life event and OCD. Maternal (RR = 0.16, 95% CI [0.03, 0.77]) and paternal (RR = 0.17, 95% CI [0.04, 0.78]) emotional warmth interacted specifically with any traumatic life event but not with any separation event in predicting OCD. We did not find any interactions with parental overprotection or rejection in predicting OCD. Parental emotional warmth may be a protective factor for OCD among individuals who experience traumatic life events. Future studies should evaluate whether interventions enhancing parental emotional warmth among those who experience traumatic life events can prevent OCD.

Health practitioners' recognition and management of postpartum obsessive-compulsive thoughts of infant harm.

The postpartum period has been associated with elevated rates of onset ofobsessive-compulsive disorder (OCD) among women, with a prevalence of 2-9%. Postpartum OCD is often characterized by recurrent, unwanted, and highly distressing thoughts, images, or impulses of deliberate infant harm. This study investigated health practitioners' recognition of, and clinical management strategies for, postpartum obsessive-compulsive symptoms (OCS). Ninety-four perinatal health practitioners from a range of disciplines and professional backgrounds completed a survey comprised of a hypothetical case vignette and questions eliciting their responses to a clinical presentation of postpartum infant harming obsessions. Almost 70% of participants did not accurately identify OCS within the case. Furthermore, the majority of practitioners endorsed at least one contraindicated clinical management strategy likely to aggravate postpartum OCS. Accurate recognition of OCS was associated with the selection of fewer contraindicated strategies. Some aspects of practitioner training and experience were associated with correct OCS identification. These findings underscore the need for targeted, interdisciplinary education to improve the detection and management of women experiencing postpartum OCS.

“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

Advances in the pharmacological management of obsessive-compulsive disorder in the postpartum period

ABSTRACTIntroduction: Obsessive-compulsive disorder (OCD) is a psychiatric disorder characterized by obsessions and compulsions. Obsessions are defined as intrusive, recurrent and distressing thoughts, images or impulses, whereas compulsions are defined as repetitive behaviors or mental acts. While there is an associated distress, and indeed oftentimes, the individual’s awareness that these behaviors are excessive and unreasonable, the individual continues to be disabled by an inability to cease their compulsions. The postpartum period may herald the onset of OCD or precipitate an exacerbation of the preexisting OCD symptoms. Common OCD symptom clusters occur in the postpartum period, with specific challenges associated with motherhood and lactation.Areas covered: This brief review aims to review the extent and nature of publications evaluating pharmacological treatment of OCD in the postpartum period.Expert opinion: Education and training should aim to improve the recognition and treatment of postpartum OCD. Due to the limited nature of studies, more research is required to assess the role of selective serotonin reuptake inhibitors in the postpartum period.

The speed of progression towards obsessive-compulsive disorder

BackgroundThere is current interest in the elaboration of early intervention programs for obsessive-compulsive disorder (OCD). To this end, it is important to investigate the speed of progression from subthreshold symptoms to diagnosable OCD. In this study, we have retrospectively investigated the speed of progression towards full-blown OCD and sociodemographic and clinical factors associated with a faster transition. MethodsPatients enrolled in the Brazilian Research Consortium on Obsessive-Compulsive Spectrum Disorders (N = 954) were interviewed with a comprehensive assessment battery that included the interval (in years) between the onset of subthreshold OCD symptoms and the onset of full-blown OCD. ResultsIt took a median of 7 years (interquartile range: 2–13 years) for subthreshold symptoms to convert to diagnosable OCD. Faster OCD onset was associated with lower age at the time of assessment, male gender, being in new romantic states as precipitants for compulsions, greater severity of sexual/religious symptoms and lower severity of hoarding and YBOCS compulsions severity scores, greater rates of generalized anxiety disorder and agoraphobia without panic disorder, and negative family history for OCD. LimitationsThe retrospective design of this study allowed for susceptibility to memory bias about age at onset of OCD symptoms. We were unable to capture progressions taking less than 12 months. ConclusionsWe could identify a specific phenotype that was more likely to escalate rapidly to clinical levels within this large clinical sample. This phenomenon may be particularly relevant in the context of selecting individuals for early intervention initiatives in situations when resources are scarce.

