Onset Of Obsessive-compulsive Disorder Research Articles

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.

Executive functioning impairments in adolescents with early diagnosis of obsessive compulsive disorder

Despite the neuropsychology literature provide reliable evidence of impaired executive functions in obsessive-compulsive disorder (OCD), it has not been determined whether these deficits are prior to onset of the disorder or they begin to appear as consequence. To investigate whether recent onset of OCD in adolescence is characterized by executive functioning difficulties in behavioral inhibition, attentional flexibility, and decision-making. Executive functions were compared in adolescents with recent (past year) appearance of OCD symptoms (n = 40) and control group (n = 40). Three computerized tests within the CANTAB battery were completed by all subjects (the Affective Go/No Go task, the Intra-Dimensional, Extra-Dimensional Set-Shifting task, and the Decision-Making task). Using one-way ANOVA showed that compared with control group, the OCD adolescents displayed a bias towards negative stimuli with less errors on sad and hopeless words on the Affective Go/No Go task. They also made faster decisions while they bet more of their available points compared to controls, in the Decision-Making task. Adolescents with recent OCD diagnosis (less than one year) showed greater attention towards sad and hopeless stimuli and more impulsive behavior when making decisions. However, they were able to switch attentional set to neutral stimuli. These findings suggest that executive functioning impairments can characterize adolescence OCD from early beginning of the disorder.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

The impact of poor insight on the course of Obsessive-Compulsive Disorder in patients receiving naturalistic treatment

ObjectiveSome patients with Obsessive Compulsive Disorder (OCD) think that their obsessive-compulsive beliefs are true. These patients have OCD with poor or absent insight, a clinical profile that poses a challenge to the clinician. The purpose of this study is to characterize the clinical profile of poor insight OCD and study the impact of poor insight on the two year course of OCD. MethodData were analysed of 253 adult patients with OCD, participating in the prospective naturalistic Netherlands Obsessive Compulsive Disorder Association (NOCDA) Study. Insight was measured using a standardized instrument, the Overvalued Ideas Scale. ResultsGood, fair, poor and absent insight occurred at every severity level of OCD. Poor insight was associated with higher OCD symptom severity, more chronicity, more comorbidity and predicted poor outcome at two-year follow-up, independently of treatment, severity of OCD- and depressive symptoms, age of onset, comorbidity and chronicity of OCD. ConclusionsMore severe and more complex symptoms characterize OCD with poor insight. Poor insight occurs at every severity level of OCD and appears to be an independent phenomenon which predicts poor outcome in OCD. Future work should determine whether improving insight causes better outcome in OCD.

Internet-delivered, family-based treatment for early-onset OCD: A pilot randomized trial.

Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. (PsycINFO Database Record

Clinical practice guidelines for Obsessive-Compulsive Disorder.

Obsessive-compulsive disorder (OCD) is a common psychiatric illness with lifetime prevalence of 1-3% [1]. It is the fourth-most common psychiatric illness and a leading cause of disability. OCD is associated with significant impairment in functioning, quality of life and disability. If untreated, OCD is a chronic illness with a waxing and waning of symptoms. A recent meta-analysis of long-term naturalistic prospective studies demonstrated that nearly a half of patients experience remission with much higher rates of remission in Indian patients compared to those in the west [2]. Early diagnosis and appropriate treatment may improve outcomes. Despite OCD being a common mental illness, most seek treatment after several years of suffering. Those who suffer from OCD tend to be secretive about their symptoms and suffer from shame and embarrassment. Less than a third of OCD sufferers receive appropriate pharmacotherapy and even less receive evidence-based psychotherapy. Symptoms The hallmarks of OCD are presence of obsessions and compulsions. Obsessions are repetitive, unwanted, intrusive thoughts, images or urges that are mostly ego-dystonic and cause severe distress or anxiety. Compulsions (or rituals) are repetitive behaviours or mental acts that are performed in response to an obsession to reduce anxiety/distress or prevent a dreaded consequence. Obsessions and compulsions are time consuming, distressing and are often resisted unsuccessfully. Clinical manifestations of OCD are remarkably similar across cultures and geographic locations. Common obsessions and compulsions and symptom dimensions identified through factor-analytical studies are shown in Table 1. Table 1 Common symptoms of OCD

Pediatric obsessive-compulsive disorder with tic symptoms: clinical presentation and treatment outcome.

Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

A Case of Childhood Onset Obsessive Compulsive Disorder Presented as School Refusal for a Year

School refusal is a common problem seen among children as well as adolescents. It is very commonly present with other psychiatric co-morbidities like anxiety disorders, mood disorders, neuro-developmental disorders, child abuse and many more. OCD is also a common psychiatric condition in children and adolescents. Childhood presentation of OCD becomes difficult to diagnose due to its presentation as well as child’s inability to describe symptoms. If untreated, it will significantly hamper child’s academic, social and family functioning. We present a case of 12 years old boy with one year symptoms of school refusal, sadness and anxiety. He had been evaluated and found to have obsessions and compulsions underlying above mentioned symptoms. He was improved with Fluoxetine, Clomipramine and supportive psychotherapy.

Is "not just right experience" (NJRE) in obsessive-compulsive disorder part of an autistic phenotype?

Harm avoidance (HA) and "not just right experience" (NJRE) have been proposed to be 2 core motivational processes underlying obsessive-compulsive disorder (OCD). The objective of this study was to explore whether NJRE demarcates a neurodevelopmental OCD subgroup distinct from HA related to autistic traits and/or to a broader phenotype of cognitive rigidity and sensory processing difficulties associated with an earlier age of OCD onset. A correlational design investigated whether NJRE and HA are distinct entities in OCD and explored their relationship to autism spectrum disorder (ASD) traits measured by the Autism Quotient (AQ), sensory processing, set-shifting, and age of OCD onset in an OCD sample (N=25). NJRE was only moderately (r=.34) correlated to HA and not significant in this study. Consistent with predictions, NJRE was associated with sensory processing difficulties and an earlier age of OCD onset. No significant relationships were found between NJRE and ASD traits as measured by the AQ or set-shifting difficulties. These preliminary findings suggest a lack of evidence demonstrating NJRE as a manifestation of core autistic traits as measured by the AQ. However, NJRE was associated with sensory abnormalities and an earlier age of OCD onset. The role of NJRE as a developmental, and possibly neurodevelopmental, risk factor for OCD possibly warrants further investigation.

P.1.k.010 - Prevalence changes in DSM-IV major mental disorders: a comparison of two nation-wide surveys conducted 10 years apart in Korea

We conducted a household survey of 3,012 adults aged 18 and over in order to estimate the prevalence of DSM-IV obsessive-compulsive disorder (OCD) in urban areas in Konya, Turkey. Trained psychiatry interns administered the 2.1 version of the OCD section of the Composite International Diagnostic Interview (CIDI). The 12-month period prevalence rate of OCD was 3.0%. The mean age of onset of OCD was 25.9 ± 12.5 (range, 7 to 63) years. The prevalence rate of OCD was slightly higher among females (males 2.5%, females 3.3%), but the difference was not statistically significant. The relative risk for divorced, separated, or widowed subjects was approximately 4.2 times higher for OCD than others (2.7% v 10.5%). The 1-year prevalence of OCD inversely related to age group in male subjects, but increased with age in female subjects. The prevalence rate of OCD was not different by the level of education, except it was statistically higher among subjects who were literate but had no schooling, of which the causal relationship was high prevalence rate of OCD among female literate-but no schooling subjects. Subjects with few (one or two) and more siblings (seven or more) had a significantly higher prevalence rate of OCD than subjects with moderate numbers of siblings (three to six). No significant difference was found according to employment, fertility, birth order, and income of the subjects. About 30% of subjects with OCD had only obsessions, whereas 68.5% had both obsessions and compulsions. Only one subject (1.1%) with OCD met compulsion criteria without obsessions. The prevalence rate of OCD we found in Konya, Turkey was similar to the prevalence rates of most epidemiological studies.

The Clinical Characteristics of ADHD and Obsessive-Compulsive Disorder Comorbidity

Objective: To investigate the clinical implications of obsessive-compulsive disorder (OCD) and ADHD comorbidity in adults. Method: The OCD patients who had and had no diagnosis of adulthood ADHD were compared in terms of several demographic and clinical variables. Results: The mean number of obsessions and compulsions; hoarding, symmetry, and miscellaneous obsessions; ordering/arranging and hoarding compulsions; total, attentional, and motor subscale scores of Barratt Impulsivity Scale (BIS)-11 were more frequent among the patients with OCD-ADHD. The mean age of onset was more likely to be earlier in ADHD-OCD group than in OCD group. Impulsivity, symmetry obsessions, and hoarding compulsions strongly predicted the coexistence between ADHD and OCD. Conclusion: OCD-ADHD comorbidity in adults seemed to be associated with an earlier onset of OCD, with the predominance of impulsivity, and with a different obsessive-compulsive symptom (OC) profile from OCD patients without a diagnosis of ADHD.

