Hostname: page-component-78c5997874-v9fdk Total loading time: 0 Render date: 2024-11-05T08:40:40.945Z Has data issue: false hasContentIssue false
  • English
  • Français

Phenomenology of patients with early- and adult-onset obsessive-compulsive disorder

Published online by Cambridge University Press:  11 October 2011

Umberto Albert ,
Chiara Picco ,
Giuseppe Maina ,
Federica Forner ,
Eugenio Aguglia  and
Filippo Bogetto
Umberto Albert
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino Clinica Psichiatrica, Università degli Studi di Trieste, Trieste
Chiara Picco
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Giuseppe Maina*
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Federica Forner
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Eugenio Aguglia
Affiliation:
Clinica Psichiatrica, Università degli Studi di Trieste, Trieste
Filippo Bogetto
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
*
Indirizzo per la corrispondenza: Prof. G. Maina, Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Via Cherasco 11, 10126 Torino. Fax: +39-011-673.473 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Summary

Objective – To evaluate potential differences in socio-demographic and clinical characteristics (obsessivecompulsive symptomatology, axis I and II comorbidity) between OCD adults with an early age at onset (≤18 years) and later onset, (≤18 yrs). Design – Clinical controlled study. Setting – Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin. Methods – We included 149 subjects with a principal diagnosis of OCD (DSM-IV) and a Y-BOCS total score ≤ 16 All patients underwent a semistructured clinical interview aimed at investigating sociodemographic characteristics and clinical features of the disorder. Lifetime Axis I comorbidity, according to DSM-IV criteria, was investigated with a structured interview following Othmer & Othmer guidelines (1994; 1999). Personality disorders were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Results – 39 patients referred age at onset of OCD before 18 years (earlyonset group) and 110 patients at 18 years or later (later-onset group). Significant differences were found between the two groups: early-onset subjects are characterized by a preponderance of males, a chronic course of illness and a strong association with Schizotypal Personality Disorder. Discussion – When subtyping OCD according to age at onset we found significant differences which suggest a possible heterogeneity of the disorder. Our results seem to confirm that early-onset OCD may represent a more severe subgroup, with clinical characteristics such as the chronic course and the high association with Schizotypal PD which are significant in order to apply specific therapeutic strategies.

Riassunto

Scopo – Valutare eventuali differenze nelle caratteristiche sociodemografiche e cliniche (sintomatologia ossessivo–compulsiva, la comorbidità di Asse I e la comorbidità di Asse II) in soggetti adulti con disturbo ossessivo–compulsivo ad esordio precoce (>18 anni) e in eta adulta (≤18 anni). Disegno – Studio clinico controllato. Setting – Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università di Torino. Metodo – Sono stati inclusi nello studio 149 pazienti adulti con diagnosi di DOC (DSM–IV) e un punteggio Y–BOCS totale <16.1 soggetti sono stati valutati attraverso un'intervista semi–strutturata diretta ad indagare le caratteristiche socio–demografiche é cliniche. La comorbidita longitudinale di Asse I, secondo i criteri del DSM–IV, è stata valutata attraverso un'intervista clinica strutturata diretta secondo le indicazioni di Othmer & Othmer (1994; 1999): particolare attenzione è stata rivolta alia rilevazione dei disturbi dello spettro ossessivo–compulsivo (Hollander et al, 1996; 1997). Per l'analisi della comorbidita con i disturbi di personalitá è stata utilizzata la Structured Clinical Interview for DSM–IV Axis II Disorders (SCID–II). Risultati – 39 pazienti (26.2%) hanno presentato l'esordio del DOC prima dei 18 anni (early–onset) e 110 pazienti (73.8%) hanno presentato l'esordio del DOC dopo i 18 anni (later–onset). Sono state rilevate differenze significative tra i due gruppi di confronto: i soggetti con esordio precoce presentano una predominanza del sesso maschile, un decorso cronico del disturbo e l'associazione con il disturbo schizotipico di personalità. Conclusioni – Suddividendo il campione secondo l'eta di esordio del disturbo abbiamo rilevato alcune differenze significative nell'espressivita del DOC che indicano una possibile eterogeneita del disturbo, meritevole di ulteriori approfondimenti. In particolare, il rilievo nel gruppo ad esordio precoce di un decorso prevalentemente cronico e soprattutto di una specifica associazione con il disturbo schizotipico di personalita appare significativo ai fini dell'impostazione di specifiche strategic terapeutiche.

