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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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