Analysis of microorganisms in periapical lesions: A systematic review and meta-analysis.

AIMS: The aim of this study was to systematically review the literature on prevalence of microorganisms and their viability/activity in endodontic periapical lesions. DESIGN: Literature research was performed on five electronic biomedical databases from their start dates to June 2020. Only studies evaluating the presence of microorganisms in periapical lesions in human permanent teeth with secondary/persistent infection were included. Two reviewers independently assessed the eligibility for inclusion, extracted data and evaluated the risk of bias. Meta-analysis and binominal tests were used to analyse the resulting data. RESULTS: From the 1,313 records found, 23 full-texts were included for qualitative and quantitative analysis. The prevalence of microorganisms in endodontic periapical lesions was 87 % (95 % CI, 75-94) and the prevalence of viable/active microorganisms was 82 % (95 % CI, 66-91). There were statistical differences in the geographic area subgroup and between viable bacteria and active viruses. The most common detection method of microorganisms was the molecular one (69 %), and the most prevalent bacteria were the species Actinomyces, Fusobacterium and Prevotella (40 %). Most of the included studies had moderate risk of bias. CONCLUSIONS: The prevalence of microorganisms in endodontic periapical lesions was 87 % and the prevalence of viable/active microorganisms was 82 %.

Funcionamento Diferencial do Item no Inventário de Depressão Beck / Differential Item Functioning in the Beck Depression Inventory

INTRODUÇÃO: Diversos estudos mostram o Funcionamento Diferencial do Item (DIF) em itens do Inventário de Depressão Beck (BDI), ao compararem homens e mulheres. A presença de um grande número de itens com DIF no BDI é uma severa ameaça à validade da medida da intensidade de sintomas depressivos obtida pela Teoria da Resposta ao Item (TRI) e às conclusões baseadas nos escores derivados dos itens com e sem DIF. OBJETIVO: Os objetivos deste estudo foram identificar esses itens do BDI, ajustar o modelo de TRI para itens constrangedores (modelo 2), o qual acomoda itens com a presença de DIF, e comparar esses resultados com os do ajuste do modelo logístico de dois parâmetros tradicional da TRI (modelo 1). MÉTODOS: Os resultados obtidos com ambos os modelos foram comparados. RESULTADOS: Os itens que apresentaram DIF foram: tristeza, sentimento de fracasso, insatisfações, culpa, punição, choro, fatigabilidade e perda da libido. Os resultados do ajuste dos dois modelos são similares quanto à discriminação, gravidade (à exceção dos itens com DIF) e no cálculo de escores para os indivíduos. Apesar disso, o modelo 2 é vantajoso, pois mostra as diferenças em gravidade do sintoma depressivo para os grupos avaliados, trazendo, dessa forma, mais informação ao pesquisador sobre a população estudada. CONCLUSÃO: Esse modelo, que tem um alcance mais amplo em termos de população-alvo, pode ser uma ótima alternativa na identificação e acompanhamento de indivíduos com potencial depressivo. .

INTRODUCTION: There are several studies showing the presence of Differential Item Functioning (DIF) in some items of the Beck Depression Inventory (BDI), when comparing men and women. The presence of a large number of items with DIF in BDI is a severe threat to the validity of measurement of the intensity of depressive symptoms obtained by Item Response Theory (IRT) and to the conclusions based on the scores derived from the items with or without DIF. OBJECTIVE: The objectives of this study were to identify these items from the BDI, adjust the IRT model for embarrassing items (model 2), which accommodates items with the presence of DIF, and compare these results with the fit of the traditional two-parameter logistic IRT model (model 1). METHODS: The results obtained with the both models were compared. RESULTS: Items with DIF were: sadness, feeling of failure, dissatisfaction, guilty, punishment, crying, fatigability and loss of libido. The results of the adjustment of the two models are similar in discrimination, gravity (except for items with DIF), and in the calculation of scores for individuals. Nevertheless, model 2 is beneficial because it shows the differences in gravity of depressive symptoms for groups evaluated, thus providing more information to the researcher on the study population. CONCLUSION: This model, which has a broader scope in terms of target population, may be a good alternative to the identification and follow-up of individuals with potential depression. .

Differential item functioning in the beck depression inventory.