Keywords

disturbo ossessivo-compulsivoetà di esordiosottotipiobsessive-compulsive disorderage at onsetsubtypes
Type
Articles
Information
Epidemiology and Psychiatric Sciences , Volume 11 , Issue 2 , June 2002 , pp. 116 - 126
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

BIBLIOGRAFIA

Ackerman, D.L., Greenland, S., Bystritsky, A., Morgenstern, H. & Kats, R.J. (1994). Predictors of treatment response in obsessive compulsive disorder: multivariate analyses from a multicenter trial of clomipramine. Journal of Clinical Psychopharmacology 14, 247–254.CrossRefGoogle ScholarPubMed
Baer, L., Jenike, M.A., Black, D.W.Treece, C, Rosenfeld, R. & Greist, J. (1992). Effect of Axis II diagnoses on treatment outcome with clomipramine in 55 patients with obsessive compulsive disorder. Archives of General Psychiatry 49, 862–866.CrossRefGoogle ScholarPubMed
Bellodi, L., Sciuto, G., Diaferia, G., Ronchi, P. & Smeraldi, E. (1992). Psychiatric disorders in families of patients with obsessive compulsive disorder. Psychiatry Research 42, 111–120.CrossRefGoogle ScholarPubMed
Black, A.(1974). The natural history of obsessionl neurosis. In Obsessional State (ed. Beech, H.R.). Methuen: London.Google Scholar
Bogetto, F., Albert, U., Maina, G., Venturello, S. & Ravizza, L. (1997). La comorbidita del disturbo ossessivo-compulsivo con i disturbi di Asse I: differenza tra i sessi e correlazione con il decorso clinico. Giomale Haliano di Psicopatologia 3, 179–188.Google Scholar
Bogetto, F., Venturello, S., Albert, U., Maina, G. & Ravizza, L. (1999). Gender-related clinical differences in obsessive-compulsive disorder. European Psychiatry 14, 434–441.CrossRefGoogle ScholarPubMed
Busatto, G.F., Buchpiguel, C.A., Zamignani, D.R., Garrido, G.E., Glabus, M.F., do Rosario-Campos, M.C., Castro, C.C., Maia, A., Rocha, E.T., McGuire, P.K. & Miguel, E.C. (2001). Regional cerebral blood flow abnormalities in early-onset obsessive compulsive disorder: an exploratory SPECT study. Journal of American Academy of Child and Adolescent Psychiatry 40(3),347–354.CrossRefGoogle ScholarPubMed
Carlson, G.A., Bromet, E.J. & Sierves, S. (2000). Phenomenology and outcome of subjects with early versus late-onset of psychotic mania. American Journal of Psychiatry 157(2), 213–219.CrossRefGoogle Scholar
do Rosario-Campos, M.C., Leckman, J.F., Mercadante, M.T., Gedanke, Shavitt R., da Silva Prado, H., Sada, P., Zamignani, D. & Miguel, E.C. (2001). AdulK with early-onset obsessive compulsive disorder. American Journal of Psychiatry 158 (11), 1899–1903.CrossRefGoogle Scholar
First, M.B., Gibbon, M., Spitzer, R.L., Williams, J.B.W. & Benjiamin, L.S. (1997). Structured Clinical Interview for DSM-IV Disorders (SCID). American Psychiatry Press: Washington, DC.Google Scholar
Flament, M.F., Rapoport, J.L., Berg, C, Sceery, W., Kilts, C, Mellsrtrom, B. & Linnoila, M. (1985). Clomipramine treatment of childhood obsessive compulsive disorder. Archives of General Psychiatry 42, 977–983.CrossRefGoogle ScholarPubMed
Flament, M.F., Whitaker, A., Rapoport, J., Davies, M., Berg, C.Z., Kalikow, K., Sceery, W. & Shaffer, D. (1988). Obsessive compulsive disorder in adolescence: an epidemiological study. Journal of American Academy of Child and Adolescent Psychiatry 27(6), 764–771.CrossRefGoogle ScholarPubMed
Geller, D.A., Biederman, J., Reed, E., Spencer, T. & Wilens, T. (1995). Similarities in response to fluoxetine in the treatment of children and adolescents with obsessive-compulsive disorder. Journal of American Academy of Child and Adolescent Psychiatry 34, 36–44.CrossRefGoogle ScholarPubMed
