Severity Of OCD Research Articles

AUTISTIC SPECTRUM DISORDER IN ADULTS WITH OBSESSIVE COMPULSIVE DISORDER: RESULTS FROM A UK SURVEY

BackgroundObsessive compulsive disorder (OCD) and autistic spectrum disorder (ASD) are each characterised by compulsive behaviours. Existing data suggest up to 20% of treatment seeking individuals with OCD demonstrate comorbid autistic traits [1].The impact of autistic traits on OCD is poorly understood. In this study, we investigated the frequency, phenomenology and demographic characteristics associated with the presence of comorbid autistic traits in adult patients attending a specialist clinic for OCD. MethodologyConsecutive patients attending a UK specialist OCD clinic with a clinical diagnosis of DSM IV OCD were invited to consent. Participants completed the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) Checklist, Brown Assessment of Beliefs Scale (BABS) and the Autism Quotient (AQ) [2], a 50-item self-rated screen for autistic traits (AT). A total AQ score of 26/50 was chosen as the ‘cut-off’ to determine the likelihood of ASD. Previous validation studies using the AQ have shown that a score of >=26 predicts a 50% likelihood of DSM-IV ASD [3]. Patients were rated for severity of OCD and Obsessive Compulsive Personality Disorder with the Y-BOCS and Compulsive Personality Assessment Scale (CPAS), respectively. Gender and age of onset of OCD was also collected. Participants who scored >=26 on the AQ (OCD+AT) were seen by an experienced clinician for a structured one-to-one assessment for ASD (including Autistic Disorder, Asperger’s Syndrome, Pervasive Development Disorder Not Otherwise Specified) based on DSM-IV criteria. ResultsOut of a total sample of 135 OCD outpatients, complete data was collected for 67. Twenty-nine of these (43%) scored >=26 on the AQ and of these 21 (31% of sample) were diagnosed with an ASD (Female 48%) following in-depth clinician assessment.In the OCD+AQ group the gender-ratio was roughly equal, (Female 49%, whereas amongst OCD–AQ group, females predominated (58%). Compared to normative data [3], in the complete OCD sample the mean AQ total score (mean=24.19, SD=8.17) fell between that reported for a healthy population sample without mental disorder (mean=16.4, SD=6.3) and another sample diagnosed with high-functioning ASD (mean=35.8, SD=6.5). In the OCD sample, the AQ total score frequencies approximated a bimodal distribution, with the OCD+AT subgroup clustering around a mean total AQ score of 31.69 (SD=4.21). In the OCD+AT group, the AQ items endorsed most frequently occurred within symptom-domains representing impaired ‘attentional switching’ (mean 8.45, SD 1.55), ‘social skills’ (mean 6.86, SD 1.98) ‘communication skills’ (mean 5.38, SD 1.27) ‘attention to detail (mean 6.03, SD=1.92) and ‘imagination’ (mean 5.03, SD1.84 ).No significant differences between the OCD+AT and OCD-AT groups were observed in the age of OCD onset (mean=14.54, SD=8.76 versus 14.10SD=8.03) or the total Y-BOCS score (19.56,SD=8.78 versus 17.74, SD=8.18). However, the OCD+AT group scored significantly higher on the CPAS (mean 17.26, SD=7.24 versus 11.37, SD=7.2: P=0.002) and the BABS (mean 8.30, SD=5.95 versus 4.84, SD=4.42, P=0.014). The AQ total score correlated moderately with the CPAS and BABS (Pearson’s correlation (2 tailed) respectively 0.41 (P=0.001);0.30 (P=0.013). DiscussionOur study sample was limited by small size and the results should be considered preliminary. We found a high prevalence of autistic traits and ASD (around one third) in the treatment-seeking OCD population. These patients were no more severely symptomatic with OCD than the patients scoring low on the AQ, suggesting this does not simply represent a more severe form of OCD.Although the autistic traits that were the most strongly endorsed involved problems shifting attention, suggesting overlap with OCD, other autistic traits not usually associated with OCD were also frequently endorsed, including poor social, communication and imaginative skills, providing support for a true overlap with ASD. The presence of autistic traits was associated with OCPD and poor insight, which carries implications for treatment. The finding of an equivalent gender ratio merits further exploration.

Comparison of clinical characteristics of familial and sporadic obsessive-compulsive disorder

BackgroundObsessive-compulsive disorder (OCD) is a heterogeneous condition with evidence of familiality in a considerable proportion of patients. A classification into familial and sporadic forms has been proposed to explain the heterogeneity. The current study aims to compare the demographic, clinical and comorbidity patterns of patients with and without a family history of OCD in first-degree relatives. Method802 consecutive patients who consulted a specialty OCD Clinic at a tertiary care psychiatric hospital in India were evaluated with the Mini-International Neuropsychiatric Interview, the Yale-Brown Obsessive–Compulsive Scale, and the Clinical Global Impression Scale. Family history was assessed by interviewing patients and at least one first-degree relative. ResultsFamily history of OCD was seen in 152 patients (19%). Family history was associated with juvenile onset (Χ2=19.472, p<0.001), obsessions of contamination (Χ2=6.658, p=0.01), hoarding (Χ2=4.062, p=0.032), need for symmetry (Χ2=3.95, p=0.047), washing compulsion (Χ2=7.923, p=0.005), ordering compulsions (Χ2=6.808, p=0.009), repeating compulsions (Χ2=4.950, p=0.026) and compulsions by proxy (Χ2=7.963, p=0.005). Family history was also associated with greater severity of OCD (t=−2.31, p=0.022) and compulsions (t=−3.09, p=0.002) and longer duration of illness at presentation (t=−2.93, p=0.004). ConclusionOur findings suggest that familial OCD may have distinctive clinical features. Studying familial forms of OCD may offer unique insight in to understanding the genetic basis of OCD.

