Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder

Stewart, S. Evelyn; Hezel, Dianne M.; Stachon, Andrea

doi:10.2165/11632860-000000000-00000

Cited by 16 publications

(10 citation statements)

References 93 publications

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“…An additional consideration is that the degree of symptom-based shame may vary depending on the obsessional content. A number of conceptual and case descriptions suggest that shame is especially likely in response to violent or sexual obsessions (Berle and Phillips, 2006; Cougle et al, 2008; Herbst et al, 2012; Marsanic et al, 2011; Stewart et al, 2012; Torres et al, 2001). The only empirical study of this issue in a clinical sample (Kim et al, 2013) revealed no significant correlations of specific OCD symptoms with shame (partial r s all non-significant and ranging from −.08 to .24).…”

Section: Resultsmentioning

confidence: 99%

“…Finally, shame in OCD may be maintained, and even exacerbated, by the treatment avoidance and social withdrawal that shame promotes. Numerous observations in the clinical OCD literature note that shame leads to avoidance of disclosing symptoms to treatment providers or loved ones (Abbey et al, 2007; Bram and Bjorgvinsson, 2004; Canavera et al, 2009; Chavira et al, 2008; Herbst et al, 2012; Kim et al, 2013; Marsanic et al, 2011; Monti et al, 1998; Moritz, 2008; Moritz and Jelinek, 2008; Moritz et al, 2011; Newth and Rachman, 2001; Rothenberg, 1998; Salkovskis, 1990; School, 2005; Simonds and Thorpe, 2003; Stewart et al, 2012; Sulkowski et al, 2011; Vythilingum and Stein, 2005; Williams et al, 1998; Zohar et al, 2007). Moreover, some authors anecdotally observe that such avoidance likely impedes social functioning and support (Abbey et al, 2007; Nymberg and Van Noppen, 1994; Sorensen et al, 2004).…”

Section: Resultsmentioning

confidence: 99%

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Shame in the obsessive compulsive related disorders: A conceptual review

Weingarden

Renshaw

2015

Journal of Affective Disorders

129

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Background Theoretical and anecdotal support for the role of shame in obsessive compulsive related disorders (OCRDs) is prominent. Developing our understanding of shame’s role in OCRDs is important to building knowledge about this new diagnostic category. This review aims to consolidate our understanding of shame in each OCRD, through summarizing existing clinical, conceptual, and empirical work. Methods We provide an overview of shame, its measurement considerations, and a full review of 110 articles addressing shame in OCRDs. Results General shame and shame about having a mental illness are the broadest types of shame relevant to OCRDs; symptom-based shame and body shame may be more specific to OCRDs. In OCD, violent, sexual, or blasphemous obsessions may trigger symptom-based shame. In trichotillomania (TTM) and skin picking (SP), symptom-based shame may be related to pulling, picking, and post-pulling/picking behaviors. In hoarding disorder, symptom-based shame may accompany beliefs about being defective due to living with clutter. Body shame appears inherent to body dysmorphic disorder, while in TTM and SP it may arise as a secondary response to damage resulting from body focused repetitive behaviors. Limitations Much of the current knowledge on shame in OCRDs comes from anecdotal, case, and conceptual work. Empirical studies do not always assess specific types of shame, instead assessing shame as a general construct. Conclusions Shame is closely related to OCRDs. Clinical and research recommendations drawing from the literature are provided.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Shame in the obsessive compulsive related disorders: A conceptual review

Weingarden

Renshaw

2015

Journal of Affective Disorders

129

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“…SLITRK5 knockout mice display a pathologic over-grooming phenotype that is accompanied by disrupted corticostriatal circuit activity. Moreover, pathologic grooming behavior in SLITRK5 knockout mice is normalized by serotonin reuptake inhibitors; the most effective pharmacologic treatments for OCD [12, 13]. …”

Section: Introductionmentioning

confidence: 99%

Rare Synaptogenesis-Impairing Mutations in SLITRK5 Are Associated with Obsessive Compulsive Disorder