Common variants of HTR3 genes are associated with obsessive-compulsive disorder and its phenotypic expression.

Evidence from literature supports the existence of associations between serotonin-related genetic variants and obsessive-compulsive disorder (OCD), but few studies have explored the involvement of serotonin receptor type 3 genes (HTR3) in OCD. To identify whether HTR3 variability affects an individual’s susceptibility to OCD, we examined 10 HTR3 variants in 596 individuals with OCD and 599 controls. A significant difference existed in the genotypic distribution of the HTR3B variant rs1176744 between individuals with OCD and controls (odds ratio [OR] = 0.74, 95% confidence interval [CI] = 0.60–0.91, P = 0.0043). A protective haplotype in HTR3B was also associated with OCD (OR = 0.77, CI = 0.63–0.95, permutated P = 0.0179). Analyses of OCD sub-phenotypes demonstrated significant associations between rs3758987 and early onset OCD in male subjects (OR = 0.49, CI = 0.31–0.79, P = 0.0031) and among rs6766410, rs6443930, and the cleaning dimension in female subjects (OR = 0.36, CI = 0.18–0.69, P = 0.0016 and OR = 0.47, CI = 0.29–0.79, P = 0.0030, respectively). Additionally, rs6766410 was related to contamination-based disgust in OCD (P = 0.0044). These results support that common HTR3 variants are involved in OCD and some of its clinical phenotypes.

Childhood, adolescent and adult age at onset and related clinical correlates in obsessive–compulsive disorder: a report from the International College of Obsessive–Compulsive Spectrum Disorders (ICOCS)

Objective: Many studies suggest that age at onset (AAO) is an important factor for clinically differentiating patients with juvenile and adult onset of obsessive–compulsive disorder (OCD). The present international study aimed to assess the prevalence of different AAO groups and compare related socio-demographic and clinical features in a large sample of OCD patients.Methods: A total of 431 OCD outpatients, participating in the ICOCS network, were first categorised in groups with childhood (≤12 years), adolescent (13–17 years) and adult-onset (≥18 years), then in pre-adult and adult onset (≥18 years) and their socio-demographic and clinical features compared.Results: Twenty-one percent (n = 92) of the sample reported childhood onset, 36% (n = 155) adolescent onset, and 43% (n = 184) adult onset. Patients with adult onset showed a significantly higher proportion of females compared with the other subgroups (χ2 = 10.9, p< 0.05). Childhood- and adolescent-onset patients had been more frequently treated with cognitive behavioural therapy (CBT), compared to adult-onset patients (χ2 = 11.5; p < 0.05). The pre-adult- versus adult-onset analysis did not show any additional significant difference.Conclusions: The present international multicentre study confirms that OCD onset occurs more frequently before adult age, with approximately one out of five patients showing childhood onset. Pre-adult onset was associated with higher rate of CBT, while adult onset was more prevalent in females.

The relation between depressive and obsessive-compulsive symptoms in obsessive-compulsive disorder: Results from a large, naturalistic follow-up study

ObjectiveDespite the frequent occurrence of depressive symptoms in obsessive-compulsive disorder (OCD), little is known about the reciprocal influence between depressive and obsessive-compulsive symptoms during the course of the disease. The aim of the present study is to investigate the longitudinal relationship between obsessive-compulsive and depressive symptoms in OCD patients. MethodWe used the baseline and 1-year follow-up data of the Netherlands Obsessive Compulsive Disorder Association (NOCDA) study. In 276 patients with a lifetime diagnosis of obsessive-compulsive disorder, depressive and obsessive-compulsive symptoms were assessed at baseline and at one-year follow-up with the Beck Depression Inventory (BDI) and the Yale-Brown Obsessive Compulsive Symptom (Y-BOCS) scale. Relations were investigated using a cross-lagged panel design. ResultsThe association between the severity of depressive symptoms at baseline and obsessive-compulsive symptoms at follow-up was significant (β=0.244, p<0.001), while the association between the severity of obsessive-compulsive symptoms at baseline and depressive symptoms at follow-up was not (β=0.097, p=0.060). Replication of the analyses in subgroups with and without current comorbid major depressive disorder (MDD) and subgroups with different sequence of onset (primary versus secondary MDD) revealed the same results. LimitationsThere may be other factors, which affect both depressive and obsessive-compulsive symptoms that were not assessed in the present study. ConclusionThe present study demonstrates a relation between depressive symptoms and the course of obsessive-compulsive symptoms in OCD patients, irrespective of a current diagnosis of MDD and the sequence of onset of OCD and MDD.

