Early onset of obsessive-compulsive disorder and associated comorbidity.

BACKGROUND: Previous studies have aimed to identify subtypes of obsessive-compulsive disorder (OCD) based on their age of onset (AOO). Obsessive-compulsive spectrum disorders (OCS disorders) such as tic disorders have been particularly associated with an early onset in some studies. However, subtypes of early- and late-onset OCD are unevenly determined, and the biological and the clinical validity of these subtypes are unknown. This study was undertaken to discriminate the subtypes of OCD in different AOO levels and to test the hypothesis that different AOO bands are associated with a differential pattern of comorbidity. METHODS: Two hundred fifty-two patients with OCD were interviewed directly with the German version of the Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety Version, which provides DSM-IV diagnosis. Subgroups with different ages of onset were investigated (cut-off levels of 10, 15, and 18 years). RESULTS: Subjects with an early AOO (onset < or =10 years) were significantly more likely to have OCS disorders (odds ratio [OR]=3.46; P=.001; 95% confidence interval [CI]: 1.72-6.96), in particular tic/Tourette's disorders (OR=4.63; P=.002; 95% CI: 1.78-12.05), than were late-onset subjects. CONCLUSIONS: For most mental disorders (e.g., anxiety and mood disorders), no associations with AOO of OCD were identified. However, subjects in the early-onset group (< or =10 years) had a significant increase in comorbid tic and Tourette's disorders. Future research should examine potential neurobiological features associated with early-onset presentations of OCD. Early detection and management of comorbidities may offset impairments later in life.

Distinguishing between hypochondriasis and somatization disorder: a review of the existing literature.

A valid classification is important for further understanding of the somatoform disorders. The main disorders in this grouping - somatization disorder and hypochondriasis - have lengthy historical traditions and are defined in a contrasting manner. Various authors point to distinguishing demographic and clinical features, but there have been few direct comparisons of patients with these disorders. A review of the literature indicates those domains where differences are most likely to be found. Research assessing these may serve to refine and validate these key somatoform categories and/or dimensions.

Hypochondriasis and its relationship to obsessive-compulsive disorder.

Hypochondriasis is a heterogeneous disorder. This was well demonstrated in the study by Kellner et al, which showed that patients with high levels of disease fear tended to be more anxious or phobic, whereas patients with high levels of disease conviction tended to have more and more severe somatic symptoms. Little comorbidity exists to support the statement that hypochondriasis is an obsessive-compulsive spectrum disorder. Although patients exist whose hypochondriac concerns are identical in quality to the intrusive thoughts of patients with OCD, as a group, patients with hypochondriasis do not share a comorbidity profile comparable with that of patients with OCD. The data support a closer relationship between hypochondriasis and somatization disorder than between hypochondriasis and OCD. The family history data is limited by the lack of adequate studies. Using comparable methods of the family history approach, Black's study reported a higher frequency of GAD but not OCD among the relatives of OCD patients--a finding similar to what Noyes found among the relatives of hypochondriac patients; however, using the direct interview method, somatization disorder was the only statistically more common disorder, among relatives of female hypochondriac patients. Therefore, although the parallel in overlap with GAD is suggestive of a commonality between OCD, GAD, and hypochondriasis, the finding of a greater frequency of somatization disorder leans against the hypothesis that hypochondriasis is best considered an OCD spectrum disorder. The pharmacologic treatment data are the one type of biologic evidence that supports a bridge to OCD. The pharmacologic studies suggest that for patients with general hypochondriasis, TCAs are not effective and that higher dosages and longer trials of the SRIs are needed. These pharmacologic observations are comparable with the ones made for patients with OCD but dissimilar to the observations made for depression. The benefit of imipramine among patients with illness phobia must be assessed in placebo-controlled trials among illness phobics and among hypochondriacs. Even more valuable would be a direct comparison of a TCA (e.g., imipramine or desipramine) and a selective SRI (e.g., fluoxetine) to determine whether the response to selective SRIs is greater. Although the pharmacologic data are compelling in supporting the hypothesis that hypochondriasis is an obsessive-compulsive spectrum disorder, the comorbidity data are equally compelling in dispelling that hypothesis. Perhaps future studies clarify the subtypes of hypochondriasis, be they "phobic, obsessive, and depressive," "chronic and episodic," "early onset versus late onset" or some other as yet undetermined subtype. Such clarification may be aided by better instruments to assess the obsessive-compulsive and hypochondria spectrums within individuals and families and by neuropsychological or pharmacologic challenge and neuroimaging studies.

