Difference between revisions of "Obsessive-Compulsive Disorder"

Revision as of 20:35, 30 October 2012

Introduction

Epidemiology

OCD in children and adolescents often goes unrecognized and undiagnosed due to its idiosyncratic, not always obvious nature.

• Point prevalence of pediatric OCD is 0.25% (British study 5-15 y.o., Heyman I, IntRevPsych 2003);
• Overall pediatric prevalence rate is 1-2% (USA studies, Apter A, JAACAP 1996)
• Incidence of OCD peaks during two developmental periods, pre-adolescents, and young adults (mean 20 y.o.). (Geller D, March J, Practice Parameter, JAACAP 2012)

Genetic and non-genetic factors

• OCD has a significant familial/genetic component with higher concordance rates in monozygotic twins vs. dizygotic twins.
• Environmental triggers and immunological cross-reactions, particularly to Strep infection had been implicated.
  • PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, is attributed to immune response to Group A Strep, which can cause cross-reactivity and inflammation of basal ganglia. This can produce (the somewhat controversial) syndrome of PANDAS, which involves tics, OCD, and hyperactivity.

Presentation

Children may have compulsions without obsessions.

Common obsessions

• The most common obsessions in children and adolescents involve aggressive and catastrophic worries (e.g death of parent); these become less common in adults. (Geller DA, J Nerv Men D/o 2001)
• Sexual and religious obsessions are more common in adolescents.
• Contamination worries are common throughout the developmental spectrum.

Common compulsions

• Most common compulsions across the developmental spectrum involve checking, cleaning, and ordering rituals.
• Hoarding compulsions are more common in children in adolescents and become less common in adults. (Geller DA, J Nerv Men D/o 2001)

Diagnosis

Treatment

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