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

Abstract

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.

Selenium and Its Compounds in the Treatment of Anxiety and Related Disorders: A Scoping Review of Translational and Clinical Research

“…It is estimated that around 3-9% of the general population suffers from an anxiety disorder, and another 5-15% fulfil the diagnostic criteria for anxiety-related disorders such as obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) [2-5]. There is a high degree of comorbidity between anxiety disorders, OCD and PTSD [6,7], which probably reflects common pathogenic mechanisms involving the interaction of genetic vulnerability factors with environmental stressors [8,9]. The pathophysiology of these disorders is complex, involving structural and functional alterations of specific cortical and subcortical brain structures [10][11][12], dysfunction of specific neurotransmitter systems [13,14], immune-inflammatory pathways [15], oxidative stress [16,17] and impaired neural plasticity [18].…”

Use of right orbitofrontal repetitive transcranial magnetic stimulation (rTMS) augmentation for treatment-refractory obsessive-compulsive disorder with comorbid major depressive disorder

“…Obsessive-Compulsive Disorder (OCD) is commonly comorbid with depression: up to 70% of patients suffer depressive symptoms and 40% meet criteria for Major Depressive Disorder (MDD) (Ruscio et al, 2010;Sharma et al, 2021). Comorbid OCD-MDD has a poorer prognosis than either illness alone, and psychotherapeutic and pharmacological treatments for individuals with OCD-MDD are limited (Stein et al, 2019).…”

Affecting OCD

“…About one third of the OCD patients is diagnosed with a mood disorder, mainly major depressive disorder (Sharma et al, 2021;Quarantini et al, 2011;Kalra et al, 2008), but the group of OCD patients suffering from depressive symptoms is presumably larger . The prevalence and severity of depressive symptoms may differ between symptom dimensions, although studies are inconclusive.…”

“…Studies on the effect of depressive symptoms and anxiety on the prognosis of OCD are inconsistent. Some authors relate depressive symptoms (Sharma et al, 2021;Visser et al, 2014;Jacubovski et al, 2013) and anxiety van Oudheusden et al, 2018; to an unfavorable course. Also the conclusions of studies on the effect of anxiety and depressive symptoms on treatment outcome vary due to differences in treatment modality and methodology .…”

“…Often, these symptoms meet the classification criteria of comorbid diagnoses such as major depressive disorder or anxiety disorders (Sharma et al, 2021;Visnawath et al, 2012;. Other studies showed that almost all OCD patients reported at least mild depressive symptoms, while only one third to two third of them are diagnosed with depression .…”