Pediatric obsessive–compulsive disorder with tic symptoms: clinical presentation and treatment outcome

Højgaard, Davíð R.M.A.; Skarphéðinsson, Guðmundur; Nissen, Judith Becker; Hybel, Katja Anna; Ivarsson, Tord; Thomsen, Per Hove

doi:10.1007/s00787-016-0936-0

Cited by 19 publications

(14 citation statements)

References 62 publications

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“…The rates of OCD in TS subjects vary from 10% to 35%. Otherwise, the rates range from 7% of TS in OCD patients to 53% of tics in OCD patients [2,3,8,9].…”

Section: Obsessive-compulsive Disorder and Tourette Syndromementioning

confidence: 99%

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Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

Rothenberger

Roessner

2019

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While Behavioral Therapy (BT) should be recommended as the first step in the treatment of OCD as well as TS, medication can be added for augmentation and in certain situations (e.g. family preference, BT not available or feasible) the priority may even reverse. This narrative review is given on the complexity of drug treatment in patients comorbid for obsessive-compulsive disorder (OCD) and Tourette syndrome (TS) and other tic problems. OCD with TS is a co-occuring combination of two generally delimitable, but in detail also overlapping disorders which wax and wane with time but have different courses and necessities and options of treatment. Distinct subtypes like "tic-related OCD" are questionable. Obsessive-compulsive symptoms (OCS) and tics are frequently associated (OCS in TS up to 90%, tics in OCD up to 37%). Sensory-motor phenomena like urges and just-right feelings reflect some behavioral overlap. The main additional psychopathologies are attention-deficit hyperactivity disorder (ADHD), mood problems and anxiety. Also, hair pulling disorder and skin picking disorder are related to OCD with TS. Hence, the assessment and drug treatment of its many psychopathological problems needs high clinical experience, careful planning, and ongoing evaluation/adaptation. Drugs are able to reduce clinical symptoms but cannot cure the disorders, which should be treated in parallel in their own right; i.e. for OCD serotonin reuptake inhibitors (SSRI) and for TS (tics) certain antipsychotics can be successfully prescribed. In cases of OCD with tics, when OCS respond only partially, an augmentation with antipsychotics (recommended: aripiprazole and risperidone) may improve OCS as well as tics. Also, the benzamide sulpiride, an atypical antipsychotics, may be beneficial in treating the combination of OCS, tics and anxious-depressive problems. Probably, any additional psychopathologies of OCD might attenuate the effectiveness of SSRI on OCS; on the other hand, in cases of OCD with tics, SSRI may reduce not only OCS but also stress sensitivity and emotional problems and thus leading to better selfregulatory abilities, useful to improve tic suppression. In sum, some clinical guidance can be given, but there remain many uncertainties because of a scarce data base for psychopharmacotherapy in OCD with TS. Recently, a high quality primer on Tourette Syndrome (TS) has been published, giving a timely and comprehensive overview related to all relevant aspects of the disorder [1]. This includes the suggestion that primarily Behavior Therapy (BT) should be recommended for the treatment of both OCS/OCD and TS. BT seems to be equally effective for pure as well as tic-related OCD [2-4]. But many patients remain symptomatic after BT intervention. In this situation, medication comes into play for augmentation. Further, drug treatment may be given the priority if BT is not available, not feasible or not preferred by the family. Concerning the practically important relationship between obsessive-compulsive symptoms (OCS) and TS the present r...

