Childhood-Onset Obsessive Compulsive Disorder

Abstract

Childhood-onset obsessive-compulsive disorder affects 1%-2% of children and adolescents. While symptoms reported by children and behavioral therapies and pharmacological interventions administered to children are similar to those seen among individuals who develop obsessive compulsive disorder in adulthood, there are several differences with regards to sex ratios, comorbidity patterns, neuroimaging findings. Family and twin studies support the role of genetics in some forms of obsessive compulsive disorder. Prefrontal cortex, cingulate cortex, thalamus, nucleus caudatus, putamen and globus pallidus are the main brain areas affected in children with obsessive compulsive disorder. Selective serotonin reuptake inhibitors (SSRI) are the treatment of choice for pharmacotherapy of obsessive compulsive disorder and exposure and response prevention are the most commonly applied behavioral therapy methods in obsessive compulsive disorder. Despite advances in the treatment of the disorder, obsessive compulsive disorder is still considered as a debilitating chronic disorder.

Keywords

• obsession, compulsion, obsessive compulsive disorder, childhood-onset, anxiety disorder

Çocukluk Çağı Başlangıçlı Obsesif Kompulsif Bozukluk

Öz

Çocukluk çağı başlangıçlı obsesif kompulsif bozukluk, çocuk ve ergenlerin %1-2 kadarını etkiler. Obsesif kompulsif bozukluk tanılı çocukların bildirdikleri yakınmalar ve tedavide kullanılan davranışsal terapiler ve ilaç tedavileri erişkin başlangıçlı olguları ile benzerlik göstermektedir. Bununla birlikte cinsiyet oranları, eştanı örüntüleri ve nörogörüntüleme çalışmalarının sonuçları, iki grup arasında farklılıkların da bulunduğuna işaret etmektedir. Aile ve ikiz çalışmaları, obsesif kompulsif bozukluğun bazı formlarında genetik faktörlerin rolü olduğunu desteklemektedir. Nörogörüntüleme çalışmalarında prefrontal korteks, singulat korteks, talamus, kaudat nükleus, putamen ve globus pallidus ön plana çıkmaktadır. Obsesif kompulsif bozukluğun farmakolojik tedavisinde ilk seçenek olarak seçici serotonin geri alım inhibitörleri tercih edilmektedir. Davranışçı tedavide ise en sık maruz bırakma ve tepkiyi önleme teknikleri uygulanmaktadır. Obsesif kompulsif bozukluk tedaviye yanıt verse de genellikle kronik seyirli bir bozukluk olduğu kabul edilmektedir.

Anahtar Kelimeler

• obsesyon, kompulsiyon, obsesif kompulsif bozukluk, çocukluk

References

1. Abay E, Pulular A, Memiş ÇÖ, Süt N. Edirne ili merkezindeki lise öğrencilerinde obsesif-kompulsif bozukluğun epidemiyolojisi. Düşünen Adam: Psikiyatri ve Nörolo- jik Bilimler Dergisi 2010; 23:230-237.
2. Türkbay T, Söhmen T. Obsesif kompulsif bozukluk ile psikotik bozukluğun karışma- sı: bir olgu sunumu. Çocuk ve Gençlik Ruh Sağlığı Dergisi 2000; 7:106-112.
3. Rasmussen SA, Eisen JL. The epidemiology and differential diagnosis of obsessive compulsive disorder. J Clin Psychiatry 1992; 53 (Suppl):4-10.
4. Flament M. Epidemiology of obsessive-compulsive disorder in children and adolescents. Encephale 1990; 16:311-316.
5. Zohar AH. The epidemiology of obsessive-compulsive disorder in children and adolescents. Child Adolesc Psychiatr Clin N Am 1999; 8:445-460.
6. Geller DA, Biederman J, Jones J, Park K, Schwartz S, Shapiro S et al. Is juvenile obsessive-compulsive disorder a developmental subtype of the disorder? A review of the pediatric literature. J Am Acad Child Adolesc Psychiatry 1988; 37:420-427.
7. Leonard HL, Lenane MC, Swedo SE, Rettew DC, Gershon ES, Rapoport JL.Tics and Tourette's disorder: a 2- to 7-year follow-up of 54 obsessive-compulsive children. Am J Psychiatry 1992; 149:1244-1251.
8. Diler RS, Avci A. Sociodemographic and clinical characteristics of Turkish children and adolescents with obsessive-compulsive disorder. Croat Med J 2002; 43:324-329.

9. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington D.C., APA, 1994.
10. Öner P, Aysev A. Çocuk ve ergenlerde obsesif kompulsif bozukluk. Sürekli Tıp Eği- tim Dergisi 2001; 10(11):409-411.
11. Swedo SE, Leonard HL, Rapoport JL. Childhood-onset obsessive compulsive disorder. Psychiatr Clin North Am 1992; 15:767-775.
12. Karno M, Golding JM, Sorenson SB, Burnam MA. The epidemiology of obsessive compulsive disorder in five US communities. Arch Gen Psychiatry 1988; 45:1094- 1099.
13. Stewart, SE, Geller DA, Jenike M, Pauls D, Shaw D, Mullin B et al. Long-term outcome of pediatric obsessive-compulsive disorder: a meta analysis and qualitative review of the literature. Acta Psychiatr Scand 2004; 110:4-13.
14. Rapoport JL, Elkins R, Langer DH, Sceery W, Buchsbaum MS, Gillin JC et al. Childhood obsessive-compulsive disorder. Am J Psychiatry 1981; 138:1545- 1554.
15. Riddle MA, Scahill L, King R, Hardin MT, Towbin KE, Ort SI et al. Obsessive compulsive disorder in children and adolescents: phenomenology and family history. J Am Acad Child Adolesc Psychiatry 1990; 29:766-772.
16. Rettew DC, Swedo SE, Leonard HL, Lenane MC, Rapoport JL. Obsessions and compulsions across time in 79 children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1992; 31:1050-1056.
17. Pauls DL, Alsobrook JP, Goodman W, Rasmussen S, Leckman JF. A family study of obsessive-compulsive disorder. Am J Psychiatry 1995; 152:76-84.
18. Rasmussen SA. Genetic studies of obsessive compulsive disorder. In Current Insight in Obsessive Compulsive Disorder (Eds E Hollander, J Zohar, D Marazziti):93-114. England, Wiley, 1994.
19. van Grootheest DS, Cath DC, Beekman AT, Boomsma DI. Twin studies on obsessive- compulsive disorder: a review. Twin Res Hum Genet 2005; 8:450-458.
20. Sanematsu H, Nakao T, Yoshiura T, Nabeyama M, Togao O, Tomita M et al. Predictors of treatment response to fluvoxamine in obsessive-compulsive disorder: an fMRI study. J Psychiatr Res 2010; 44:193-200.
21. Rosenberg DR, Keshavan M.S. Toward a neurodevelopmental model of obsessive- compulsive disorder. Biol Psychiatry 1998; 43:623-640.
22. Szeszko PR, MacMillan S, McMeniman M Chen S, Baribault K, Lim KO et al. Brain structural abnormalities in psychotropic drug-naive pediatric patients with obsessive- compulsive disorder. Am J Psychiatry 2004; 161:1049-1056.
23. Gilbert AR, Akkal D, Almeida JR, Mataix-Cols D, Kalas C, Devlin B et al. Neural correlates of symptom dimensions in pediatric obsessive-compulsive disorder: a functional magnetic resonance imaging study. J Am Acad Child Adolesc Psychiatry 2009; 48:936-944.
24. Lázaro L, Bargalló N, Castro-Fornieles J. Brain changes in children and adolescents with obsessive-compulsive disorder before and after treatment: a voxel-based morphometric MRI study. Psychiatry Res 2009; 172:140-146.
25. Radua J, Mataix-Cols D. Voxel-wise meta-analysis of grey matter changes in obsessive-compulsive disorder. Br J Psychiatry 2009; 195:393-402.
26. Huyser C, Veltman DJ, de Haan E, Boer F. Paediatric obsessive-compulsive disorder, a neurodevelopmental disorder? Evidence from neuroimaging. Neurosci Biobehav Rev 2009; 33:818-830.
27. Atmaca M, Yildirim H, Ozdemir H , Koc M, Ozler S, Tezcan E. Neurochemistry of the hippocampus in patients with obsessive-compulsive disorder. Psychiatry Clin Neurosci 2009; 63:486-490.
28. MacMaster FP. Translational neuroimaging research in pediatric obsessive- compulsive disorder. Dialogues Clin Neurosci 2010; 12:165-741.
29. Renynghe de Voxrie GV. Anafranil in obsessive neurosis. Arch Neurol Belg 1968; 68:787-792.
30. Capstick N. Clomipramine in obsessional states. Psychosomatics 1971; 12:332-335.
