Maria C. Mancebo

Juvenile-onset OCD: clinical features in children, adolescents and adults

Objective:  To examine clinical correlates of juvenile‐onset OCD across the lifespan.

Five-year course of obsessive-compulsive disorder: predictors of remission and relapse.

BACKGROUND Obsessive-compulsive disorder (OCD) is a heterogeneous and disabling condition; however, no studies have examined symptom categories or subtypes as predictors of long-term clinical course in adults with primary OCD. METHOD A total of 213 adults with DSM-IV OCD were recruited from several mental health treatment sites between July 2001 and February 2006 as part of the Brown Longitudinal Obsessive Compulsive Study, a prospective, naturalistic study of treatment-seeking adults with primary OCD. OCD symptoms were assessed annually over the 5-year follow-up period using the Longitudinal Interval Follow-Up Evaluation. RESULTS Thirty-nine percent of participants experienced either a partial (22.1%) or a full (16.9%) remission. Two OCD symptom dimensions impacted remission. Participants with primary obsessions regarding overresponsibility for harm were nearly twice as likely to experience a remission (P < .05), whereas only 2 of 21 participants (9.5%) with primary hoarding achieved remission. Other predictors of increased remission were lower OCD severity (P < .0001) and shorter duration of illness (P < .0001). Fifty-nine percent of participants who remitted subsequently relapsed. Participants with obsessive-compulsive personality disorder were more than twice as likely to relapse (P < .005). Participants were also particularly vulnerable to relapse if they experienced partial remission versus full remission (70% vs 45%; P < .05). CONCLUSIONS The contributions of OCD symptom categories and comorbid obsessive-compulsive personality disorder are critically important to advancing our understanding of the prognosis and ultimately the successful treatment of OCD. Longer duration of illness was also found to be a significant predictor of course, highlighting the critical importance of early detection and treatment of OCD. Furthermore, having full remission as a treatment target is an important consideration for the prevention of relapse in this disorder.

Taboo thoughts and doubt/checking: a refinement of the factor structure for obsessive-compulsive disorder symptoms.

The purpose of this report was to improve upon earlier factor analyses of obsessive-compulsive disorder (OCD) symptom categories by minimizing the heterogeneity in the aggressive obsessions category. An exploratory factor analysis was conducted on data from 293 adults with primary OCD. The resulting five factors (Symmetry/Ordering, Hoarding, Doubt/Checking, Contamination/Cleaning, and Taboo Thoughts) are phenomenologically more homogeneous than prior category-based factors and are consistent with those derived in previous item-level analyses.

A 2-year prospective follow-up study of the course of obsessive-compulsive disorder.

BACKGROUND Surprisingly little is known about the long-term course of obsessive-compulsive disorder (OCD). This prospective study presents 2-year course findings, as well as predictors of course, from the Brown Longitudinal Obsessive Compulsive Study, the first comprehensive prospective investigation of the observational course of OCD in a large clinical sample. METHOD The sample included 214 treatment-seeking adults with DSM-IV OCD at intake who identified OCD as the most problematic disorder over their lifetime. Subjects were enrolled from 2001-2004. At annual interviews, data on weekly OCD symptom status were obtained using the Longitudinal Interval Follow-Up Evaluation. Probabilities of full remission and partial remission over the first 2 years of collected data and potential predictors of remission were examined. RESULTS The probability of full remission from OCD was 0.06, and the probability of partial remission was 0.24. Of the 48 subjects whose OCD symptoms partially or fully remitted, only 1 relapsed within the first 2 years. Earlier age at onset of OCD, greater severity of symptoms at intake, older age at intake, and being male were associated with a decreased likelihood of remission. Insight, diagnostic comorbidity, and treatment were not found to be associated with the likelihood of achieving full or partial remission. CONCLUSIONS Though one-quarter of the sample had periods of subclinical OCD symptoms during the prospective period, full remission was rare, consistent with the view of OCD as a chronic and persistent illness. Age at onset, OCD symptom severity, current age, and sex emerged as potent predictors of course.

A pilot study of moderate-intensity aerobic exercise for obsessive compulsive disorder.

This preliminary study examined the impact of aerobic exercise as an adjunctive intervention to regular care in reducing obsessive compulsive disorder (OCD) symptoms in a clinical sample. Fifteen patients (53% male; mean age = 44.4 years) receiving behavioral therapy and/or pharmacotherapy for OCD and who still demonstrated clinically significant OCD symptoms (i.e., Yale-Brown obsessive compulsive scale, Y-BOCS scores above 16) were enrolled in a 12-week moderate-intensity exercise intervention. Measures of OCD symptom severity were obtained at baseline, end of treatment, and at 3- and 6-week, and 6-month follow-up. Study findings at the end of this 12-week aerobic exercise intervention point to a beneficial effect (Cohens d = 1.69) on reduction in OCD symptom severity. Further, reductions in OCD symptom severity appear to persist 6 months later. Lastly, improvement in overall sense of well-being was observed after the 12-week intervention. Results of this study suggest that a randomized clinical trial evaluating the efficacy of this 12-week aerobic exercise intervention is warranted.