Current Pharmacological Treatments for Childhood Onset OCD

Obsessive-compulsive disorder (OCD) is a chronic condition associated with substantial morbidity, comorbidity, and functional impairment in affected youths. Fortunately, efficacy has been established for multiple pharmacotherapies; however, treatment response remains neither universal nor complete; hence, treatment development efforts continue. This review aims to examine evidence for recent trials examining augmentation strategies for partial responders to serotonin reuptake inhibitors (SRIs), the efficacy of adding D-cycloserine (DCS) to cognitive behavioral therapy (CBT), interventions for OCD symptoms associated with infection, and a meta-analytic view of SRI efficacy and dose-response outcomes. Augmentative treatment with SRIs or additional CBT confers additional benefit in CBT partial responders; however, DCS augmentation does not enhance CBT outcomes. Further treatment development is needed to establish effective interventions for infection-related OCD symptoms, and an SRI dose-response curve does not appear to be evident when examining across multiple SRI trials. Implications of these finding for next-stage research efforts and clinical practice are considered.

Neurocognitive risk markers in pediatric obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) has complex genetic underpinnings, particularly in its early-onset form, which places siblings at a 10-fold increased risk of developing the disorder. Examination for neurocognitive markers preceding pediatric OCD onset has not been conducted, although markers have been identified in adult OCD. This study compared neurocognition across groups of OCD-affected youth (n=87), unaffected siblings of those with early-onset OCD (n=67), and healthy controls (HC; n=79). A total of 233 participants aged 6-18years old completed standardized neurocognitive tests of cognitive flexibility, decision making, planning, response inhibition, spatial working memory, attention, recognition nonverbal memory, and intelligence. They were administered the Anxiety Disorders Interview Schedule-Parent version (ADIS-P) and completed self-report anxiety and OCD questionnaires. Linear mixed-effects models tested for differences between groups, adjusting for age, gender, IQ, state anxiety, and ethnicity, and accounting for random effects of family membership. OCD-affected youth and unaffected siblings performed significantly worse on planning in comparison to HCs (Cohen's d=0.74; 95% CI=[0.11, 1.36]; Cohen's d=0.75; 95% CI=[0.12, 1.38], respectively; omnibus group effect p=.007). No other significant between-group differences were identified. Neurocognitive performance differences between groups identified planning as a preexisting trait marker of pediatric OCD, while no other domain presented as a marker of pediatric OCD. This differs from adult OCD, which is associated with broader cognitive impairments. Investigating longitudinal trajectories and predictive significance of neurocognition in those affected by, and at risk for, early-onset OCD is warranted. Ideally, this will enhance individualized risk stratification and inform future prevention and early intervention strategies.

New Onset Obsessive Compulsive Disorder Following High Frequency Repetitive Transcranial Magnetic Stimulation over Left Dorsolateral Prefrontal Cortex for Treatment of Negative Symptoms in a Patient with Schizophrenia.

Obsessive-compulsive symptoms and/or obsessive-compulsive disorders (OCD) are frequently comorbid with schizophrenia, though the exact clinical and etiological relationship between them is poorly understood. Here we describe a case that, to the best of our knowledge, is the first report of new-onset OCD in a patient who was receiving high-frequency repetitive transcranial magnetic stimulation over left dorsolateral pre-frontal cortex as an adjuvant therapy for negative symptoms of schizophrenia. Thisreport supports our understanding of OCD as a brain disorder involving hyper-activity of pre-frontal cortex and cortico-striatal-thalamo-cortical circuit dysfunction.

