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Genetic and environmental contributions underlying stability in childhood obsessive-compulsive behavior.

BACKGROUND: Little is known about the stability of obsessive-compulsive (OC) behavior during childhood. The objective of this study is to determine the developmental stability of pediatric OC behavior and the genetic and environmental influences on stability in a large population-based twin sample. METHODS: Maternal and paternal ratings on the 8-item Obsessive Compulsive Scale of the Child Behavior Checklist (CBCL-OCS) on Dutch mono- and dizygotic twin pairs from 8083 families were collected at ages 7, 10, and 12 years. Using a longitudinal twin design, stability of OC behavior and genetic and environmental influences on stability were determined. Using cutoff criteria, persistent, resilient, and new onset cases were identified in this sample. RESULTS: OC behavior assessed by the CBCL-OCS showed a moderate stability with phenotypic correlations of around .50 for boys and for girls. Stability of OC behavior was influenced by genetic factors, by environmental factors shared by children growing up in the same family, and by non-shared environmental factors. Stability for OCS was lower when categorical data were analyzed than when quantitative definitions were used. CONCLUSIONS: OC behavior is moderately stable in childhood. Stability of OC behavior is influenced by genetic, shared, and non-shared environmental factors.

Child↗

The role of cognitive and affective processing in a transgenic mouse model of cortical-limbic neuropotentiated compulsive behavior.

Obsessive compulsive disorder (OCD) may involve abnormal cortical-limbic processing or responsiveness. Mice with behaviors resembling the symptoms of OCD and related disorders were made by expression of a neuropotentiating cholera toxin (CT) transgene in cortical-limbic D1 receptor-expressing neurons. Because these D1CT mice express CT in the piriform cortex and amygdala (major cognitive and affective olfactory processing areas) it was tested whether abnormal odor perception, discrimination, or responsiveness facilitates their compulsion-like behavior. The mice exhibited normal olfactory discriminative capability. An anxiogenic odor potentiated their abnormal repetitive leaping, but novel or familiar nonthreatening odors did not. These data suggest that compulsions can be triggered not by impaired cortical-limbic processing but by increased cortical-limbic responsiveness, particularly to sensory or cognitive stimuli with affective properties.

Animals↗

Error-related electrocortical responses are enhanced in children with obsessive-compulsive behaviors.

The error-related negativity (ERN or Ne) and positivity (Pe) are event-related potential components elicited during simple discrimination tasks after an error response. The ERN and Pe have a fronto-central scalp distribution and may be an indirect measure of anterior cingulate (AC) activity as it relates to performance monitoring. Brain imaging studies suggest that obsessive-compulsive disorder (OCD) is associated with exaggerated activity of the AC while electrophysiological studies have found an association between OCD and pronounced ERNs in adults. The present study explored the relation between obsessive-compulsive behaviors, the ERN, and the Pe in a sample of nonclinical 10-year-old children. It was found that more parent-reported obsessive-compulsive behaviors were associated with larger ERN and Pe components in the children. Results suggest unique contributions of the ERN and Pe in predicting obsessive-compulsive behaviors.

Anxiety↗

Kanner's syndrome or early-onset psychosis: a taxonomic analysis of 142 cases.

Case history data on 142 psychotic children were obtained using the Rimland Diagnostic Check List. A particular variety of the method known as numerical taxonomy was used to classify the children into subgroups on the basis of responses on the Check List. A comparison was made between a classification of Kanner's syndrome vs. "no Kanner's syndrome" and a classification using random classes as starting points. The "best" classification of the data was one in which 2 classes were obtained, one containing all the Kanner's syndrome children plus other early-onset, nonrelating psychotic children and the other containing children with later onset and more varied symptoms. Those attributes which significantly differentiated between the classes both in the "best" classification and in the Kanner's syndrome classification were extracted. A distinction between Kanner children and other similar children was found only for 3 specific behaviors: obsessive desire for sameness, islets of special ability, and skillful manipulation of small objects.

Adolescent↗

Cholinergic mechanisms in Gilles de la Tourette's syndrome.