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“…The rates of OCD in TS subjects vary from 10% to 35%. Otherwise, the rates range from 7% of TS in OCD patients to 53% of tics in OCD patients [2,3,8,9].…”

Section: Obsessive-compulsive Disorder and Tourette Syndromementioning

confidence: 99%

“…This includes the suggestion that primarily Behavior Therapy (BT) should be recommended for the treatment of both OCS/OCD and TS. BT seems to be equally effective for pure as well as tic-related OCD [2][3][4]. But many patients remain symptomatic after BT intervention.…”

Section: Introductionmentioning

confidence: 99%

Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

Rothenberger

Roessner

2019

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“…However, with many OCD presentations extending beyond anxious states (e.g., disgust, "not-right" as the core negative valence state), the DSM-5 (1) has evolved to categorise OCD outside of the anxiety disorders and along with select phenomenologically similar comorbidities [Obsessive-Compulsive Related Disorders (OCRDs)]. Correspondingly, tic disorders have been examined as phenotypic markers for a homogeneous subgrouping among heterogeneous presentations of OCD (10)(11)(12), and their lifetime presence is a DSM-5 OCD specifier. Recent reviews have examined the epidemiological, clinical and psychopathological relationships between certain personality disorders, specifically schizotypal personality disorder (9) and obsessive-compulsive personality disorder (13), and OCD, suggesting the relevance of systematic clinical assessments and a need for further clinical, neurobiological and genetic enquiry in this area.…”

Section: Introductionmentioning

confidence: 99%

Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis

Sharma

Balachander

et al. 2021

Front. Psychiatry

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Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs.Systematic Review Registration: Unique Identifier: CRD42020215904.

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“…Obsessive–compulsive disorder (OCD) is a heterogeneous condition, composed of distinct subtypes [ 1 ]. These subtypes can be described according to the predominant obsessions or compulsions, the age at onset [ 2 , 3 , 4 , 5 , 6 ], the content of the obsessions or compulsions [ 7 , 8 , 9 ], insight level [ 10 , 11 ], the presence of sensory phenomena [ 12 , 13 ], the presence of tics [ 14 , 15 , 16 , 17 ], psychiatric comorbidities [ 18 , 19 ], the response to conventional treatments [ 20 , 21 , 22 ], the presence of a familial history of OCD [ 23 , 24 , 25 ], and many other clinical features. The relationship between environmental factors and each of these subtypes or the course or severity of the clinical features of OCD, however, has not yet been substantially explored.…”

Section: Introductionmentioning

confidence: 99%

Stressful Life Events and the Clinical Expression of Obsessive–Compulsive Disorder (OCD): An Exploratory Study

Imthon¹,

Caldart²,

Rosário

et al. 2020

JCM

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Background: In obsessive–compulsive disorder (OCD), symptom content and severity appear to fluctuate over the course of the life cycle in accordance with stressful life events. The objective of this paper was to compare OCD patients with and without reported stressful life events (SLEs) in terms of the sociodemographics of patients and the clinical characteristics of OCD. Methods: This was a cross-sectional study involving 1001 patients with OCD. Data concerning SLEs were collected via the Yale OCD Natural History Questionnaire, while for OCD symptoms, the Dimensional Yale–Brown Obsessive–Compulsive Scale was used. Results: Of the 1001 OCD patients, 605 (60.5%) reported experiencing at least one SLE in their lifetime. Self-declared nonwhite skin color (odds ratio (OR) = 1.51), the presence of a sensory phenomenon (OR = 1.47), and comorbidity with post-traumatic stress disorder (PTSD) (OR = 2.38) were some of the logistic regression variables related to the reported SLEs with relevant statistical significance and risk (i.e., OR) values. Conclusions: Our results indicate that SLEs may make Brazilian OCD patients vulnerable to the onset or exacerbation of obsessive–compulsive symptoms. The positive association of the occurrence of SLEs and sensory phenomena in this population could corroborate that environmental influences impact the neurobiology associated with OCD, and likely with other psychiatric disorders as well.

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Pediatric obsessive–compulsive disorder with tic symptoms: clinical presentation and treatment outcome

Abstract: Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

Cited by 19 publications

References 62 publications

Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

Psychopharmacotherapy of Obsessive-Compulsive Symptoms within the Framework of Tourette Syndrome

Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis

Stressful Life Events and the Clinical Expression of Obsessive–Compulsive Disorder (OCD): An Exploratory Study

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