obsessive-compulsive disorder in childhood and adolescence
TRANSCRIPT
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Obsessive-Compulsive Disorder
in Childhood and AdolescencePrepared by:
Chino M. dela Cruz
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Characterized by
Recurrent intrusive thoughtsassociated ith an!iety or "earand#or repetitive purpose"ul
mental or behavioral actionsaimed at reducing "ears andtensions caused by obsessions.
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$pidemiology
OCD is common among childrenand adolescents
Point prevalence o" %.&'
(i"etime prevalence o" )-*'
Among young children ith OCD+there is a slight male
predominance that decreasesith age
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$tiology
,$$/C0Rate o" OCD among 1st degree
relatives o" children and
adolescents ith OCD is tentimes greater than the generalpopulation.
OCD has been recognized to runin "amilies
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0usceptibility loci onchromosomes 12+ 32+ 42+ 5p+ 6p+1%p and 1&2
0apap 3 gene 7 promisingcandidate gene "or OCD
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euroimmunology
8ypothesized to be related to anin9ammatory process in theA0A( ,A,(/A a# an
autoimmune response to anin"ection that may trigger OCDand tics.
Prototype o" this hypothesis: OCDin small group o" children andadolescents "olloing
documented e!posure to orin"ection ith ,A80
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ermed as PADA0 ;PediatricAutoimmune europsychiatricDisorders Associated ith
0treptococcus<
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eurochemistry
$vidence suggest that multipleneurotransmitter systems play arole in OCD
0erotonin and DopamineClinical obsessions and
compulsions may be e!acerbated
during treatment o" AD8D00R/s diminish symptoms o" OCD
◦ Can be augmented by dopamine
antagonists
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euroimaging
Children and adults ith OCDhave:
◦ 0maller volumes o" basal ganglia
segments◦ 0maller gray matter density in
parieto"rontal cortical regions andanterior pre"rontal corte!
◦ 8ypermetabolism o" "rontal cortical-striatal-thalamocortical netor=s;adult studies<
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D/A,O0/0 AD C(//CA(>$A?R$0
Most common reportedobsessions in children:
◦ $!treme "ears o" contamination
◦ @orries related to harm be"allingthemselves+ "amily members
◦ >ear o" harming others due to losingcontrol over aggressive impulses
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ypical compulsive rituals inchildren and adolescents:
◦ Cleaning
◦ Chec=ing◦ Counting
◦ Repeating behaviors
◦
Arranging items
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Associated behaviors:◦ Avoidance
◦ /ndecision
◦ Doubt◦ 0loness to complete tas=s
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D0M & added speciers: good+"air+ poor and absent insight
8igh comorbidity ith: an!iety
disorders+ AD8D+ tic disorders;esp. ouretteBs syndrome<
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Pathology and (aboratory$!amination
o specic labs are use"ul indiagnosis o" OCD
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Dierential Diagnosis
Children and adolescents ith,AD+ separation an!iety disorder+and social phobia e!perience
intense orries that are o"tene!pressed repeatedly but aremundane compared to
obsessions.Children ith autism may also
display repetitive behavior
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Course and Prognosis
Chronic+ a!ing and aningdisorder ith variability inseverity and outcome
*%-&%' recover ith minimalresidual symptoms
/" ith subthreshold OCD
symptoms+ high ris= o"developing "ull OCD disorderithin ) years
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Responsive to availabletreatments+ resulting inimprovements+ i" not complete
remission+ in the maority o"cases.
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