Gilles de la Tourette syndrome (GTS), a chronic, familial, neuropsychiatric disorder of unknown etiology, is characterized clinically by the presence of motor and vocal tics that wax and wane in severity over time and by the occurrence of a variety of neurobehavioral disturbances including hyperactivity, self-mutilatory behavior, obsessive compulsive behavior, learning disabilities, and conduct disorder. Pharmacological studies suggest that the tics of GTS result from dysfunction of monoaminergic systems, more specifically from increased dopaminergic activity due to postsynaptic dopamine receptor supersensitivity. However, given that striatal dopaminergic and cholinergic systems exhibit reciprocal antagonism in other movement disorders such as Parkinsonism and chorea, it is conceivable that the cholinergic system is implicated in the disease. In the present communication it is proposed that: (a) the emergence of motor and vocal tics in GTS is associated with increased central cholinergic activity; (b) cholinergic overactivity is involved in the manifestation of other symptoms in GTS including depression, sleep disorders, motion sickness, pain, sensory tics, and the waxing and waning course of the disease; (c) abnormalities of the cholinergic system support previous evidence linking GTS with delayed cerebral maturation in a subset of young patients; and (d) drugs which stimulate cholinergic receptors may exacerbate symptoms of GTS, and as with dopamine agonists, should be avoided in patients with GTS.

Depressive Disorder↗

Obsessive-compulsive behavior, DSM-III, and a psychodynamic classification of psychopathology.

This paper reviews obsessive-compulsive behavior, both neurosis and character, and relates these to DSM-III, as well as to a psychodynamic classification of psychopathology. The DSM-III obsessive-compulsive disorder and the classical obsessive-compulsive neurosis are found to be very similar descriptively. In contrast, the DSM-III compulsive-personality disorder is found to be a much more psychopathological entity than the classical obsessive-compulsive character.

Borderline Personality Disorder↗

Development of a state measure of obsessive compulsive behavior.

The Reaction Inventory-Interference was developed to identify obsessional thoughts and compulsive acts, which interfere with an individual's daily activities. The 50 items in the inventory were administered to 172 Ss. On the basis of item test correlations, 40 items were retained for subsequent analyses. The estimate of internal consistency for the 40 item inventory was .95. The correlation between the 40-item inventory and the "symptom" score on the Leyton Obsessional Inventory was .66. Factor analysis of the 40-item inventory yielded nine factors.

Compulsive Behavior↗

Obsessive-compulsive behaviors in parents of multiplex autism families.

Parents of autistic probands with high and low rates of repetitive behaviors were compared for rates of obsessive-compulsive traits and disorder. The rate of repetitive behaviors was assessed using the Autism Diagnostic Interview-Revised (ADI-R) in 176 autistic probands from 57 multiplex families. Obsessive-compulsive disorder (OCD) in parents was determined by direct interview using a parental history questionnaire, with screening for obsessive-compulsive traits using the Yale-Brown Obsessive-Compulsive Scale checklist. Children who had high total scores on the repetitive behavior domain of the ADI-R were significantly more likely to have one or both parents with obsessive-compulsive traits or disorder compared with children who had low total scores on this domain. Children with high scores on D1/D2 of the ADI-R (narrow restricted interests and rituals) were significantly more likely to have one or both parents with OCD, especially fathers, than those with low D1/D2. The occurrence of obsessive-compulsive traits or disorder in parents of autistic children in multiplex families is significantly more likely if autistic children have a high occurrence of repetitive behaviors. Dichotomizing autistic probands by severity and type of repetitive behaviors (circumscribed interests and compulsive rituals) may yield more homogenous groups, which could be helpful in genetic linkage studies.

Adult↗

Obsessive-compulsive behavior associated with dexamethasone treatment.

A patient treated with dexamethasone for cerebral edema secondary to a cerebral tumor developed acute obsessive-compulsive behavior. Discontinuation of dexamethasone was accompanied by a rapid subsidence of this behavior, suggesting a causal association. This appears to be the first such report.

Brain Edema↗

Platelet 3H-imipramine binding sites in obsessive-compulsive behavior.