INTRODUCTION: There are several studies showing the presence of Differential Item Functioning (DIF) in some items of the Beck Depression Inventory (BDI), when comparing men and women. The presence of a large number of items with DIF in BDI is a severe threat to the validity of measurement of the intensity of depressive symptoms obtained by Item Response Theory (IRT) and to the conclusions based on the scores derived from the items with or without DIF. OBJECTIVE: The objectives of this study were to identify these items from the BDI, adjust the IRT model for embarrassing items (model 2), which accommodates items with the presence of DIF, and compare these results with the fit of the traditional two-parameter logistic IRT model (model 1). METHODS: The results obtained with the both models were compared. RESULTS: Items with DIF were: sadness, feeling of failure, dissatisfaction, guilty, punishment, crying, fatigability and loss of libido. The results of the adjustment of the two models are similar in discrimination, gravity (except for items with DIF), and in the calculation of scores for individuals. Nevertheless, model 2 is beneficial because it shows the differences in gravity of depressive symptoms for groups evaluated, thus providing more information to the researcher on the study population. CONCLUSION: This model, which has a broader scope in terms of target population, may be a good alternative to the identification and follow-up of individuals with potential depression.

Improving psychometric assessment of the Beck Depression Inventory using multidimensional item response theory.

We studied the latent factor structure of the Beck Depression Inventory (BDI) under the light of Multidimensional Item Response Theory models. Under a Bayesian Markov chain Monte Carlo setting, we chose the most adequate model, estimated its parameters and verified its fit to the data. An evaluation of the inventory in terms of the assumed dimensions seems to agree with previous investigations in the factor structure of the BDI present in the literature. Cognitive and somatic-affective latent traits were identified in the analysis making possible the interpretation of symptom evolution along these dimensions, in terms of probability of their appearance.

A model for psychiatric questionnaires with embarrassing items.

We propose an item response theory model to analyse psychiatric questionnaires that contain embarrassing items. We use Bayesian methods to estimate its parameters and consider a simulation study to evaluate the performance of the proposed estimators. The results are illustrated with the analysis of data collected to evaluate teenager depression, highlighting the gender difference in the probabilities of 'crying crisis', a trait known to embarrass some male populations.

Coronary reserve impairment prevents the improvement of left ventricular dysfunction and adversely affects the long-term outcome of patients with hypertensive dilated cardiomyopathy.

In hypertension, left ventricular (LV) hypertrophy develops as an adaptive mechanism to compensate for increased afterload and thus preserve systolic function. Associated structural changes such as microvascular disease might potentially interfere with this mechanism, producing pathological hypertrophy. A poorer outcome is expected to occur when LV function is put in jeopardy by impaired coronary reserve. The aim of this study was to evaluate the role of coronary reserve in the long-term outcome of patients with hypertensive dilated cardiomyopathy. Between 1996 and 2000, 45 patients, 30 of them male, with 52+/-11 years and LV fractional shortening <30% were enrolled and followed until 2006. Coronary flow velocity reserve was assessed by transesophageal Doppler of the left anterior descending coronary artery. Sixteen patients showed >/=10% improvement in LV fractional shortening after 17+/-6 months. Coronary reserve was the only variable independently related to this improvement. Total mortality was 38% in 10 years. The Cox model identified coronary reserve (hazard ratio=0.814; 95% CI=0.72-0.92), LV mass, low diastolic blood pressure, and male gender as independent predictors of mortality. In hypertensive dilated cardiomyopathy, coronary reserve impairment adversely affects survival, possibly by interfering with the improvement of LV dysfunction.

Mood changes in the course of preparation for the Brazilian university admission exam - a longitudinal study.

OBJECTIVE: Academic examinations are an important source of stress for students. This study is intended to assess senior high school students' mood changes during the preparation for a very important academic examination, the Brazilian university admission examination. METHOD: Positive and Negative Affect Schedule - Expanded Form was used to assess the students three times in the course of the months preceding the examination. RESULTS: ANOVA for repeated measures showed that Negative Affect increased as the examination approached, and that this increment was already present months before the examination took place. A single conditionally independent random effect model showed that time spent studying was associated with fluctuations in mood. CONCLUSION: Teenagers, in preparation for a very important examination, may present mood disturbances associated with both the proximity of the examination and their study load months before the examination actually takes place. Other stressing factors may play a role in these findings and should be further investigated.