OBSESSIVE-COMPULSIVE DISORDER CLINICAL STAGING: FROM ENDOPHENOTYPE TO BEHAVIORAL ADDICTION (A THEORETICAL FRAMEWORK)

abstract Purpose of the study Up to date, no clinical staging models have been proposed or tested for obsessive-compulsive disorder (OCD). The last years’ research has clearly recognized the phenotypical and neurobiological heterogeneity of OCD and has focus on sub-typing OCD both in terms of symptom dimensions and comorbidity patterns. However, there are several evidences supporting the idea that the illness course is responsible for neurobiological changes. Consequently, is reasonable to suppose that these neurobiological changes could be responsible for changes in the phenotypical and clinical expression of the disease [1] . Moreover, longitudinal studies showed that longer duration of illness is a significant predictor of poor long-term course, highlighting the critical importance of early detection and treatment of OCD. Thus, defining and testing a clinical staging model for OCD could be relevant both in the definition of its pathophisiology and in developing new strategies for an earlier intervention. Methods Here, we propose a theoretical staging model based on a putative course of the foundamental neurophenomenological dimensions of OCD and we describe the progressive shift from an anxiety disorder to a behavioral addiction during the course of illness. Results Reward dysfunction represents a key feature of addiction progression. Although anxiety symptoms are a core feature of OCD, current literature shows growing evidences of a reward dysfunction in OCD, mainly in resistant patients. These data support the hypothesis that addiction and OCD share some common neurobiological dysfunctions and have led some authors to view OCD as a behavioural addiction. In this perspective patients may develop a dependency upon compulsive behaviours, because of their rewarding effect when performed perfectly or when compulsions reduce obsession-induced anxiety and distress [2] . The cortico-striatal loop is clearly involved in OCD pathophysiology and neurophenomenology [3] . In this loop we can identify three main neurophenomenological dimensions of OCD: the cognitive dimension (motor disinhibition and cognitive inflexibility), the anxiety dimension and the reward dysfunction dimension. In a clinical staging perspective these dimensions appear at different time during the course of illness in a three stage model representing the progressive shift from frontoamygdalar dysfunction to nucleus accumbens dysfunction. First stage: the endophenotype stage. In this stage the patient present only subtreshold symptoms, but show endophenotypical abnormalities such as motor disinhibition and cognitive inflexibility. Second stage: the anxiety/alarm stage. In this stage the patient has the OCD onset and the anxiety dimension is prominent. Third stage: the reward dysfunction stage. In this stage the patient becomes addicted to compulsions. In our model the OCD patient become addicted to compulsions through the same stages of addiction. Compulions are effective in reducing anxiety in the first stages (binge stage) and become progressively just a habit during the tolerance and withdrawal/habit stages Conclusions defining and testing a clinical staging model for OCD could be relevant both in the definition of its pathophisiology and in developing new strategies for an earlier intervention.

Obsessive-compulsive adults with and without childhood ADHD symptoms.

Obsessive-compulsive disorder (OCD) and attention-deficit and hyperactivity disorder (ADHD) frequently coexist. To understand whether childhood ADHD can increase the risk of OCD in adulthood and whether it influences the phenomenology of OCD, we investigated the symptoms of ADHD during childhood in obsessive-compulsive adults who had never been diagnosed as ADHD. Adults with OCD (n=83) were given the Wender Utah Rating Scale (WURS), Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Barratt Impulsiveness Scale-11 (BIS-11), Hamilton Depression Rating Scale-17 (HDRS-17) and Beck Anxiety Inventory (BAI). The prevalence of childhood ADHD symptoms was 40.9% (n=34) and that of adult ADHD was 16.9% (n=14). Patients with childhood ADHD symptoms had an earlier onset of OCD, higher scores of the BAI and BIS-11. The scores of the Y-BOCS and HDRS-17 did not differ between those having and not having childhood ADHD symptoms. Childhood history of ADHD symptoms is common in adult OCD patients who have never been diagnosed as ADHD. Childhood ADHD symptoms are associated with an earlier age of OCD, more severe anxiety and higher impulsiveness. Even remitted ADHD may be a risk factor for OCD in later life.