Geller, D.A., Biederman, J., Griffin, S., Jones, J. & Lepkowitz, T.R. (1996). Comorbidity of juvenile obsessive compulsive disorder with distruptive behaviour. Journal of American Academy of Child and Adolescent Psychiatry 35 (12), 1632–1646.Google Scholar
Geller, D.A., Biederman, J., Jones, J., Park, K., Schwartz, S., Shapiro, S. & Coffey, B. (1998). Is juvenile obsessive compulsive disorder a developmental subtype of the disorder? A review of pediatric literature. Journal of American Academy of Child and Adolescent Psychiatry 37 (4), 420–427.Google ScholarPubMed
Geller, D.A., Biederman, J., Faraone, S., Frazier, J.Coffey, B., Kim, G. & Bellordre, C.A. (2000). Clinical correlates of obsessive compulsive disorder in children and adolescents referred to specialized and non-specialized clinical settings. Depression and Anxiety 11, 163–168.3.0.CO;2-3>CrossRefGoogle ScholarPubMed
Geller, D.A., Biederman, J., Faraone, S., Agranat, A., Cradock, K., Hagermoser, L., Kim, G., Frazier, J. & Coffey, B. (2001). Developmental aspects of obsessive compulsive disorder: findings in children, adolescents and adults. Journal of Nervous and Mental Disesase 189, 471–477.CrossRefGoogle ScholarPubMed
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C, Fleischmann, R.L., Hill, C.L., Heninger, G.R. & Charney, D.S. (1989a). The Yale Brown Obsessive Compulsive Scale, I: development, use and reliability. Archives of General Psychiatry 46, 1006–1011.CrossRefGoogle ScholarPubMed
Goodman, W.K., Price, L.H., Rasmussen, S.A., Mazure, C, Delgado, P., Heninger, G.R. & Charney, D.S. (1989b). The Yale Brown Obsessive Compulsive Scale, II: validity. Archives of General Psychiatry 46, 1012–1016.CrossRefGoogle ScholarPubMed
Goodwin, D.W., Guze, S.B. & Robins, E. (1969). Follow-up studies in obsessional neurosis. Archives of General Psychiatry 20, 182–187.CrossRefGoogle ScholarPubMed
Hanna, G.L. (1995). Demographic and clinical features of obsessivecompulsive disorder in children and adolescents. Journal of American Academy of Child and Adolescent Psychiatry 34 (1), 19–27.CrossRefGoogle ScholarPubMed
Hollander, E. (1997). Obsessive-compulsive disorder: the hidden epidemic. Journal of Clinical Psychiatry, Suppl.No 12, vol. 58, pp. 3–6.Google Scholar
Hollander, E., Kwon, J.H., Stein, D.J., Broatch, J., Rowland, C.T. & Himelein, C.A. (1996). Obsessive compulsive and spectrum disorders: overview and quality of life issues. Journal of Clinical Psychiatry, Suppl. No. 8, vol.57, pp. 3–6.Google ScholarPubMed
Jenike, M.A., Baer, L., Minichiello, W.E., Schwartz, C.E.& Corey, R.J. Jr (1986). Concomitant obsessive compulsive disorder and schizotypal personality disorder. American Journal of Psychiatry 143(4), 530–533.Google ScholarPubMed
Last, C.G. & Strauss, C.C. (1989). Obsessive compulsive disorder in childhood. Journal of Anxiety Disorders 3, 295–302.CrossRefGoogle Scholar
Lenane, M., Swedo, S.E., Leonard, H., Pauls, D.L., Ceery, W. & Rapoport, J.L. (1990). Psychiatric disorders in dirst degree relatives of children and adolescents with obsessive compulsive disorder. Journal of American Academy of Child and Adolescent Psychiatry 29 (3), 407–412.CrossRefGoogle Scholar
Leonard, H.L., Lenane, M.C., Swedo, S.E., Rettew, D.C., Gershon, E.S. & Rapoport, J.L. (1992). Tics and Tourette's syndrome: a 2- to 7-year follow-up study of 54 children with obsessive compulsive disorder. American Journal of Psychiatry 149, 1244–1251.Google Scholar