Mood changes in the course of preparation for the Brazilian university admission exam - a longitudinal study / Alterações de humor ao longo da preparação para o vestibular - um estudo longitudinal

OBJECTIVE: Academic examinations are an important source of stress for students. This study is intended to assess senior high school students' mood changes during the preparation for a very important academic examination, the Brazilian university admission examination. METHOD: Positive and Negative Affect Schedule - Expanded Form was used to assess the students three times in the course of the months preceding the examination. RESULTS: ANOVA for repeated measures showed that Negative Affect increased as the examination approached, and that this increment was already present months before the examinationtookplace. Asingle conditionallyindependent random effect model showed that time spent studying was associated with fluctuations in mood. CONCLUSION: Teenagers, in preparation for a very important examination, may present mood disturbances associated with both the proximity of the examination and their study load months before the examination actually takes place. Other stressing factors may play a role in these findings and should be further investigated.

OBJETIVO: Exames acadêmicos são uma fonte importante de estresse para estudantes. Este estudo teve como objetivo avaliar alterações de humor em estudantes de terceiro ano do Ensino Médio ao longo da preparação para um exame acadêmico de grande importância, o vestibular. MÉTODO: Positive and Negative Affect Schedule - Expanded Form foi utilizado para avaliar os estudantes três vezes ao longo dos meses antecedendo o exame. RESULTADOS: ANOVA para medidas repetidas mostrou que o afeto negativo aumentou com a aproximação do exame e que esse aumento já estava presente meses antes dele acontecer. Um modelo de efeitos aleatórios com independência condicional mostrou que o tempo de estudo estava associado às flutuações de humor. CONCLUSÃO: Adolescentes em preparação para exames muito importantes podem apresentar um distúrbio de humor associado à proximidade do exame e à quantidade de estudo meses antes que ele ocorra. Outros estressores podem estar associados a esses achados e devem ser investigados.

Anxiety disorders and rheumatic Fever: is there an association?

INTRODUCTION: Findings suggest that obsessive-compulsive disorder (OCD) and related disorders, referred to as obsessive-compulsive spectrum disorders (OCSDs), are more common in patients with rheumatic fever (RF). OBJECTIVES: To determine whether RF or Sydenham's chorea increases the probability of anxiety disorders in the relatives of individuals with RF with and without SC. METHODS: This was a case-control family study in which 98 probands and 389 first-degree relatives (FDRs) were assessed using structured psychiatric interviews. A Poisson regression model was used to determine whether the presence of any disorder in one family member influences the rate of disorders in the remaining family members. RESULTS: Generalized anxiety disorder (GAD) occurred more frequently in the FDRs of RF probands than in those of control probands (P=.018). The presence of RF, GAD, or separation anxiety disorder in one family member significantly increased the chance of OCSDs in another member of the family. CONCLUSION: We found familial aggregation among RF, GAD, and OCSDs. Clinicians should be aware of the possible familial relationship between GAD and OCSDs in their RF patients and their family members, which may suggest a genetic component between them. Further studies on OCD should include anxiety disorders to better define OCD spectrum.

Low coronary driving pressure early in the course of myocardial infarction is associated with subendocardial remodelling and left ventricular dysfunction.

Subendocardial remodelling of the left ventricular (LV) non-infarcted myocardium has been poorly investigated. Previously, we have demonstrated that low coronary driving pressure (CDP) early postinfarction was associated with the subsequent development of remote subendocardial fibrosis. The present study aimed at examining the role of CDP in LV remodelling and function following infarction. Haemodynamics were performed in Wistar rats immediately after myocardial infarction (MI group) or sham surgery (SH group) and at days 1, 3, 7 and 28. Heart tissue sections were stained with HE, Sirius red and immunostained for alpha-actin. Two distinct LV regions remote to infarction were examined: subendocardium (SE) and interstitium (INT). Myocyte necrosis, leucocyte infiltration, myofibroblasts and collagen volume fraction were determined. Compared with SH, MI showed lower CDP and LV systolic and diastolic dysfunction. Necrosis was evident in SE at day 1. Inflammation and fibroplasia predominated in SE as far as day 7. Fibrosis was restricted to SE from day 3 on. Inflammation occurred in INT at days 1 and 3, but at a lower grade than in SE. CDP correlated inversely with SE necrosis (r = -0.65, P = 0.003, at day 1), inflammation (r = -0.76, P < 0.001, at day 1), fibroplasia (r = -0.47, P = 0.04, at day 7) and fibrosis (r = -0.83, P < 0.001, at day 28). Low CDP produced progressive LV expansion. Necrosis at day 1, inflammation at days 3 and 7, and fibroplasia at day 7 correlated inversely with LV function. CDP is a key factor to SE integrity and affects LV remodelling and function following infarction.