Several studies indicate a serotonergic dysfunction in patients with obsessive-compulsive disorder (OCD). We examined serotonergic function in OCD by determining platelet 3H-impiramine binding sites in patients with OCD during a drug-free baseline period as well as normal control volunteers. The maximum number of binding sites (Bmax) and apparent dissociation constant (Kd) was determined using 3H-imipramine (IMI) as the binding ligand. We observed that the mean 3H-IMI binding Bmax (fmol/mg protein) determined in 24 patients with OCD was not significantly different from that in 23 normal control subjects. There were no significant differences in the Kd between patients with OCD and normal control subjects. Our results are thus similar to those reported by Insel et al (1985) and Black et al (1990), who observed no significant differences in platelet 3H-IMI binding between OCD patients and controls; but different from those reported by Weizmann et al (1986), who observed decreased 3H-IMI Bmax in OCD patients. The discrepancy in the results is not clear, but may be related to several factors. Our results thus indicate that any abnormality in serotonergic function present in patients with OCD is not related to imipramine binding sites in the platelets. However, the possibility that there may be an abnormal platelet serotonin uptake or other serotonergic function in OCD cannot be ruled out.

Adult↗

Behavioral characteristics of 187 young adults with autism.

A survey was conducted on the present behavioral characteristics of 187 cases of adult autism in patients over 18 years of age employing Achenbach's Child Behavior Checklist (CBCL). When their behavioral characteristics were evaluated in relation to Present Language Developmental Level (PLDL) and Present Adaptive Level (PAL), it was seen that greater variation in behavior characteristics was seen among those exhibiting increasingly lower PLDL and PAL scores. Behavior characteristics reminiscent of depression were noted even among those exhibiting high PLDL. Behavior pointing to obsession was found in common among almost all cases of autism irrespective of PLDL or PAL. Psychotic symptoms such as hallucinations and delusions were absent in most cases. The results of the present study were indicative not only of the significance of obsessive behavior in autism, but also its significance in terms of delving further into the psychopathology of the disorder.

Adolescent↗

[Obsessive-compulsive behavior caused by bilateral lesions of the lenticular nuclei. A new case].

Another case of obsessive behaviour as the consequence of lentiform nuclei lesions is reported. All the aspects of an obsessive neurosis were present: irresistible compulsiveness, acute anxiety in case of non accomplishment, magic-like clues. The symptoms appeared after a carbon monoxide poisoning, in a 31-years-old woman who had previously a pathological personality, of the psychopathic type, but without obsessive features. The onset of compulsions was paralleled by frontal-like psychological changes, but there was no reduction of intellectual or mnesic functions. A previous depressive state continued after the poisoning, so that the patient did not show an empty mind as did the other patients; the loss of "self-psychic activation" was only partial. All these case-reports emphasize the fact that the neuropsychological testing must not be limited to the behaviour and must investigate the "mental content" as well. They also lead us to emphasize similitudes between psychic disorders related to lenticular lesions and those related to frontal lobe lesions, including obsessive-like activities. Such case-reports provide a model in which some components of the obsessive neurosis, hebephrenia and depression are the consequence of an identified brain damage. It can be suggested that the neural circuits involving frontal lobes and parts of the neostriatum and of the pallidum are implicated in the mechanisms of these three types of psychoses.

Adult↗

Behavior therapy for obsessive compulsive disorder.

Behavior therapy for OCD with exposure and response prevention is effective in reducing obsessions and rituals in at least half of those suffering this disabling disorder. Office-based sessions in which patients participate actively in designing exposure and response prevention homework are usually sufficient. Therapist assistance is sometimes needed for those who fail to perform these assignments on their own. Poor compliance, severe comorbid conditions, and CNS-depressing drugs can interfere with behavior therapy. Techniques to manage these difficulties, including modifications of behavior treatment and the use of serotonin reuptake inhibiting drugs, can increase substantially the number of patients responsive to behavior therapy.

Adaptation, Psychological↗

[Loss of psychic auto-activation. Obsessive-compulsive behavior. Toxoplasmic abscess of the basal ganglia].

A 34 year old woman with AIDS presented with adynamia and obsessive-compulsive behaviour. CT scan revealed bilateral toxoplasmic lesions involving basal ganglia. The neuropsychological picture resolved under specific antitoxoplasmic treatment. However, relapse of toxoplasmosis occurred in associating with the same behavioral changes. This is the first case of such a syndrome due to infectious lesions, and in which improvement through transient, was observed.

AIDS-Related Opportunistic Infections↗