31. Ananth J, Pecknold, JC, van den Steen, N, and Engelsmann, F. Double-blind comparative study of clomipramine and amitriptyline in obsessive neurosis. Prog Neuropsychopharmacol Biol Psychiatry 1981; 5:257–262.
32. Leonard HL, Swedo SE, Rapoport JL, Koby EV, Lenane MC, Cheslow DL et al. Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents: A doubleblind crossover comparison. Arch Gen Psychiatry 1989; 46:1088-1092.
33. Goddard AW, Shekhar A, Whiteman, AF, McDougle CJ. Serotoninergic mechanisms in the treatment of obsessive-compulsive disorder. Drug Discov Today 2008; 13:325- 332.
34. Gross-Isseroff R, Cohen R, Sasson Y, Voet H, Zohar J. Serotonergic dissection of obsessive compulsive symptoms: a challenge study with m-chlorophenylpiperazine and sumatriptan. Neuropsychobiology 2004; 50:200-205.
35. Koo MS, Kim EJ, Roh D, Kim CH. Role of dopamine in the pathophysiology and treatment of obsessive-compulsive disorder. Expert Rev Neurother 2010; 10:275-290.
36. Olver JS, O'Keefe G, Jones GR, Burrows GD, Tochon-Danguy HJ, Ackermann U, et al. Dopamine D(1) receptor binding in the anterior cingulate cortex of patients with obsessive-compulsive disorder. Psychiatry Res 2010; 83:85-88.
37. Moore GJ, MacMaster FP, Stewart C, Rosenberg DR. Case study: caudate glutamatergic changes with paroxetine therapy for pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1998; 37:663-667.
38. Chakrabarty K, Bhattacharyya S, Christopher R, Khanna S. Glutamatergic dysfunction in OCD. Neuropsychopharmacology 2005; 30:1735-1740.
39. Coric V, Taskiran S, Pittenger C, Wasylink S, Mathalon DH, Valentine G et al. Riluzole augmentation in treatment-resistant obsessive-compulsive disorder: an open- label trial. Biol Psychiatry 2005; 58:424-428.
40. Grant P, Lougee L, Hirschtritt M, Swedo SE. An open-label trial of riluzole, a glutamate antagonist, in children with treatment-resistant obsessive-compulsive disorder. J Child Adolesc Psychopharmacol 2007; 17:761-767.
41. Swedo SE, Leonard HL, Garvey M. Pediatric auto-immune neuropsychiatric disorders associated with streptococcal infections (PANDAS): a clinical description of the first fifty cases. Am J Psychiatry 1998; 155:264-271.
42. Swedo SE, Rapoport JL, Cheslow DL, Leonard HL, Ayoub EM, Hosier DM et al. High prevalence of obsessive-compulsive symptoms in patients with Sydenham’s chorea. Am J Psychiatry 1989; 146:246–249
43. Chapman F, Visvanathan K, Carreno-Manjarrez R, Zabriskie JB. A flow cytometric assay for D8/17 B cell marker in patients with Tourette’s syndrome and obsessive- compulsive disorder. J Immunol Methods 1998; 219:181-186.
44. Aslan H, Ünal M. Obsesif Kompulsif Bozukluk (Saplantı Zorlantı Bozukluğu). Anksiyete Monografları Serisi 1995; 3:101-142.
45. Demirok D, Unal F, Pehlivantürk B. Çocuk ve ergenlerde obsesif kompulsif bozuk- luk: Sosyodemografik ve klinik özellikler. Çocuk ve Ergen Ruh Sağlığı Dergisi 2001; 8:11-18.
46. Towbin KE, Riddle MA. Obsessive-compulsive disorder. In Child and Adolescent Psychiatry (Ed M Lewis):685-687. Baltimore, Williams and Wilkins, 1991.
47. Swedo SE, Rapoport JL, Leonard HL Lenane M, Cheslow D. Obsessive compulsive disorder in children and adolescents: clinical phenomenology of 70 consecutives cases. Arch Gen Psychiatry 1989; 40:335-344.
48. Türkbay T, Doruk A, Erman H Söhmen T. Obsesif kompulsif bozukluğun belirti dağılımının ve komorbiditesinin çocuk ve ergenler ile erişkinler arasında karşılaştırıl- ması. Klinik Psikiyatri Dergisi 2000; 3:86-91.
49. Hanna GL. Demographic and clinical features of obsessive- compulsive disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry 1995; 19:134-144.
50. Kalra SK, Swedo SE. Children with obsessive-compulsive disorder: are they just "little adults"? J Clin Invest 2009; 119:737-746.