Obsessive-compulsive symptoms in sibling pairs concordant for obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a heterogeneous disorder of unknown etiology. Phenotypic studies of affected sib-pairs (SPs) may help to characterize familial components of the phenotype. To determine whether SPs affected with OCD are similar in age at onset of obsessive-compulsive symptoms (OCS), symptom dimensions and presence of tic disorders (TDs). Forty OCD siblings ranging from 13 to 59 years old were evaluated by expert psychiatrists or psychologists. Families with two or more siblings affected with OCD were recruited from several OCD clinics in Brazil. The Yale Brown Obsessive-Compulsive Scale Checklist was used to assess OCS and the severity of OCD. The OCD diagnoses were made according to the DSM-IV. The chi-square test was used to assess concordance of TD presence within SPs based on the TD frequency reported in the literature (30%). There were significantly more siblings with early-onset OCS than with late-onset OCS (P = 0.002). Age at onset of OCS correlated positively and significantly between the two members of each SP (P = 0.005). Fourteen patients (35%) were diagnosed with TDs. There was no concordance of the TD presence within the SPs. When both were male, there was a significant sibling correlation in the contamination obsessions/cleaning compulsions dimension (ICC = 0.74; P = 0.002). Similarly, when both siblings were female, they were comparable in the hoarding obsessions/compulsions dimension (ICC = 0.76; P = 0.01). Familial factors seem to contribute to specific OCD phenotypic components such as age at onset of OCS and specific dimensions. The obvious influence of gender is as yet unexplained.

Obsessive-compulsive spectrum disorders and rheumatic fever: a family study.

BACKGROUND: Obsessive-compulsive spectrum disorders (OCSDs) are more frequent in patients with active or prior rheumatic fever (RF), suggesting that OCSD and RF may share underlying etiologic mechanisms. Our objective was to estimate the frequency of OCSD in first-degree relatives (FDRs) of RF patients and controls to determine whether there is a familial relationship between OCSD and RF. METHODS: This is a case-control family study. Of the 98 probands included in this study, 31 had RF without Sydenham's chorea (SC) and had 131 relatives, 28 had RF with SC and had 120 relatives, and 39 were controls without RF. All probands, 87.9% of the RF FDRs and 93.7% of the control FDRs were assessed directly with structured psychiatric interviews and best-estimate diagnoses were assigned. Odds ratios of morbid risks were estimated using logistic regression by the generalized estimating equations (GEE) method and compared between groups. RESULTS: The rate of OCSDs was significantly higher among FDRs of RF probands than among FDRs of controls (n=37; 14.7% vs. n=10; 7.3%, i=.0279). A diagnosis of OCSDs in an RF proband was associated with a higher rate of OCSDs among FDRs when compared to control FDRs (p-GEE=.02). There was a trend for a higher rate of OCSDs among FDRs of RF probands presenting no OCSD, although the difference was not significant (p-GEE=.09). CONCLUSION: The results are consistent with the hypothesis that a familial relationship exists between OCSD and RF, since an OCSD in the RF proband was found to increase the risk of OCSDs among FDRs. Additional neuroimmunological and genetic studies involving larger samples are needed to further elucidate this apparent familial relationship between RF and OCSD.

Prenatal, perinatal, and postnatal risk factors in obsessive-compulsive disorder.

BACKGROUND: The etiology of obsessive-compulsive disorder (OCD) remains unknown, although it is thought to involve an interaction of genetic and environmental factors. This study aimed to identify prenatal, perinatal, and postnatal risk factors in OCD. METHODS: We compared retrospectively 68 OCD patients to 70 control subjects based on responses given on a standardized questionnaire. The questionnaire was designed to evaluate environmental factors, with a special focus on gestation, labor, birth, and early infancy aspects. RESULTS: The group of OCD patients had risk factors with greater frequency than the control group. Notable among the significant findings (p < or = 0.001) were edema of the hands, feet, or face and excessive weight gain during gestation; hyperemesis gravidarum; prolonged labor; preterm birth; and jaundice. When socioeconomic class was used as a covariable in the logistic regression analysis, prolonged labor and edema during pregnancy remained statistically significant. CONCLUSIONS: Some early risk factors may be associated with the expression of OCD later in life such as edema during pregnancy and prolonged labor. If our findings are confirmed in future studies, greater attention should be given to such factors in predisposed individuals, especially in prenatal care and delivery.