Leonard, H.L. & Swedo, S.E. (2001). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). International Journal of Neuropsychopliarmacology 4(2), 191–198.Google Scholar
Luxenberg, J.S., Swedo, S.E., Flament, M.F., Friedland, D.P.; Rapoport, J. & Rapoport, S.I. (1988). Neuroanatomical abnormalities obsessive compulsive disorder detected with quantitative X-ray computed tomography. American Journal of Psychiatry 145, 1089–1093.Google ScholarPubMed
Maina, G., Albert, U., Bogetto, F. & Ravizza, L. (2000). Onset of obsessive compulsive disorder: premorbid condition and prodromal phase. CNS Spectrums 5(12), 31–43.CrossRefGoogle ScholarPubMed
McDougle, C.J., Goodmann, W.K. & Price, L.H. (1990). Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. American Journal of Psychiatry 147, 652–654.Google ScholarPubMed
Nestadt, G., Samuels, J., Riddle, M., Bienvenu, J., Liang, K., LaBuda, M., Walkup, J., Grados, M. & Hoehn-Saric, R. (2000). A family study of obsessive compulsive disorder. Archives of General Psychiatry 57, 358–363.CrossRefGoogle ScholarPubMed
Noshirvani, H.F., Kasvikis, Y., Marks, I.M., Tsakiris, F. & Monteiro, W.O. (1991). Gender-divergent aetiological factors in obsessive compulsive disorder. British Journal of Psychiatry 158, 260–263.CrossRefGoogle ScholarPubMed
Othmer, E. & Othmer, S.C. (1994). The Clinical Interview Using DSMIV. Volume 1: Fundamentals. American Psychiatric Press: Washington DC.Google Scholar
Othmer, E. & Othmer, S.C. (1999). Ulntervista Clinica con II DSMIV. Raffaello Cortina: Milano.Google Scholar
Pauls, D.L., Alsobrook, J.P. II, Goodman, W., Rasmussen, S. & Leckman, J.F. (1995). A family study of obsessive compulsive disorder. American Journal of Psychiatry 152, 76–84.Google ScholarPubMed
Perlmutter, S.J., Garvey, M.A., Castellanos, X., Mittleman, B.B., Giedd, J., Rapoport, J.L. & Swedo, S.E. (1998). A case of pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections. American Journal of Psychiatry 155, 1592–1598.CrossRefGoogle Scholar
Peterson, B.S., Leckman, J.F., Tucker, D., Scahill, L., Staib, L., Zhang, H., King, R., Cohen, D.J., Gore, J.C. & Lombroso, P. (2000). Preliminary findings of antistreptococcal antibody titers and basal ganglia volumes in tic, obsessive compulsive and attention-deficit/hyperactivity disorders. Archives of General Psychiatry 57:364–372.CrossRefGoogle ScholarPubMed
Rapoport, J.L. (1990). The walking nigthmare: an overview of obsessive compulsive disorder. Journal of Clinical Psychiatry 51, Suppi., 25–28.Google Scholar
Rasmussen, S.A. & Eisen, J.L. (1992). The epidemiology and clinical features of obsessive-compulsive disorder. Psychiatric clinics of North America, 15 743–758.CrossRefGoogle ScholarPubMed
Rasmussen, S.A. & Tsuang, M.T. (1986). Clinical characteristics and family history in DSM-III obsessive compulsive disorder. American Journal of Psychiatry 143, 317–322.Google ScholarPubMed
Rasmussen, S.A. & Eisen, J.L. (1998). Epidemiology and clinical features of obsessive-compulsive disorder. In Obsessive Compulsive Disorders: Pratical Management, 3rd ed. (ed. Jenike, M.A., Baer, L. and Minichiello, W.E.), pp. 12–43. Mosby: St Louis, MO.Google Scholar
Ravizza, L., Barzega, G., Bellino, S., Bogetto, F. & Maina, G. (1995). Predictors of drug treatment response in obsessive-compulsive disorder. Journal of Clinical Psychiatry 56 (8), 368–374.Google ScholarPubMed
Ravizza, L., Maina, G. & Bogetto, F. (1997). Episodic and chronic obsessive compulsive disorder. Depression and Anxiety 6, 154–158.3.0.CO;2-C>CrossRefGoogle ScholarPubMed
