Y.C. Janardhan Reddy

The relationship of obsessive-compulsive disorder to putative spectrum disorders: results from an Indian study

The relationship between obsessive-compulsive disorder (OCD) and putative obsessive-compulsive (OC) spectrum disorders is unclear. This study investigates the prevalence of putative OC spectrum disorders in OCD subjects in a controlled clinical design. The putative OC spectrum disorders studied included somatoform disorders (body dysmorphic disorder [BDD] and hypochondriasis), eating disorders, tic disorders (e.g., Tourettes syndrome [TS]), and impulse control disorders (e.g., trichotillomania). Only those disorders that are commonly noted to be possibly related to OCD are studied. Included in this study were 231 subjects with a diagnosis of OCD according to DSM-IV criteria and 200 controls who were not screened for psychiatric morbidity. The subjects and controls were assessed in detail by extensive clinical and semistructured interviews by expert clinical psychiatrists. The lifetime diagnoses were made by consensus of two psychiatrists. Prevalence of tic disorders, hypochondriasis, BDD, and trichotillomania was significantly greater in OCD subjects compared to controls. However, the prevalence of sexual compulsions, pathological gambling, eating disorders, and depersonalization disorder was not greater in the OCD subjects compared to controls. The findings of this comorbidity study suggest that tic disorders, hypochondriasis, BDD, and trichotillomania are perhaps part of the OC spectrum disorders. There is a need to evaluate evidence from other sources such as epidemiological, neurobiological, and family studies to further our understanding of the concept of OC spectrum disorders.

Is juvenile obsessive-compulsive disorder a developmental subtype of the disorder?--Findings from an Indian study.

Juvenile obsessivecompulsive disorder (OCD) has been hypothesized to be different from adult-onset OCD suggesting that juvenile OCD may be a developmental subtype of the disorder. There is some evidence that juvenile OCD may be phenotypically different from juvenile-onset adult OCD. This study examines the phenotypic characteristics of juvenile OCD (current age ≤ 18 years, n = 39), juvenile-onset adult OCD (onset ≤ 18 years,cur rent age>18 years, n = 87) and adult-onset OCD (onset > 18 years, n = 105). Qualified psychiatrists expert in evaluating OCD subjects conducted clinical and structured interviews. In the multinomial logistic regression analysis, controlling for chronological age and gender, the juvenile OCD was associated with male preponderance, elev ated rates of certain obsessive-compulsive symptoms, a ttention-deficit hyperactivity disorder, chronic tics, body dysmorphic disorder and major depression. In addition, juvenile-onset adult OCD differed from juvenile OCD by having later age-atonset and low rate of ADHD. The juvenile-onset adult OCD was positively associated with social phobia and chronic tics compared to adult-onset OCD. The juvenile OCD appears to be different from both juvenile-onset adult OCD and adult-onset OCD supporting previous observations that juvenile OCD could be a developmental subtype of the disorder.

A prospective study of bipolar disorder in children and adolescents from India

Bipolar disorder in adults is known to run an episodic course. However, little information exists on the long‐term naturalistic course of bipolar disorder in juvenile populations. The present study was undertaken with the objectives of (i) documenting the rates of recovery and relapse, (ii) identifying the predictors of recovery and relapse and (iii) assessing the rates of comorbid conditions. A total of 30 subjects with onset of bipolar illness (according to DSM‐III‐R criteria) in childhood and adolescence were assessed systematically at baseline and 4 to 5 years later. All 30 subjects (100%) had recovered from their index episodes and none had exhibited chronicity. Twenty of the 30 subjects (67%) had relapsed, with most relapses occurring within 2 years of recovery from index episodes. No predictors of recovery and relapse could be identified. Conduct disorder was the only comorbid diagnosis in two subjects (7%). The main implication of our study, in view of the high rates of relapse in the crucial developmental phase of a young individual, is that long‐term maintenance medication should be considered in juvenile bipolar patients, even if it is a first episode.

Impulse control disorders and “behavioural addictions” in the ICD-11

Psychiatric classifications have traditionally recognized a number of conditions as representing impulse control disorders. These have included pathological gambling, intermittent explosive disorder, kleptomania, pyromania, and trichotillomania.

Cognitive endophenotypes in OCD: a study of unaffected siblings of probands with familial OCD.

BACKGROUND Impairments in executive functions and non-verbal memory are considered potential endophenotype markers of obsessive-compulsive disorder (OCD). For the neuropsychological deficits to be considered endophenotypes, they should be demonstrable in unaffected family members. AIM To compare the neuropsychological performance in unaffected siblings of probands with familial OCD with that of individually matched healthy controls. METHODS Twenty-five unaffected siblings of OCD probands with familial OCD, and 25 individually matched healthy controls were assessed with tests of attention, executive function, memory and intelligence. RESULTS Unaffected siblings showed significant deficits in tests of decision making and behavioural reversal i.e., the Iowa Gambling Task (IGT) and the Delayed Alternation Test (DAT) respectively, but performed adequately in other tests. CONCLUSIONS Our study suggests that the deficits in decision making and behavioural reversal could be potential endophenotypes in OCD. These deficits are consistent with the proposed neurobiological model of OCD involving the orbitofrontal cortex. Future studies could couple cognitive and imaging strategies to identify neurocognitive endophenotypes in homogenous samples of OCD.