Acute changes in obsessions and compulsions following moderate-intensity aerobic exercise among patients with obsessive-compulsive disorder

Aerobic exercise can acutely influence anxious and depressive mood in both clinical and nonclinical populations. However, there are no existing studies that have examined the acute effect of exercise on mood, anxiety, obsessions, and compulsions in patients with OCD. The primary aim of this study was to examine acute changes in these symptoms after engaging in single exercise sessions during a 12-week exercise intervention for 15 (53% female; mean age=41.9 years) patients with OCD. Participants reported reductions in negative mood, anxiety, and OCD symptoms at the end of each exercise session relative to the beginning. Changes in the magnitude of the effect of exercise in reducing negative mood and anxiety remained fairly stable while levels of self-reported obsessions and compulsions decreased over the duration of the intervention. Results of this study point toward the promising effect of exercise for acute symptom reduction in patients with OCD.

Late-onset obsessive compulsive disorder : Clinical characteristics and psychiatric comorbidity

There has been little research examining clinical correlates of late-onset OCD in a large sample of individuals with a primary diagnosis of OCD. Using a sample of 293 consecutive subjects with lifetime DSM-IV OCD, we compared subjects with late-onset (after age 30 years) OCD to those with earlier onset on a variety of clinical measures. Symptom severity was examined using the Yale-Brown Obsessive Compulsive Scale. Thirty-three (11.3%) of the 293 subjects with OCD reported onset of OCD on or after age 30 years (mean age of OCD onset of 38.8+/-9.7 years). Subjects with late-onset had significantly shorter durations of illness prior to receiving treatment, less severe obsessinality, and a trend demonstrating a greater likelihood of responding to cognitive behavioral therapy (CBT). Late-onset OCD subjects were also significantly less likely to report contamination, religious, or somatic obsessions. Comorbidity, insight, depressive symptoms, quality of life, and social functioning did not differ between groups. These preliminary results suggest that although onset on or after age 30 years is fairly uncommon among people with OCD, individuals developing OCD later in life have similar clinical characteristics as those with earlier onset and may respond better to CBT.

Substance use disorders in an obsessive compulsive disorder clinical sample.

The prevalence and clinical correlates of substance use disorders (SUDs) were examined in a clinical sample of Obsessive Compulsive Disorder (OCD). As part of their intake interview into an observational study of the course of OCD, 323 participants completed a battery of standardized measures. Twenty-seven percent of the sample met lifetime criteria for a SUD. 70% of participants with comorbid SUDs reported that OCD preceded SUD onset by at least one year. Younger age at OCD onset and presence of Borderline Personality Disorder (BPD) were each associated with increased risk of alcohol use disorders but only BPD was associated with increased risk of drug use disorders. SUDs affect more than one-quarter of individuals who seek treatment for OCD. Individuals with a juvenile-onset of OCD or comorbid BPD may be especially vulnerable to SUDs. Further research is needed to identify risk factors for SUDs and to better understand their impact on OCD course.

Obsessive Compulsive Personality Disorder and Obsessive Compulsive Disorder: Clinical Characteristics, Diagnostic Difficulties, and Treatment

BACKGROUND The overlap between obsessive compulsive personality disorder (OCPD) and obsessive compulsive disorder (OCD) has received increasing recognition and continues to be a source of much debate. With the advent of new research methodologies, researchers have attempted to distinguish whether OCPD and OCD are two distinct phenomena that can co-occur or whether they are similar, overlapping constructs. METHODS MEDLINE was used to systematically review the OCPD and OCD literature published between 1991 and 2004. RESULTS Using the more stringent DSM-IV criteria, results from OCD clinical samples suggest that the majority of individuals with OCD (75%) do not have OCPD. Similarly, results from personality disorder samples suggest that the majority of individuals with OCPD (80%) do not have OCD. CONCLUSIONS While there is evidence that OCD and OCPD are linked, the literature does not support either one as a necessary or sufficient component of the other.

A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder.

BACKGROUND Obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD) are possibly related disorders characterized by poor functioning and quality of life. However, few studies have compared these disorders in these important domains. METHODS We compared functioning and quality of life in 210 OCD subjects, 45 BDD subjects, and 40 subjects with comorbid BDD+OCD using reliable and valid measures. RESULTS OCD and BDD subjects had very poor scores across all measures, with no statistically significant differences between the groups. However, comorbid BDD+OCD subjects had greater impairment than OCD subjects on 11 scales/subscales, which remained significant after controlling for OCD severity. Comorbid BDD+OCD subjects had greater impairment than BDD subjects on 2 scales/subscales, which were no longer significant after controlling for BDD severity, suggesting that BDD severity may have accounted for greater morbidity in the comorbid BDD+OCD group. CONCLUSIONS Functioning and quality of life were poor across all three groups, although individuals with comorbid BDD+OCD had greater impairment on a number of measures. It is important for clinicians to be aware that patients with these disorders--and, in particular, those with comorbid BDD and OCD--tend to have very poor functioning and quality of life across a broad range of domains.