Reddy, P.S., Reddy, Y.C., Srinath, S., Khanna, S., Sheshadri, S.P. & Girimaji, S.R. (2001). A family study of juvenile obsessive-compulsive disorder. Canadian Journal of Psychiatry 46(4), 346–351.CrossRefGoogle ScholarPubMed
Rettew, DC, Swedo, S.E., Leonard, H.L., Lenane, M.C. & Rapoport, J.L. (1992). Obsession and compulsions across time in 79 children and adolescents with obsessive-compulsive disorder. Journal of American Academy of Child and Adolescent Psychiatry 31(6), 1050–1056.CrossRefGoogle ScholarPubMed
Riddle, M., Scahill, L., King, R., Hardin, M.T., Towbin, K.E., Ort, S.I., Leckman, J.F. & Cohen, D.J. (1990). Obsessive compulsive disorder in children and adolescents: phenomenology and family history. Journal of American Academy of Child and Adolescent Psychiatry 29, 766–772.CrossRefGoogle ScholarPubMed
Sobin, C, Blundell, M.L. & Karayiorgou, M. (2000a). Phenotypic differences in early- and late-onset obsessive compulsive disorder. Comprehensive Psychiatry 41(5), 373–379.CrossRefGoogle ScholarPubMed
Sobin, C, Blundell, M.L., Weiller, F., Gavigan, C, Haiman, C. & Karayiorgou, M. (2000b). Evidence of a schizotypy subtype in OCD. Journal of Psychiatric Research 34(1), 15–24.CrossRefGoogle ScholarPubMed
Swedo, S.E., Rapoport, J.L., Leonard, H., Lenane, M. & Cheslow, D.L. (1989a). Obsessive compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry 46, 355–364.CrossRefGoogle ScholarPubMed
Swedo, S.E., Shapiro, M.B., Grady, C.L., Cheslow, D.L., Leonard, H.L., Kumar, A., Friedland, R., Rapoport, S.I. & Rapoport, J.L. (1989b). Cerebral glucose metabolism in childhood-onset obsessive compulsive disorder. Archives of General Psychiatry 46, 518–523.CrossRefGoogle ScholarPubMed
Swedo, S.E., Pietrini, P., Leonard, H.L., Schapiro, M.B., Retew, D.C., Goldberger, E.L., Rapoport, S.I., Rapoport, J.L. & Grady, C.L. (1992). Cerebral glucose metabolism in childhood-onset obsessive compulsive disorder: revisualization during pharmacotherapy. Archives of General Psychiatry 49, 690–694.CrossRefGoogle ScholarPubMed
Swedo, S.E., Leonard, H.L., Mittelman, B.B., Allen, A.J., Rapoport, J.L., Dow, S., Kanter, M.E., Chapman, F. & Zabriskie, J. (1997). Identification of children with pediatric autoimmune neuropsychiatric disorder associated with streptococcal infections by a marker associated with rheumatic fever. American Journal of Psychiatry 154: 110–112.Google ScholarPubMed
Swedo, S.E., Leonard, H.L., Garvey, M., Mittleman, B.B., Allen, A.J., Perlmutter, S., Dow, S.Zamkoff, J., Dubbert, B.K. & Lougee, L. (1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections clinical description of the first 50 cases. American Journal of Psychiatry 155, 264–271.CrossRefGoogle ScholarPubMed
Thomsen, P. (1993). Obsessive-compulsive disorder in children and adolescents: self-reported obsessive-compulsive behavior in pupils in Denmark. Ada Psychiatrica Scandinavica 88, 212–217.CrossRefGoogle Scholar
Toro, J., Curvera, M., Osejo, E. & Salamero, M. (1992). Obsessive compulsive disorder in children and adolescents: a clinical study. Journal of American Academy of Child and Adolescent Psychiatry 33, 1025–1037.Google ScholarPubMed
Valleni-Basile, L.A., Garrison, C.Z., Jackson, K.L., Waller, J.L., McKeown, R.E., Addy, C.L. & Cuffe, S.P. (1994). Frequency of obsessive-compulsive disorder in a community sample of young adolescents. Journal of American Academy of Child and Adolescent Psychiatry 33 (6), 782–791.CrossRefGoogle Scholar
Weissman, M.M., Bland, R.C. & Canino, G.J. (1994). The Cross National Epidemiolgy of obsessive compulsive disorder. Journal of Clinical Psychiatry, Suppl. No. 3, vol. 55, pp. 5–10.Google Scholar