51. Kaplan HI, Sadock BJ. Synopsis of Psychiatry, 8th edition. Baltimore, Williams and Wilkins, 1998.
52. Mancebo, MC, Garcia AM, Pinto A, Freeman JB, Przeworski A, Stout R et al. Juvenile-onset OCD: clinical features in children, adolescents and adults. Acta Psychiatr Scand 2008; 118:149-159.
53. Fireman B, Koran LM, Leventhal JL, Jacobson A. The prevalence of clinically recognized obsessive-compulsive disorder in a large health maintenance organization. Am J Psychiatry 2001; 158:1904-1910.
54. Leonard HL, Freeman J, Garcia A, Garvey M, Snider L, Swedo SE. Obsessive- compulsive disorder and related conditions. Pediatr Ann 2001; 30:154-160.
55. Geller DA. Obsessive-compulsive and spectrum disorders in children and adolescents. Psychiatr Clin North Am 2006; 29:353-370.
56. Toros F, Tot S, Avcı A. Çocuk ve ergenlerde Tourette Bozukluğu: Sosyodemografik, klinik özellikler ve eştanılar. Turk Psikiyatri Derg 2002; 13:187-195.
57. Öztürk MO. Ruh Sağlığı ve Bozuklukları, 8.baskı. Ankara, Hekimler Yayın Birliği, 1994.
58. Pişgin İ, Özen DŞ. Çocukluktan erişkinliğe obsesif kompulsif bozuklukta hatalı değerlendirme ve inanç alanları. Psikiyatride Güncel Yaklaşımlar 2010; 2:117-131.
59. Thomsen PH, Mikkelsen HU. Development of personality disorders in children and adolescents with obsessive-compulsive disorder. A 6- to 22-year follow-up study. Acta Psychiatr Scand 1993; 87:456-462.
60. Wagner KD, Cook EH, Chung H, Messig M. Remission status after long-term sertraline treatment of pediatric obsessive-compulsive disorder. J Child Adolesc Psychopharmacol. 2003; 13 (Suppl 1):53-60.
61. Wever C, Rey JM. Juvenile obsesive compulsive disorder. Austr NZJ Psychiatry 1997; 31:105-113.
62. Rosenberg DR, Stewart CM, Fitzgerald KD, Tawile V, Carroll E. Paroxetine open- label treatment of pediatric outpatients with obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 1999; 38:1180-1185.
63. Alaghband-Rad J, Hakimshooshtary M. A randomized controlled clinical trial of citalopram versus fluoxetine in children and adolescents with obsessive-compulsive disorder (OCD). Eur Child Adolesc Psychiatry 2009; 18:131-135.
64. Arias Horcajadas F, Soto JA, García-Cantalapiedra MJ, Rodríguez Calvin JL, Morales J, Salgado M. Effectiveness and tolerability of addition of risperidone in obsessive- compulsive disorder with poor response to serotonin reuptake inhibitors Actas Esp Psiquiatr 2006; 34:147-152.
65. Bloch MH, Landeros-Weisenberger A, Kelmendi B, Coric V, Bracken MB, Leckman JF. A systematic review: antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Mol Psychiatry 2006; 11:622-632.
66. McDougle CJ, Goodman WK, Leckman JF, Lee NC, Heninger GR, Price LH. Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder. A double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 1994; 51:302-308.
67. Matsunaga H, Kiriike N, Matsui T, Oya K, Iwasaki Y, Koshimune K et al. Obsessive- compulsive disorder with poor insight. Compr Psychiatry 2002; 43:150-157.
68. Lombroso PJ, Scahill L, King RA, Lynch KA, Chappell PB, Peterson BS et al. Risperidone treatment of children and adolescents with chronic tic disorders: a preliminary report. J Am Acad Child Adolesc Psychiatry 1995; 34:1147-1152.
69. Blanco C, Olfson M, Stein DJ, Simpson HB, Gameroff MJ, Narrow WH. Treatment of obsessive-compulsive disorder by U.S. psychiatrists. J Clin Psychiatry 2006; 67:946-951.
70. Alonso P, Menchon JM, Pifarre J, Mataix-Cols D, Torres L, Salgado P et al. Long- term follow-up and predictors of clinical outcome in obsessive-compulsive patients treated with serotonin reuptake inhibitors and behavioral therapy. J Clin Psychiatry 2001; 62:535-540.