Impairment of verbal learning and memory and executive function in unaffected siblings of probands with bipolar disorder

OBJECTIVES Impairments in executive function and memory have been reported in relatives of patients with bipolar disorder, suggesting that they could be potential endophenotypes for genetic studies, but the findings are inconsistent. In this study, neuropsychological performance in unaffected siblings of probands with family loading for bipolar disorder is compared to that of individually matched healthy controls. We hypothesized that performance on tests of executive functions and memory would be impaired in unaffected siblings of probands with bipolar disorder compared to matched healthy controls. METHODS We evaluated 30 unaffected siblings of probands with bipolar I disorder and 30 individually matched healthy controls using tests of attention, executive function, and memory. Unaffected siblings and healthy control subjects did not differ with respect to gender, age, and years of education. RESULTS Unaffected siblings performed poorly on the Tower of London test (TOL), the Reys auditory verbal learning test (RAVLT), and the Reys complex figure test. In the multivariate analysis, significance was noted for the TOL, total number of moves (p = 0.007) and the RAVLT total learning score (p = 0.001). CONCLUSIONS Our study suggests that the deficits in verbal learning and memory and executive functions (planning) could be potential endophenotypes in bipolar disorder. These deficits are consistent with the proposed neurobiological model of bipolar disorder involving the frontotemporal and subcortical circuits. Future studies could couple cognitive and imaging strategies and genomics to identify neurocognitive endophenotypes in bipolar disorder.

Issues in the pharmacological treatment of obsessive–compulsive disorder

Aims:  Obsessive–compulsive disorder (OCD) preferentially responds to a class of antidepressants called serotonin reuptake inhibitors (SRI). This review discusses certain issues unique to pharmacological treatment of OCD: choice of SRI, dose and duration of treatment, options after first failed SRI trial and treatment of SRI non‐responders.

Association of DRD2 gene variant with schizophrenia

Schizophrenia is a complex multifactorial disorder for which the pathobiology still remains elusive. Dysfunction of the dopamine D2 receptor signaling has been associated with the illness, but numerous studies provide confounding results. This study investigates the association of synonymous polymorphisms (His313 and Pro319) in the dopamine D2 receptor gene with schizophrenia using a case-control approach, with 101 cases and 145 controls. Our results demonstrated that genotype distribution for the His313 polymorphism was significantly different between schizophrenia patients and control subjects (p=0.0012), while the Pro319 polymorphism did not show any association with the disease. The results suggest that the synonymous SNP His313 in DRD2 may be associated with the illness. However, there is a need for further replication studies with larger sample sets.

Neuropsychological functioning in obsessive-compulsive disorder: are executive functions the key deficit?

OBJECTIVE Although several studies have examined neuropsychological functions in obsessive-compulsive disorder (OCD), findings are not conclusive, predominantly due to small samples and assessment of limited domains. We aim to map the neuropsychological profile of OCD in a large sample with a comprehensive battery of tests. METHOD Neuropsychological functions were tested in 150 subjects with DSM-IV OCD and 205 healthy control subjects. RESULTS Subjects with OCD performed significantly worse than healthy control subjects on Colour Trails 1 time, Tower of Hanoi 3-disk time, Wisconsin Card Sorting Test categories completed, Iowa Gambling Task, Complex Figure Test immediate and delayed recall (p<0.001). CONCLUSIONS Subjects with OCD evince deficits in scanning, planning time, concept formation, decision making and encoding of non-verbal memory after controlling for the effects of age, gender and education. The profile is suggestive of a predominantly executive dysfunction, with difficulties in strategizing and organizing stimuli and cognitive resources for maximum efficiency. The findings implicate dorsolateral prefrontal, superior medial prefrontal and anterior cingulate cortices, suggesting that OCD might not be a purely orbitofronto-striatal disorder as previously conceptualized.

A family study of early-onset bipolar I disorder.

BACKGROUND Relatives of early-onset bipolar probands have greater risk for affective disorders than those of adult-onset bipolar probands. METHODS Relatives of 50 adolescent bipolar I probands and 36 adult-onset bipolar probands (onset > or = 25 years) were assessed using the Family Interview for Genetic Studies (FIGS) by a qualified psychiatrist blind to the proband status. Morbid risk was calculated using Weinbergs method of age correction. RESULTS Relatives of early-onset probands had significantly greater risk for affective disorders compared to the relatives of adult-onset bipolar probands. CONCLUSIONS Early-onset bipolar disorder is more familial than the adult bipolar disorder. IMPLICATIONS Subdivision of bipolar disorder according to age-at-onset may identify homogeneous subtypes useful for genetic studies. LIMITATIONS Patients were recruited from a major psychiatric hospital. The family history method was used to collect information about relatives.