Obsessive-Compulsive Disorder

2009 ◽  
Author(s):  
Vladan Starcevic, MD, PhD
Keyword(s):  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Clinical Features ◽  
Age Of Onset ◽  
Clinical Manifestations ◽  
Severity Of Illness ◽  
Repetitive Behaviors ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Close Relationship

As its name implies, the main characteristics of obsessive-compulsive disorder (OCD) are obsessions and/or compulsions. Different types of obsessions and compulsions make OCD a heterogeneous condition. Also, OCD exists on a continuum from mild cases to those with extremely severe and incapacitating manifestations generally not seen in other anxiety disorders. Clinical manifestations of OCD are striking and leave few people who observe them unimpressed. This is arguably due to the seriousness with which persons with OCD take their own obsessions and compulsions along with concurrent realization that these same obsessions and compulsions are senseless and should be gotten rid of. Indeed, there are few other examples in psychopathology where insight and deficiency of insight stand together, and where espousing and fighting the absurd are so intertwined. For all these reasons, OCD is often portrayed as a puzzling or intriguing disorder; in addition, it often represents a treatment challenge. Obsessive-compulsive disorder is probably the least controversial condition within the anxiety disorders because its clinical features are well described and relatively easily recognized and because hardly anyone doubts its existence as a psychopathological entity. What is controversial about OCD, however, is where it belongs and how it should be classified. This is a consequence of a number of features of OCD that make it look different from other anxiety disorders and of the close relationship that OCD has with some conditions outside of the realm of anxiety disorders. Listed below are a number of key questions about OCD…. 1. In view of its different clinical features and the vastly different severity of these features, should OCD be considered a unitary condition or divided into subtypes? 2. If OCD is to be divided into subtypes, on the basis of what criteria should it be done? Types of obsessions and compulsions, reasons for performing compulsions, severity of illness, degree of insight, age of onset, or something else? 3. Should neutralizing responses other than compulsions be given a more prominent role in the description and conceptualization of OCD? 4. How does insight contribute to the conceptualization of OCD? 5. What are the core features of OCD? Is OCD primarily an affective disorder, is it characterized by a primary disturbance in thinking, or is it essentially a disorder of repetitive behaviors?

Early Onset Obsessive-Compulsive Disorder With and Without Tics

CNS Spectrums ◽  
2009 ◽  
Vol 14 (7) ◽  
pp. 362-370 ◽  
Author(s):  
Maria Alice de Mathis ◽  
Juliana B. Diniz ◽  
Roseli G. Shavitt ◽  
Albina R. Torres ◽  
Ygor A. Ferrão ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Early Onset ◽  
Age Of Onset ◽  
Age At Onset ◽  
Clinical Manifestations ◽  
Tic Disorders ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Diagnostic And Statistical Manual ◽  
History Of

ABSTRACTIntroduction: Research suggests that obsessive-compulsive disorder (OCD) is not a unitary entity, but rather a highly heterogeneous condition, with complex and variable clinical manifestations.Objective: The aims of this study were to compare clinical and demographic characteristics of OCD patients with early and late age of onset of obsessive-compulsive symptoms (OCS); and to compare the same features in early onset OCD with and without tics. The independent impact of age at onset and presence of tics on comorbidity patterns was investigated.Methods: Three hundred and thirty consecutive outpatients meeting Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria for OCD were evaluated: 160 patients belonged to the “early onset” group (EOG): before 11 years of age, 75 patients hadResults: The EOG had a predominance of males, higher frequency of family history of OCS, higher mean scores on the “aggression/violence” and “miscellaneous” dimensions, and higher mean global DY-BOCS scores. Patients with EOG without tic disorders presented higher mean global DY-BOCS scores and higher mean scores in the “contamination/cleaning” dimension.Conclusion: The current results disentangle some of the clinical overlap between early onset OCD with and without tics.