Brain structural correlates of obsessive–compulsive disorder with and without preceding stressful life events

Objectives There is growing evidence supporting a role for stressful life events (SLEs) at obsessive–compulsive disorder (OCD) onset, but neurobiological correlates of such effect are not known. We evaluated regional grey matter (GM) changes associated with the presence/absence of SLEs at OCD onset. Methods One hundred and twenty-four OCD patients and 112 healthy controls were recruited. Patients were split into two groups according to the presence (n = 56) or absence (n = 68) of SLEs at disorder’s onset. A structural magnetic resonance image was acquired for each participant and pre-processed with Statistical Parametric Mapping software (SPM8) to obtain a volume-modulated GM map. Between-group differences in sociodemographic, clinical and whole-brain regional GM volumes were assessed. Results SLEs were associated with female sex, later age at disorder’s onset, more contamination/cleaning and less hoarding symptoms. In comparison with controls, patients without SLEs showed GM volume increases in bilateral dorsal putamen and the central tegmental tract of the brainstem. By contrast, patients with SLEs showed specific GM volume increases in the right anterior cerebellum. Conclusions Our findings support the idea that neuroanatomical alterations of OCD patients partially depend on the presence of SLEs at disorder’s onset.

Obsessive-compulsive (Anankastic) Personality Disorder: A Poorly Researched Landscape with Significant Clinical Relevance.

Byline: M. Reddy, M. Starlin, Swetha. Reddy Introduction The constellation of features similar to the obsessive-compulsive (anankastic) personality disorder (OCPD) was first described by Pierre Janet in 1903 as the psychasthenic state. This was later endorsed by Freud in his 1908 work entitled, Character and Anal Eroticism. [sup][1] In 1952, the American Psychiatric Association's Diagnostic and Statistical Manual for Mental Disorders (DSM) made it a diagnosable psychiatric condition. However, unlike other personality disorders, it has been included in all the revisions of the DSM including the DSM-V. Prevalence studies have identified OCPD as a common disorder with a point prevalence rate of 8.7% in an outpatient sample and with a prevalence rate of 23.3% in a psychiatric inpatient sample, according to DSM-IV and DSM-IIIR criteria, respectively. [sup][2] Co-Occurring Conditions It is associated with multiple co-morbid conditions. According to an excellent recent review by Diedrich and Voderholzer [sup][2] the most frequent ones are anxiety disorders with a prevalence of 23-24% and affective disorders with a prevalence of 24%. Among the anxiety disorders, Obsessive-compulsive disorder (OCD) is one of the best researched co-morbid disorders, which has co-occurrence rates of 23-45%. Though Pierre Janet initially posited psychasthenic state, as a necessary condition for the development of obsessive-compulsive symptoms, later researchers like Berg et al . [sup][3] contended that the direction of the relationship is obscure, and it might be that OCPD develops as a coping strategy after the onset of OCD. Whichever may be the direction of the relationship, many agree that majority of people suffering from have at least one personality disorder [sup][4],[5] and that there are high rates of OCPD. Some have even suggested that with OCPD has to be considered as a separate sub-type. [sup][6] We can even consider that certain patients with insight OCD subtype, instead of being delusional, might fit into the category of with OCPD traits (i.e., poor insight interpreted as ego-syntonicity) and might respond to selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT)-exposure and response prevention with/without antipsychotic augmentation, as is the case with resistant OCD. Since 1920s many researchers found the presence of OCPD traits in significant number of people suffering from the depressive disorder. [sup][7],[8] In routine clinical practice, many practitioners observe an occurrence of premorbid OCPD traits such as perfectionism, high moral standards, in the people suffering from the depressive disorder. Co-occurrence of OCPD in depressive disorder has been associated with accelerated relapse of depression. [sup][9] The DSM-V diagnosis of disruptive mood dysregulation disorder (DMDD), which is subsumed under the depressive disorders, may also be theoretically related to OCPD due to the fact that many depressive patients have OCPD traits and that the OCPD traits of perfectionism and rigidity might predispose the individual to irritability and impulsive aggression, more so in the adolescents. In a study [sup][10] which examined co-occurrence of impulsive aggression and several Axis I and II conditions ( n = 118), 24% of clinic-referred patients with impulsive aggression had OCPD compared to 52% who had antisocial personality disorders; among self-referred patients with impulsive aggression, 52% had OCPD. Further investigation into the co-occurrence of behavioral disinhibition and OCPD is warranted. OCPD trait of perfectionism has been shown to be associated with the core psychopathology of Eating disorders and somatoform disorders such as body dysmorphic disorder (BDD), hypochondriasis and chronic fatigue syndrome. OCPD and Perfectionism are proposed by some, as predisposing factors for eating disorders. [sup][11] Fineberg et al . …

Cognitive-behavioural therapy for obsessive-compulsive disorder co-occurring with psychosis: Systematic review of evidence.