Correlates of hypochondriasis in a nonclinical population.

Because few community surveys of hypochondriasis have been completed, little is known about the epidemiology of this disorder outside of clinical populations. To address this deficiency, the authors obtained information about hypochondriasis and pertinent characteristics from a group of first-degree relatives of hypochondriacal and nonhypochondriacal probands who participated in a family study. In addition to psychiatric diagnoses, the authors elicited information on demographic variables, medical history, impairment in functioning, psychiatric comorbidity, psychiatric symptoms, personality traits, and childhood experiences. The authors identified hypochondriasis in 7.7% of the relatives. These relatives had a high rate of comorbid anxiety, depressive, and somatoform disorders. They also reported substantial physical and psychological impairment, including diminished work performance and disability. In addition, these relatives reported greater utilization of health care but less satisfaction with that care. These relatives showed most of the same characteristics found in earlier studies of hypochondriacal patients.

A family study of hypochondriasis.

To examine the diagnostic validity of hypochondriasis, we undertook a preliminary family study. Nineteen probands with and 24 without DSM-III-R hypochondriasis were identified among outpatients attending a general medicine clinic. Seventy-two first-degree relatives of hypochondriasis probands and 97 relatives of control probands were personally interviewed with the use of the Structured Clinical Interview for DSM-IV. These relatives also completed self-administered measures of hypochondriasis, psychological and somatic symptoms, and personality traits. No increase in the rate of hypochondriasis was found among the relatives of hypochondriasis probands compared with the relatives of control probands. With respect to other mental disorders, only somatization disorder was more frequent among the hypochondriacal relatives. These relatives also scored higher on measures of hostility, antagonism, and dissatisfaction with medical care. The findings of this study suggest that hypochondriasis may not be an independent disorder but a variable feature of other psychopathology, one that may include somatization disorder.

[Clinico-genetic analysis of sluggish hypochondriac schizophrenia]. / Kliniko-geneticheskii analiz vialotekushchei ipokhondricheskoi shizofrenii.

The clinicogenealogical method using a genetico-mathematic analysis was employed to examine 50 probands with sluggish hypochondriac schizophrenia (126 relatives of the first degree kinship). A study was made of the structure of familial accumulation of polar hypochondriac conditions (in continuum) of the varieties of sluggish schizophrenia: senestohypochondrias (25 families of probands) and neurotic hypochondrias (25 families of probands). The clinical polymorphism of sluggish hypochondriac schizophrenia correlated with the differences in accumulation, mainly by varieties of sluggish schizophrenia and personality abnormalities. It is concluded that analysis of the structure of familial accumulation in non-delirious hypochondriac conditions favours their typological differentiation, thereby enhancing the reliability of the clinical systematization.

Bipolar mood disorders: an affected sibling study. II. Symptom correlations.

Part II of the affected sibling study raises questions of symptom correlation (incidence of delusions, states of confusion, suicide tendencies and attempts, hallucinatory episodes, hypochondriac attitudes, angry manias, and depressive stupor) in mood disorders. The investigated sample (307 sibling groups, 701 hospitalized patients; selection principle: at least 1 sibling showing a bipolar or manic axial syndrome) directs our attention to the possibility that the multiplicity of specific manic and depressive syndromes derives not only from the genetic complexity of the mood-producing system but mirrors the full range of human behavior. Moods must be conceptualized as interpretative metalanguages with respect to the entire wealth of behavioral object languages.

Hypochondriacal complaints among Hong Kong children: a mental health hazard?

The incidence of hypochondriacal complaints among clinic attenders at a general outpatients clinic is in the region of 51/thousand (51 per 1,000). A series of 33 children were studied in detail. It was found that their age range from 1 1/2-14 with a mode of 8-10 years, females having a slight predominance (1.33:1). They usually came from lower social-economic backgrounds but a substantial portion also came from social class 2. Among his latter group, psychological complaints predominate. Pain remained the most frequent complaint. There was also a predominance of complaints confined to the respiratory tract, a tendency which could be explained on a cultural and public-health basis. It was also found that only very few of the children in the study had previous hypochondriacal traits, a fact which contrasted sharply to those of their parents in whom hypochondriacal traits predominate. Hypochondriacal children, when treated, had good prognostic outcomes. Two areas of special significance in future researches are: 1. The importance of parental influence on the health attitudes of children. 2. Whether hypochondriacal children contribute significantly towards adult jupochondriasis (Primary or Secondary).