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People with obsessive-compulsive disorder (OCD) are likely to be more susceptible to the mental health impact of COVID-19. This paper shares the perspectives of expert clinicians working with OCD considering how to identify OCD in the context of COVID-19, changes in the presentation and importantly what to consider when undertaking Cognitive Behaviour Therapy (CBT) for OCD in the current climate. The expert consensus is although the presentation of OCD and treatment may have become more difficult, CBT should still continue remotely unless there are specific reasons for it not to e.g. increase in risk, no access to computer or exposure tasks or behavioural experiments cannot be undertaken. The authors highlight some of the considerations to take in CBT in light of our current understanding of COVID-19, including therapists and clients taking calculated risks when developing behavioural experiments and exposure tasks, considering viral loading and vulnerability factors. Special considerations for young people and perinatal women are discussed as well as foreseeing what life may be like for those with OCD after the pandemic is over.

Objectives. The aim of this study was to determine (1) the diagnostic efficacy of orthopantomography (OPG) in the diagnosis of sinus diseases by using cone beam computed tomography (CBCT) as the imaging gold standard, (2) which diseases can be diagnosed by using panoramic radiography or CBCT, and (3) the interobserver agreement of 2 experienced dental radiologists. Study Design. The images of 714 individuals who underwent OPG and CBCT on the same day were assessed separately by 2 dental radiologists. The results were compared by using Gwet's AC 1 statistical methods. Results. In total, 1322 maxillary sinuses were imaged. The sensitivity of OPG for the detection of any maxillary sinus pathology was poor compared with CBCT, but the specificity was high. The sensitivity of OPG for detecting mucosal thickening was 36.7%. The positive predictive value of OPG for diagnosing mucosal thickening was 79.9 %, but the negative predictive value was 51.9%. Interobserver agreement was strong (0.912) for all lesions except mucosal thickening. Conclusions. Panoramic imaging has low efficacy in the diagnosis of sinus disease, even when examined by experienced dental radiologists. OPG can be useful in excluding disease, but 3-dimensional scanning is necessary for the definitive investigation of sinus lesions.

Body dysmorphic disorder (BDD) often starts in childhood, with most cases developing symptoms before age 18. Yet, BDD research has primarily focused on adults. We report the clinical characteristics of the world’s largest cohort of carefully diagnosed youths with BDD and focus on previously unexplored sex and age differences. We systematically collected clinical data from 172 young people with BDD consecutively referred to 2 specialist pediatric obsessive–compulsive and related disorders outpatient clinics in Stockholm, Sweden and in London, England. A series of clinician-, self-, and parent-reported measures were administered. The cohort consisted of 136 girls, 32 boys, and 4 transgender individuals (age range 10–19 years). The mean severity of BDD symptoms was in the moderate to severe range, with more than one third presenting with severe symptoms and more than half showing poor or absent insight/delusional beliefs. We observed high rates of current psychiatric comorbidity (71.5%), past or current self-harm (52.1%), suicide attempts (11.0%), current desire for cosmetic procedures (53.7%), and complete school dropout (32.4%). Compared to boys, girls had significantly more severe self-reported BDD symptoms, depression, suicidal thoughts, and self-harm. Compared to the younger participants (14 or younger), older participants had significantly more severe compulsions and were more likely to report a desire for conducting cosmetic procedures. Adolescent BDD can be a severe and disabling disorder associated with significant risks and substantial functional impairment. The clinical presentation of the disorder is largely similar across sexes and age groups, indicating the importance of early detection and treatment. More research is needed specifically focusing on boys and pre-pubertal individuals with BDD.

Obsessive-compulsive disorder (OCD) has similar prevalence rates across the World.1,2 Within Western countries, including the UK, the prevalence of OCD has been shown to be roughly consistent across ethnic groups. For example, the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) study 3,4 examined the prevalence of mental disorders across adult British White, Black Caribbean, Indian, Pakistani, Bangladeshi and Irish ethnic groups. A similar point prevalence of OCD of around 1% was found across all ethnicities. Heyman et al 5 conducted a nationwide (UK) epidemiological survey to establish the prevalence of OCD in young people aged 5-15 (n410 000) and reported a significantly greater proportion of children from ethnic minorities among those with OCD (24%) compared with healthy controls (8.8%) and psychiatric controls (7.4%). Given the similar, if not higher, prevalence of OCD across ethnic groups in Britain [3][4][5] and elsewhere, 6 a proportional representation of different ethnic groups would be expected in mental health services. However, there is substantial evidence to indicate that patients from ethnic minorities, both children 7 and adults, 8 tend to be underrepresented in mental health services in Britain, although data specifically relating to OCD is lacking. Research conducted in North America suggests that patients with OCD from ethnic minorities are underrepresented in clinical trials. Williams et al 9 reviewed 21 randomised controlled trials of OCD conducted in North America and found that ethnic minorities were seriously underrepresented in such studies (91% of participants were White). As OCD has rarely been studied separately, there is little data relating specifically to ethnic inequalities in access to clinical services of this major, yet treatable, psychiatric disorder. The overall aim of the present study was to explore whether individuals with OCD from ethnic minorities are underrepresented in secondary and tertiary clinical services within a large mental health trust in South London, relative to the ethnic composition of the corresponding catchment area. We also aimed to determine whether ethnic inequalities, if found, are restricted to a particular age group (children v. adults) or type of clinical service (community mental health clinics v. specialist clinics) or specific to OCD (compared with depression). Method Study settingThe South London and Maudsley (SLaM) NHS Foundation Trust is Europe's largest specialist mental healthcare trust. It serves a population of approximately 1.2 million residents of four South London boroughs: Lambeth, Southwark, Lewisham and Croydon. A proportion of SLaM services are tertiary care national referral units, 10 including three national specialist clinics for OCD: the Clinic for Young People with OCD and Related Disorders (Maudsley Hospital; child and adolescent out-and in-patients), the Centre for Anxiety Disorders and Trauma (CADAT; Maudsley Hospital, adult out-patients) and the Anxiety Disorders Residential Unit (ADRU; Bethlem Royal H...