Comorbidity with Axis I Anxiety Disorders in Remitted Psychotic Patients 1 Year After Hospitalization

CNS Spectrums ◽  
2007 ◽  
Vol 12 (12) ◽  
pp. 913-919 ◽  
Author(s):  
Antonio Ciapparelli ◽  
Rosemma Paggini ◽  
Donatella Marazziti ◽  
Claudia Carmassi ◽  
Maria Bianchi ◽  
...  
Keyword(s):  
Panic Disorder ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Rating Scale ◽  
Severity Of Illness ◽  
Psychotic Symptoms ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Comorbid Anxiety ◽  
Axis I

ABSTRACTIntroductionComorbid anxiety disorders are frequently encountered in psychoses and mainly assessed during the hospitalization.MethodsComorbidity was investigated in 98 patients with schizophrenia, schizoaffective, or bipolar disorder, previously hospitalized for psychotic symptoms. Assessments, including Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Brief Psychiatric Rating Scale, and Clinical Global Impressions Scale, were performed during hospitalization (t0) and subsequently in a phase of remission (t1). Comorbidity was assessed at t1 only.ResultsOne or more comorbid anxiety diagnoses were made in 46 (46.9%) patients. Of these, 15 (32.6%) received multiple anxiety diagnoses, while 31 (67.4%) single anxiety diagnoses. Schizophrenic patients had a rate of social anxiety disorder (SAD) higher (P<.05) than the others. Patients assessed with panic disorder or with obsessive-compulsive disorder at t1 showed significantly greater severity of illness at t0; patients with SAD demonstrated greater severity at t1. No significant differences in the rates of individual anxiety disorders were found in patients treated with typical or atypical antipsychotics or with both.ConclusionAnxiety disorders, particularly obsessive-compulsive disorder, panic disorder and SAD, seem to be frequently comorbid in remitted psychotic patients; SAD would be more prevalent in schizophrenia and might negatively impact the course of the illness.

Anxiety and the Spectrum of Obsessive-Compulsive Disorder

CNS Spectrums ◽  
2008 ◽  
Vol 13 (S14) ◽  
pp. 4-5 ◽  
Author(s):  
Donald W. Black
Keyword(s):  
Anxiety Disorder ◽  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Age Of Onset ◽  
The Other ◽  
Specific Response ◽  
Obsessive Compulsive ◽  
Important Place ◽  
Compulsive Disorder

This supplement to CNS Spectrums focuses on the obsessive-compulsive spectrum of disorders and their relationship to anxiety. Hollander and others pioneered the concept of the obsessive-compulsive spectrum in the early 1990s, and have described its breadth and overlap with other psychiatric disorders. While its place in the psychiatric nomenclature is uncertain, the obsessive-compulsive spectrum is intertwined with the anxiety disorders in both its symptoms and biologic substrates.Obsessive-compulsive disorder (OCD) has an important place at the center of the spectrum. While currently classified in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition as an anxiety disorder, OCD is distinct from these conditions in the International Classification of Diseases. There is a strong rationale for its separation from the anxiety disorders. First, OCD often begins in childhood, whereas other anxiety disorders typically have a later age of onset. OCD has a nearly equal gender distribution, unlike the other anxiety disorders, which are more common in women. Studies of psychiatric comorbidity show that, unlike the other anxiety disorders, persons with OCD generally tend not to have elevated rates of substance misuse. Family studies suggest that first-degree relatives of persons with OCD have an elevated prevalence of OCD-related disorders including body dysmorphic disorder, hypochondriasis, and grooming disorders, but not other anxiety disorders except for generalized anxiety disorder. The brain circuitry that mediates OCD appears to be different from that involved in other anxiety disorders. Lastly, OCD is unique with regard to its specific response to selective serotonin reuptake inhibitors, while noradrenergic medications, effective in the anxiety and mood disorders, are largely ineffective. On the other hand, the benzodiazepines, which have little effect on OCD, are often effective for the other anxiety disorders.