AIMTo review available evidence on the use of cognitive behavioural therapy (CBT) for treating obsessive compulsive disorder co-occurring with psychosis.METHODSIn this paper we present a detailed and comprehensive review of the current literature focusing on CBT treatment of obsessive compulsive disorder (OCD) co-occurring with schizophrenia or schizoaffective disorder. We identified relevant literature published between 2001 and May 2016 through MEDLINE/PubMed search using as search string (“obsessive compulsive disorders” or “obsessive compulsive symptoms”) and (“schizophrenia” or “schizoaffective disorder” or “psychosis”) and (“cognitive behavioural therapy”). Other citations of interest were further identified from references reported in the accessed articles. The search was limited to studies written in English and carried out in adult patients. A total of 9 studies, 8 case reports and 1 case series, were found.RESULTSThe reviewed evidence indicates that CBT is: (1) safe, i.e., does not worsen psychotic symptoms; (2) well accepted, with a discontinuation rate quite similar to that reported for patients with OCD without psychosis comorbidity; (3) effective, with a symptom reduction quite similar to that reported for patients with OCD without psychosis and for SRIs treatment of OCD co-occurring with psychosis; and (4) effective in patients with OCD induced by second-generation antipsychotic as well as in patients with OCD not induced by second-generation antipsychotic. Alcohol/substance use disorder comorbidity and OCD onset preceding that of SCH/SA was predictors of poor outcome. These results are derived only by additional studies with adequate sample size.CONCLUSIONOur results support the use of CBT for OCD in patients with psychosis.

A Review-Pandas

PANDAS is hypothesized to be an autoimmune condition in which the body's own antibodies to streptococci attack the basal ganglion cells of the brain, by a concept known as molecular mimicry. PANDAS describes a hypothesis that there exists a subset of children with rapid onset of obsessive-compulsive disorder (OCD) or tic disorders and these symptoms are caused by group A beta-hemolytic streptococcal (GABHS) infections. PANDAS is hypothesized to be an autoimmune disorder that results in a variable combination of tics, obsessions, compulsions, and other symptoms that may be severe enough to qualify for diagnoses such as chronic tic disorder, OCD, and Tourette syndrome. PANDAS is thought to involve autoimmunity to the brain's basal ganglia. children may have other symptoms associated with exacerbations such as emotional liability, enuresis, anxiety, and deterioration in handwriting. five diagnostic criteria were proposed for PANDAS. Concerns have been raised that PANDAS may be over diagnosed, as a significant number of patients diagnosed with PANDAS by community physicians did not meet the criteria when examined by specialists, suggesting the PANDAS diagnosis is conferred by community physicians without conclusive evidence. Treatment for children

Epidemiological Survey on the Status of Obsessive-compulsive Disorder among School-age Children in Iran

Background and purpose: The age of the onset of obsessive-compulsive disord er (OCD) and its manifestation is now identified at childhood. In th e present study, we aimed to epidemiologically assess OCD and its main determinants in school-age children. Materials and Methods: This cross-sectional study was performed on 600 con secutive schoolage children (7-12 years old) in primary schools at Kermanshah, Iran in May 2012. OCD status was assessed using the Maudsley Obsessive Compulsive Inventory . Results: In this study, the prevalence of OCD in children we re 12.2% (73 person). Among OCDs, 32.0% were male and 68.0% were female with a significant difference (P < 0.001). Among different subscales of OCD, checking was more prevalent in girls than in boys (74.0% vs. 65.0%, P < 0.001), whereas doubting was more revealed in boys than in girls (56.0% vs. 34.0%, P < 0.001). In this regard, no differences w ere found between boys and girls in the rate of washing subscale (43.0% vs. 40.0%, P = 0.456) and slowness domain (30.0% vs. 34.0%, P = 0.294). Totally, mean MOCI score was significantly a higher in girls than in boys in different grades of education. OCD was influenced b y father’s occupation status, parents’ education level, order of birth, dependence to moth ers and previous history of OCD in fathers. Conclusion: The prevalence of OCD was a higher than other areas in the country and other populations. Because of the existence of OCD potent ial determinants including socioeconomic level and familial tendency, the high prevalence of the disease must be considered in correlation with these factors.