EPA-1745 – Plasma clomipramine levels in adult obsessive-compulsive disorder patients

The aim of this study was to explore the possible relationship between plasma clomipramine (CMI) and its major metabolite (DMCMI) levels and related parameters, and clinical features in OCD patients. Twenty-six OCD outpatients (13 men, 13 women), suffering from OCD were consecutively enrolled in the study. The severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The measurements were carried out after four weeks and six months from the beginning of the treatment. The drug levels were measured by a HPLC method developed by us. The correlations between biological and clinical parameters were analyzed by means of the Spearman's correlation coefficient. The Mann-Whitney test was used for comparing biological and clinical variables between men and women. The results showed that CMI levels were related to the doses at the two assessment times. A significant and positive correlation was detected at the beginning between the DMCMI/ratio and the Y-BOCS total score, however this was true only for men, where the similar correlations were measured also with the Y-BOCS subscale. After six months of CMI, men showed a significant improvement of the compulsions. These findings would highlight the potential impact of assessing CMI plasma levels and their relationships with specific symptoms, as well as the influence of the gender on the drug response.

P-812 - Clomipramine levels in adult obsessive-compulsive disorder patients

The aim of this study was to explore the possible relationship between plasma clomipramine (CMI) and its major metabolite (DMCMI) levels and related parameters, and clinical features in OCD patients. Twenty-six OCD outpatients (13 men, 13 women), suffering from OCD were consecutively enrolled in the study. The severity of OCD was assessed by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS). The measuremts were carried out after four weeks and six months from the beginning of the treatment: The drug levels were measured by a HPLC method developed by us. The correlations between biological and clinical parameters were analyzed by means of Spearman's correlation coefficient. The Mann-Whitney test was used for comparing biological and clinical variables between men and women. The results showed that CMI levels were related to the doses at the two assessment times. A significant and positive correlation was detected at the beginning between the DMCMI/ratio and the Y-BOCS total score, however this was true only for men, where the similar correlations were mesaured also with the Y-BOCS subscale. After six months of CMI, men showed a significant improvement of the compulsions. These findings would highlight the potential impact of assessing CMI plasma levels and their relationships with specific symptoms that seem to be gender-related.

Treatment outcome in adult OCD: Predictors and processes of change

The current study investigates predictors of treatment response in 41 treatment-seeking adults with OCD. Further, this study examines the relationship between OCD symptom change following CBT, and change in OCD-related cognitive variables. It was hypothesised that higher OCD severity, the presence of hoarding, sexual obsessions and religious obsessions, and elevated anxiety and depression would be associated with a poorer response to CBT. It was also hypothesised that symptom change would be associated with change in OCD-related cognitive biases. Results found that only severity of OCD and the presence of sexual obsessions predicted poorer treatment response. Furthermore, whilst treatment resulted in significant reductions in cognitive biases argued to be associated with OCD, these changes were not correlated with OCD symptomatic change. Implications of this research are discussed in light of future treatment considerations.

The neuropsychology of the schizo-obsessive subtype of schizophrenia: a new analysis

Interest in the neuro-cognitive profile of patients with schizophrenia and co-morbid obsessive compulsive disorder (schizo-OCD) is rising in response to reports of high co-morbidity rates. Whereas schizophrenia has been associated with global impairment in a wide range of neuro-cognitive domains, OCD is associated with specific deficits featuring impaired performance on tasks of motor and cognitive inhibition involving frontostriatal neuro-circuitry. We compared cognitive function using the CANTAB battery in patients with schizo-OCD (n=12) and a schizophrenia group without OCD symptoms (n=16). The groups were matched for IQ, gender, age, medication, and duration of illness. The schizo-OCD patients made significantly more errors on a task of attentional set-shifting (ID-ED set-shift task). By contrast, no significant differences emerged on the Stockings of Cambridge task, the Cambridge Gamble Task or the Affective Go/NoGo tasks. No correlation emerged between ID-ED performance and severity of schizophrenia, OCD or depressive symptoms, consistent with neurocognitive impairment holding trait rather than state-marker status. Schizo-obsessives also exhibited a trend toward more motor tics emphasizing a neurological contribution to the disorder.ConclusionOur findings reveal a more severe attentional set-shifting deficit and neurological abnormality that may be fundamental to the neuro-cognitive profile of schizo-OCD. The clinical implications of these impairments merit further exploration in larger studies.

Osteochondritis Dissecans of the Elbow

Osteochondritis dissecans of the elbow remains a difficult problem to manage in the young athlete. Though the etiology is unclear, a definite association between overuse with repetitive microtraumatic insult and OCD has been established. Early detection and appropriate treatment can provide the best chance for preventing an unfavorable outcome. In many cases, conservative treatment regimens will provide complete resolution of symptoms, return of function, and full recovery, including return to sports participation. Surgical indications should be recognized, however, and surgical management carried out when warranted. Most authors treat unstable lesions primarily by excision of the fragment, accompanied by drilling or burring of the base of the lesion. Symptoms usually improve significantly, but approximately half of all patients will continue to experience chronic pain or limitation of elbow motion, highlighting the significance and severity of OCD of the elbow.