Clinical features associated with treatment response in obsessive-compulsive disorder.

OBJECTIVE: This study aims to investigate the effect of sociodemographic and clinical features on the short-term response to pharmacological treatment in obsessive-compulsive disorder (OCD). We focused especially on investigating factors previously associated with poorer prognosis, such as comorbidity with tic disorders, early onset of symptoms, and sensory phenomena preceding compulsions, which have been described as common in both tic-related and early-onset OCD. METHOD: The study involved 41 consecutive adult patients with OCD diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria and was conducted at the OCD Spectrum Disorders Clinic of the University of Sao Paulo School of Medicine in São Paulo, Brazil, between January of 2000 and December of 2001. All patients were treated exclusively with oral clomipramine for 14 weeks. Treatment response, measured for Yale-Brown Obsessive-Compulsive Scale score decrease from baseline, was assessed by an investigator blinded as to the variables of interest present. RESULTS: Linear regression analysis showed that having a partner and sensory phenomena preceding compulsions were associated with better response to clomipramine treatment (P = .04 and P = .002, respectively). Tic comorbidity and early onset of symptoms were not associated with poorer response. CONCLUSIONS: In OCD, having a partner and sensory phenomena preceding compulsions seem to be associated with a favorable response to pharmacological treatment.

Chronic tics and Tourette syndrome in patients with obsessive-compulsive disorder.

Tourette syndrome (TS) and chronic motor/vocal tics (CMVT) are both common disorders in patients with obsessive compulsive disorder (OCD). However, there have been few studies evaluating the differences between the OCD with TS and OCD with CMVT subgroups. This study was conducted in order to further investigate possible differences between the expression of the OCD phenotype in OCD with TS and that seen in OCD with CMVT. One hundred and fifty-nine outpatients referred to an OCD research program were evaluated using the following instruments: the Structured Clinical Interview for DSM-IV; the Yale-Brown Obsessive Compulsive Scale; the Yale Global Tic Severity Scale; and the USP-HARVARD Repetitive Behaviors Interview. Patients were divided into three groups: OCD patients without tics (OCD-TICS, n=98), OCD patients with chronic motor or vocal tics (OCD+CMVT, n=31) and OCD patients with TS (OCD+TS, n=30). OCD+CMVT patients were similar to OCD+TS patients regarding the frequency of intrusive sounds, repeating behaviors, counting and tic-like compulsions (in both cases more frequent than in OCD-TICS patients). For age at obsessive-compulsive (OC) symptom onset, sensory phenomena score, number of comorbidities, frequency of somatic obsessions, bodily sensations and just-right perceptions, OCD+CMVT patients tended to be in between the other two groups. Our results suggest that there are qualitative and quantitative differences in the phenotypic expression of tic disorders in OCD patients, depending on whether the subject has TS or only CMVT.

A family study of early-onset obsessive-compulsive disorder.

Results from family studies have suggested that obsessive-compulsive disorder (OCD) is a genetically heterogeneous disorder and have emphasized the importance of identifying valid subgroups of patients. The current study focused on early-onset OCD probands and examined the recurrence risks of OCD and tics among first-degree family members. One hundred six children and adolescents with OCD were recruited from a specialty clinic for OCD and 44 control individuals without OCD were identified by random-digit dialing. These 150 probands and their 465 first-degree relatives were assessed by trained interviewers, using standardized semi-structured interviews. Diagnoses were assigned according to DSM-IV criteria by two experts blind to the proband's diagnosis, through the best-estimate process. These data were analyzed using chi(2) tests, t-tests, logistic regression, and generalized estimating equations (GEE). Case probands had a mean age of onset of OC symptoms of 6.7 years (SD = 2.8), and high comorbid rates with Tourette syndrome (33%) and chronic tics (13.2%). Compared to control relatives, case relatives had higher age-corrected recurrence risks of OCD (22.7% vs. 0.9%, odds ratio (OR) = 32.5, 95% confidence interval (CI) = 4.5-230.8, P = 0.0005), and chronic tics (11.6% vs. 1.7%, OR = 7.9, 95% CI = 1.9-33.1, P = 0.005). A comorbid diagnosis of tics in the relatives was the best predictor of their diagnosis of OCD (OR = 7.35, 95% CI = 3.79-14.25, P < 0.0001). There was a significant correlation between the ages of onset of OCD in probands and their affected relatives. Childhood onset OCD is a highly familial disorder. Some early-onset cases may represent a valid subgroup, with higher genetic loading and shared vulnerability with chronic tic disorders.