et al. 2017

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Obsessive compulsive disorder (OCD) is substantially heritable, but few molecular genetic risk factors have been identified. Knockout mice lacking SLIT and NTRK-Like Family, Member 5 (SLITRK5) display OCD-like phenotypes including serotonin reuptake inhibitor-sensitive pathologic grooming, and corticostriatal dysfunction. Thus, mutations that impair SLITRK5 function may contribute to the genetic risk for OCD. We re-sequenced the protein-coding sequence of the human SLITRK5 gene (SLITRK5) in three hundred and seventy seven OCD subjects and compared rare non-synonymous mutations (RNMs) in that sample with similar mutations in the 1000 Genomes database. We also performed in silico assessments and in vitro functional synaptogenesis assays on the Slitrk5 mutations identified. We identified four RNM’s among these OCD subjects. There were no significant differences in the prevalence or in silico effects of rare non-synonymous mutations in the OCD sample versus controls. Direct functional testing of recombinant SLITRK5 proteins found that all mutations identified in OCD subjects impaired synaptogenic activity whereas none of the pseudo-matched mutations identified in 1000 Genomes controls had significant effects on SLITRK5 function (Fisher’s exact test P = 0.028). These results demonstrate that rare functional mutations in SLITRK5 contribute to the genetic risk for OCD in human populations. They also highlight the importance of biological characterization of allelic effects in understanding genotype-phenotype relationships as there were no statistical differences in overall prevalence or bioinformatically predicted effects of OCD case versus control mutations. Finally, these results converge with others to highlight the role of aberrant synaptic function in corticostriatal neurons in the pathophysiology of OCD.

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“…Many studies have demonstrated the effi cacy of SSRIs in the treatment of OCD in both adults and children ( 278 ). The clear superiority of this class of medications makes them the fi rst-line treatment for OCD.…”

Section: Pharmacological Treatmentmentioning

confidence: 99%

Obsessive Compulsive Disorder

Murphy¹,

Stewart²,

Obregon³

2016

The Medical Basis of Psychiatry

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OCD is the fourth most common neuropsychiatric disorder with lifetime prevalence estimates of 0.4-3.5%. Family and twin studies suggest a strong genetic component, and molecular genetic studies are being carried out to identify genes contributing risk to OCD. It is postulated as a frontal-striatal disorder and functional neuroimaging studies provide a strong support for the dysfunction of cortico-striatal-thalamic-cortical neurocircuit. OCD can be secondary to a variety of medical conditions that range from deteriorative neurological illness, to head injury, and to autoimmune disorders. Few reports and no controlled studies exist in the treatment of acquired/secondary OCD. Both CBT and pharmacotherapy are effective fi rst-line treatment modalities for OCD. Brain stimulation and/or psychosurgery have been tried with varying success in treatment of refractory OCD. Environmental, genetic, and clinical factors interact in a complex fashion in the individual patient. This chapter will examine OCD from the medical perspective.Keywords Obsessive compulsive disorder · Cortical-striatal-thalamo-cortical circuit · Genetics · Neuroimaging · Autoimmune · Treatment IntroductionAs defi ned in DSM-5, obsessive compulsive disorder (OCD) is characterized by obsessions (recurrent, unwanted, and distressing thoughts, images, or impulses) and/or compulsions (complex, repetitive, rule-governed behaviors that the patient feels driven to perform). Patients usually try to actively dismiss obsessions or neutralize them by seeking reassurance, avoiding situational triggers, or engaging in compulsions. Obsessions and compulsions are maladaptive, and lead to impaired functioning. They typically center on four themes: contamination, sexual/aggressive/checking, and ordering and symmetry. Common compulsions include excessive cleaning, checking behaviors, ordering and arranging rituals, counting, and repeating routine activities. Compulsions usually involve observable behaviors (e.g., hand-washing) but may also consist of covert mental rituals (e.g., counting, or ritualized performance of mental math). Symptom themes can vary over the course of the illness but those without a personal or family history of tics are more likely to have more frequent contamination themes. In the DSM-5, hoarding has been categorized as a distinct disorder, and is no longer considered a specifi c form of OCD. The addition of a separate diagnosis is supported by extensive research suggesting that, although the two disorders can co-occur, patients with symptoms of hoarding have a number of signifi cant phenomenological differences than those with OCD, including distinct cognitive processes, reinforcement patterns, and response to treatments commonly used to address symptoms of OCD ( 1 ).The proposed lifetime prevalence of OCD in the pediatric and adult population ranges from 0.4 to 3.5% in national and international epidemiological samples ( 2 -7 ). Approximately half of all OCD patients fi rst present in childhood, before age 15 ( 8 ) with biphasic symptom p...

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Assessment and Medication Management of Paediatric Obsessive-Compulsive Disorder

Cited by 16 publications

References 93 publications

Shame in the obsessive compulsive related disorders: A conceptual review

Shame in the obsessive compulsive related disorders: A conceptual review

Rare Synaptogenesis-Impairing Mutations in SLITRK5 Are Associated with Obsessive Compulsive Disorder

Obsessive Compulsive Disorder

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