Impact of age at onset and duration of illness on the expression of comorbidities in obsessive-compulsive disorder.

BACKGROUND: Obsessive-compulsive disorder (OCD) patients usually experience comorbidities including tics, trichotillomania, body dysmorphic disorder, and mood and anxiety disorders. The present report verifies how age at onset of obsessive-compulsive symptoms and duration of illness are associated with comorbid diagnoses in OCD patients. METHOD: Psychiatric comorbidity was assessed using a structured clinical interview in 161 consecutive outpatients referred for treatment between 1996 and 2001 who met DSM-IV criteria for OCD. Age at onset and duration of illness were retrospectively assessed by direct interviews. RESULTS: An earlier age at onset of obsessive-compulsive symptoms was associated with tic disorders, while longer illness duration was associated with depressive disorder (major depressive disorder or dysthymia) and social phobia. CONCLUSION: Age at onset and duration of OCD illness are meaningful variables affecting the expression of comorbidities in OCD. Tic disorders and OCD may share common etiologic pathways. Depressive disorders, in contrast, may be secondary complications of OCD.

How to treat OCD in patients with Tourette syndrome.

Obsessive-compulsive disorder (OCD) constitutes an etiologically heterogeneous set of conditions, including a subtype that seems etiologically related to Tourette syndrome (TS). In order to treat OCD patients optimally, the clinician needs to integrate educational, psychological and pharmacological approaches. The most effective psychological intervention is cognitive-behavior therapy (CBT). Drug treatment includes clomipramine and all selective serotonin reuptake inhibitors (SSRIs). A subgroup of OCD patients, however, shows no significant improvement. Few studies suggest that the presence of tics is associated to a worse treatment response to SSRIs and that such patients benefit from combined therapy of serotonin-reuptake inhibitors plus neuroleptics. Independently of the presence of tics, there are several different augmentation strategies for resistant cases with drugs that interfere in the dopamine, serotonin, opioid and gonadal hormone systems. In addition, new therapies are now being tested against presumed postinfectious autoimmune processes. Finally, new developments are promising in neural circuit-based therapies, including neurosurgery for refractory patients.

Obsessive-compulsive spectrum disorders in rheumatic fever patients.

Based on five cases of obsessive-compulsive spectrum disorders in rheumatic fever patients, the authors discuss the range of psychiatric disorders associated with poststreptococcal autoimmune reactions and its implications for immunology/CNS interaction.

Mutilação genital e psicose / Genital mutilation and psychosis

A automutilação em pacientes psiquiátricos não é incomum, podendo estar relacionada a crenças religiosas, impulsividade, abuso de substâncias e sintomas psicóticos. Relatos de mutilação genital em pacientes esquizofrênicos são encontrados na literatura médica. Encontra-se aqui descrito um caso de automutilação genital em um paciente de 42 anos de idade, portador de esquizofrenia.

Transtorno obsessivo-compulsivo: possíveis subtipos

Several studies suggest that OCD is probably a heterogeneous disorder with several putative subtypes. Differences in treatment response, disease course, and clinical features are suggestive of the existence of subtypes with specific underlying pathophysiological substrates. Whether studying OCD from a phenomenological or genetic standpoint phenotypic characterization becomes crucial. This manuscript summarizes data that support the existence of a subgroup of OCD related to tics, a group with an early age onset; a possible subgroup related to rheumatic fever; and a group with poor insight. Validation of these putative subtypes may be possible with genetic family studies and will contribute to the development of more specific treatments

Ovos e larvas de helmintos nos sanitários de pré-escolas municipais de Sorocaba, SP e suas freqüências nas fezes das crianças / Helminth eggs and larvs in the water closet of some city nursery schools (Infant Educational Center) from Sorocaba, SP, Brazil, and their frequency in children feces

O objetivo desta pesquisa foi relacionar a presença de ovos e/ou larvas de helmintos em elementos dos sanitários com a freqüência dos mesmos nas fezes de seus usuários. Três amostras das fezes de 1050 crianças em idade pré-escolar, examinadas pelo método de sedimentaçäo, foram positivas para 184 ovos ou larvas de helmintos, em 162 crianças. Dos 465 elementos dos sanitários (assento, descarga, trinco, maçanetas e registro de torneira) de 12 pré-escolas municipais de Sorocaba examinados com fita adesiva transparente sobre lâmina de microscopia estavam contaminados, sendo encontrados l8 ovos de Ascaris lumbricoides, 1 de Enterobius vermicularis e 4 larvas de nematóides parcialmente alteradas. Näo houve correlaçäo significante entre a contaminaçäo de elementos de sanitários e das fezes de seus usuários