The imbalance between coronary reserve and wall stress explains the severity of ventricular dysfunction in hypertension.

BACKGROUND: The pathophysiologic role of coronary reserve impairment in hypertensive cardiac dysfunction is still debated. Previously, we demonstrated that satisfactory coronary vasodilatation may coexist with ventricular systolic dysfunction. It is conceivable that coronary reserve might otherwise be inappropriate for enhanced myocardial oxygen demand and may thus affect cardiac performance negatively. HYPOTHESIS: Myocardial supply-demand imbalance contributes to the severity of ventricular dysfunction in hypertension (HTN). METHODS: Fractional shortening (%) and end-systolic stress (10(3) x dyn x cm(-2)) were determined using echocardiography, and coronary reserve was calculated using transesophageal Doppler echocardiography. Coronary reserve/stress (cm2 x dyn(-1)) was utilized as a measure of supply-demand. Groups NL (20 healthy subjects), HTN1 (15 patients, fractional shortening > or = 30), HTN2 (19 patients, 20 < or = fractional shortening < 30), and HTN3 (21 patients, fractional shortening < 20) were constituted. RESULTS: Compared with NL and HTN1, groups HTN2 and HTN3 had significantly (p < 0.05) greater end-systolic stress (NL = 72 +/- 16, HTN1 = 72 +/- 23, HTN2 = 143 +/- 32, HTN3 = 186 +/- 70). Coronary reserve was impaired in HTN3 alone (NL = 3.5 +/- 0.6, HTN1 = 3.4 +/- 1.0, HTN2 = 3.1 +/- 1.0, HTN3 = 2.6 +/- 1.1), but coronary reserve/stress was reduced in both HTN2 and HTN3 (NL = 50 +/- 12, HTN1 = 53 +/- 21, HTN2 = 22 +/- 7, HTN3 = 15 +/- 7). Stepwise regression analysis identified diastolic internal dimension, end-systolic stress, and coronary reserve/stress as independently associated with fractional shortening. CONCLUSION: The imbalance between supply-demand explains the severity of hypertensive cardiac dysfunction and adds information to cardiac enlargement and elevated wall stress.

Obsessive-compulsive spectrum disorders in rheumatic fever with and without Sydenham's chorea.

BACKGROUND: Recent findings suggest that acute-phase rheumatic fever (RF) patients present with higher frequencies of obsessive-compulsive disorder (OCD) and tic disorders. Until now, there have been no such studies in RF in non-acute phases. OBJECTIVE: To verify whether patients with a history of RF with or without Sydenham's chorea (SC) present with higher rates of OCD, tic disorders, and other obsessive-compulsive (OC) spectrum disorders (such as body dysmorphic disorder [BDD]) than controls. METHOD: Between February 1999 and December 2002, 59 consecutive outpatients with non-acute RF (28 with and 31 without SC) from an RF clinic and 39 controls from an orthopedics clinic were blindly assessed for OC spectrum disorders using structured interviews to assign DSM-IV diagnosis. Data were analyzed with Fisher exact and chi(2) tests to compare frequencies of disorders, and Kaplan-Meier survival analyses were used to obtain age-corrected rates. RESULTS: The age-corrected rates of tic disorders were higher in patients with RF without SC (N = 3; 14.39%) (p =.003) when compared with controls. Age-corrected rates for OC spectrum disorders (OCD, tic disorders, and BDD) combined were higher both in RF without SC (N = 4; 20.65%) and RF with SC (N = 5; 19.55%) groups than in controls (N = 1; 2.56%) (p =.048). CONCLUSIONS: RF, even in the non-acute phase, may increase the risk for some OC spectrum disorders, such as OCD, tic disorders, and BDD. These data, although preliminary, reinforce the idea that OC spectrum disorders may share common underlying pathophysiologic mechanisms and vulnerability factors with RF or that RF could trigger central nervous system late manifestations such as OC spectrum disorders.

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.