Influence of age of onset on clinical features in obsessive-compulsive disorder

2005 ◽  
Vol 21 (3) ◽  
pp. 112-117 ◽  
Author(s):  
Raşit Tükel ◽  
Erhan Ertekin ◽  
Serap Batmaz ◽  
Filiz Alyanak ◽  
Atiye Sözen ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Clinical Features ◽  
Age Of Onset ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Specificities of Treatment in Pediatric Obsessive-Compulsive Disorder

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S3) ◽  
pp. 43-58 ◽  
Author(s):  
Martine F. Flament ◽  
Dan Geller ◽  
Metehan Irak ◽  
Pierre Blier
Keyword(s):  
Anxiety Disorders ◽  
Children And Adolescents ◽  
Obsessive Compulsive Disorder ◽  
Developmental Disorders ◽  
Meta Analysis ◽  
Clinical Manifestations ◽  
Subjective Distress ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Pediatric Ocd

AbstractObsessive-compulsive disorder (OCD) experienced in childhood or adolescence is often a chronic disorder with high subjective distress and impairment of family and social functioning. An early comprehensive intervention schedule can have a profound effect on outcome in later years. The clinical manifestations of OCD among children and adolescents do not seem to be inherently different from those of adult patients. In younger subjects, the clinical picture tends to be dominated by compulsions, and insight can be poor, with little recognition of the symptoms as a problem.There is often a shift in symptoms over time, with some symptoms being replaced by others, while in adults, the core obsessions and compulsions tend to be more stable. In addition to depression and anxiety disorders, the spectrum of comorbid psychopathology seen in pediatric OCD patients includes tic, disruptive behavior, and specific developmental disorders. The treatment of childhood and adolescent OCD relies on cognitive-behavioral techniques of psychotherapy and pharmacotherapeutic interventions similar to those recommended in adults. The efficacy of exposure and response prevention in pediatric OCD has been shown in numerous open studies, and four controlled trials. Pharmacotherapy relies on serotonergic medication, and all have been demonstrated to be significantly superior to placebo, as reported in a recently published meta-analysis. Current concerns with the use of SSRIs in children and adolescents were explored as regards OCD and anxiety disorders, and there is no evidence for an increase in suicide or related behaviors.

Age of Onset for Obsessive-Compulsive Disorder

1990 ◽  
Author(s):  
W. E. Minichiello ◽  
L. Baer ◽  
M. A. Jenike ◽  
A. Holland
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Age Of Onset ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

Neurosurgery for obsessive-compulsive disorder, other anxiety disorders and depressive disorders

2014 ◽  
Author(s):  
David MB Christmas ◽  
Ian Crombie ◽  
Sam Eljamel ◽  
Naomi Fineberg ◽  
Bob MacVicar ◽  
...  
Keyword(s):  
Anxiety Disorders ◽  
Obsessive Compulsive Disorder ◽  
Depressive Disorders ◽  
Obsessive Compulsive ◽  
Compulsive Disorder

scholarly journals Repeated Cortico-Striatal Stimulation Generates Persistent OCD-Like Behavior

Science ◽  
2013 ◽  
Vol 340 (6137) ◽  
pp. 1234-1239 ◽  
Author(s):  
Susanne E. Ahmari ◽  
Timothy Spellman ◽  
Neria L. Douglass ◽  
Mazen A. Kheirbek ◽  
H. Blair Simpson ◽  
...  
Keyword(s):  
Obsessive Compulsive Disorder ◽  
Orbitofrontal Cortex ◽  
Progressive Increase ◽  
Repetitive Behaviors ◽  
Mouse Behavior ◽  
First Line ◽  
Obsessive Compulsive ◽  
Compulsive Disorder ◽  
Chronic Fluoxetine

Although cortico-striato-thalamo-cortical (CSTC) circuit dysregulation is correlated with obsessive compulsive disorder (OCD), causation cannot be tested in humans. We used optogenetics in mice to simulate CSTC hyperactivation observed in OCD patients. Whereas acute orbitofrontal cortex (OFC)–ventromedial striatum (VMS) stimulation did not produce repetitive behaviors, repeated hyperactivation over multiple days generated a progressive increase in grooming, a mouse behavior related to OCD. Increased grooming persisted for 2 weeks after stimulation cessation. The grooming increase was temporally coupled with a progressive increase in light-evoked firing of postsynaptic VMS cells. Both increased grooming and evoked firing were reversed by chronic fluoxetine, a first-line OCD treatment. Brief but repeated episodes of abnormal circuit activity may thus set the stage for the development of persistent psychopathology.

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