Children with obsessive-compulsive disorder: are they just “little adults”?

Abstract

Childhood-onset obsessive-compulsive disorder (OCD) affects 1%-2% of children and adolescents. It is characterized by recurrent obsessions and compulsions that create distress and interfere with daily life. The symptoms reported by children are similar to those seen among individuals who develop OCD in adulthood, and the two groups of patients are treated with similar symptom-relieving behavior therapies and medications. However, there are differences in sex ratios, patterns of comorbidity, and the results of neuroimaging studies that might be important. Here we review the diagnosis and treatment of childhood-onset OCD in light of pediatric and adult studies. We also discuss current knowledge of the pathophysiology of the disorder. Despite advances in this area, further research is needed to understand better the etiopathogenesis of the disorder and to develop new, more effective therapeutic options.

Disruptive insights in psychiatry: transforming a clinical discipline

“…The basis of diagnosis is likely to be completely reformulated to consider biological information, such as genetics and imaging data. And just as we no longer use psychoanalysis for peptic ulcer disease, treatments such as antibiotics and deep brain stimulation are likely to replace current medications as we learn more about the pathophysiology of disorders, such as one form of childhood-onset OCD and depression (2,4). In a commencement speech given at Morehouse College in 1959, Martin Luther King Jr. reflected on the Rip Van Winkle story and the tragedy that this fictional character had slept through the most important revolution in American history (56).…”

“…The present series, "Rethinking Mental Disorders," introduces several of the front lines of this revolution. It may be notable that this revolution is infused by new ideas from outside psychiatry: the authors include a neurologist (2), a developmental neuroscientist (5), and a pediatrician (4). In this overview, I describe four conceptual shifts, or disruptive insights, that provide the intellectual basis of this revolution.…”

“…The challenge, of course, is identifying those elements of current theory and practice that need to be left behind. This Review Series, "Rethinking Mental Disorders," is dedicated to some of the emerging areas of discovery that may overturn many of our current beliefs about schizophrenia (1), depression (2), bipolar illness (3), childhood-onset obsessive-compulsive disorder (OCD) (4), and autism spectrum disorder (ASD) (5). As an introduction to the individual Review articles, I set the stage by identifying some of the conceptual shifts, or, as I refer to them here, "disruptive insights," that have come about through current research.…”

Dopamine ADHD/OCD Theories: Is Glutamine Part of the Story?

“…Kaira and Swedo [4] outlined patterns of comorbidity and related neuroimaging studies in children with obsessive-compulsive disorder. They pointed out that two decades of research had indicated that childhood OCD is also thought to be associated with dysfunction of cortico-striato-thalamo-cortical circuitry (Swedo, Rapoport , Leonard, Lenane & Cheslow) [5] .…”

“…Regional autoimmune reactors are suggested by the demonstration that monoclonal antibodies specific for mammalian lysoganglioside and N-acetyl-B-glucosamine, an epitope of group A streptococci". According to Kaira and Swedo [4] introduction of these antibodies into basal ganglia of rats has been shown to produce stereotypies such as "wood-chip eating, self-gnawing, biting, licking and grooming, paw to mouth movements, vacuous chewing and head and paw shaking".…”