Diagnostic Issues in Early-Onset Obsessive-Compulsive Disorder and their Treatment Implications.

BackgroundThe lifespan approach and recent shift in the conceptualization of Obsessive-Compulsive Disorder (OCD) promoted by the Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM5) along with novel insights into the pathogenesis of this heterogeneous disorder are driving the development of new outcome measures and new treatments for a disease that, on the other hand, is characterized by high rates of refractoriness.Objective and MethodsThe aim of this review is to provide a discussion of the translational evidence about Early Onset OCD (EO) in compliance with a neurodevelopmental and RdoC perspective.Results and ConclusionEO might be considered the neurodevelopmental subtype of OCD. Indeed there is evidence that different clusters of symptoms and dimensions at an early stage predict different trajectories in phenotype and that distinct neurocircuit pathways underpin the progression of the disorder. Despite the development of high refractoriness in the course of the disorder, evidence suggests that EO may be particularly treatment responsive in the early stages, thus showing the need for early recognition and additional recovery oriented studies in this subgroup.Consistent with the neurodevelopmental perspective, immunity and glutamate neurotransmission are emerging as novel pathways for parsing out the neurobiology of OCD, the EO form, in particular, supporting the implementation of new multisystemic models of the OCD phenotype. Brain connectivity patterns, immune and microbiome profiles are standing out as promising areas for biomarkers with the potential for targeted personalized therapies in EO.

Exposure and Response Prevention for Postpartum Obsessive-Compulsive Disorder.

Pregnancy and postpartum periods are associated with increased risk for onset and exacerbation of obsessive-compulsive disorder (OCD) symptoms. Common themes of the obsessive thoughts in this period are fears of accidently or intentionally harming the baby. Postpartum OCD may go underdiagnosed or misdiagnosed due to lack of standardized screening and potential shame associated with reporting these symptoms. Without treatment, OCD symptoms often persist and continue to impair mother's quality of life and interactions with the child. Literature on treatment specific to postpartum OCD is limited to case series and small studies. Exposure and response prevention (ERP), a gold-standard treatment for OCD, seems to be effective for this particular manifestation of OCD. This article presents a case history and ERP treatment course for a patient presenting with sudden onset of OCD following the birth of her child. Key differential diagnostic features, specific treatment strategies, and practice points are also explored.

Risk of schizophrenia among people with obsessive-compulsive disorder: A nationwide population-based cohort study

High comorbidity of obsessive-compulsive disorder (OCD) has been reported in patients with schizophrenia. The sequence of OCD and schizophrenia onset might clarify the underlying pathophysiological relationships between these two disorders, but available evidence is limited. In this study, we used a population-based cohort to investigate the risk of schizophrenia in people with newly diagnosed OCD. Patients who were first diagnosed with OCD from 2000 to 2013 were selected from the Longitudinal Health Insurance Research Database. The non-OCD group was randomly sampled, and matched with the OCD group by gender, age, urbanization level, and income. Cox regression analyses and competing risk model were used to estimate the risk of schizophrenia, adjusting for potential confounding factors. In total, 2009 patients with OCD and 8036 controls were identified. The crude incidences of schizophrenia in the OCD and non-OCD groups were 876.2 per 100,000 person-years and 28.7 per 100,000 person-years, respectively. After adjustment, a substantially higher risk of schizophrenia was observed in the OCD group (hazard ratio = 30.29, 95% confidence interval = 17.91–51.21). Male gender, age of OCD onset before 20 years, and antipsychotic prescription were associated with schizophrenia. Patients with comorbidity of autistic disorder have higher risk of schizophrenia (hazard ratio = 4.63, 95% confidence interval = 1.58–13.56). In conclusion, OCD diagnosis, male gender, age of OCD onset before 20 years, comorbidity of autistic disorder, and antipsychotic use were associated with higher risk of schizophrenia. It is essential for psychiatrists to note that OCD may be the initial presentation of schizophrenia.