Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD)
Categorical and dimensional aspects of co-morbidity in obsessive-compulsive disorder (OCD)
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DOI：
10.1007/s00787-007-0626-z
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发表时间：
2008-02-01
影响因子：
6.4
通讯作者：
Wallin, Lena
中科院分区：
文献类型：
--
作者：
Ivarsson, Tord;Melin, Karin;Wallin, Lena
强迫症（OCD）在诊断水平上的定义包括不同的症状，通常与其他精神问题有关。本研究探讨强迫症与共病症状模式强迫症在儿童和青少年，以调查存在的诊断异质性。对象和方法：共有113名门诊原发性强迫症患者参加。本研究采用半结构式访谈（儿童版情感障碍和精神分裂症量表和儿童耶鲁-布朗强迫量表）和父母对儿童行为量表的反应。精神病诊断与CBCL综合征评分相关，并将CBCL评分与瑞典标准数据进行比较。结果共病诊断非常常见，只有五分之一的患者患有强迫症。最常见的是神经精神疾病（47%），其中抽动障碍最常见（27%），尤其是在男孩中（40.8%; P = .006，Fisher精确检验）。焦虑症（39.8%）和情感障碍（24.8%）也很常见，没有任何性别差异。分裂性障碍的诊断不太常见（8.8%），几乎完全是对立型（ODD）（8.8%）。从维度的角度来看，使用CBCL，强迫症患者得分高于瑞典年轻人一般做的，和一些性别差异被认为是女孩得分较高的焦虑和抑郁，而女孩和男孩都有高分的思想问题，注意力问题，特别是攻击性行为。共病可解释CBCL子综合征量表评分的25%至50%，通常具有两种主要影响，并通过与性别、OCD严重程度和其他共病问题的复杂互动模式。结论虽然共病问题是强迫症的一个重要方面，亚综合征水平的症状，可以使用维度的方法进行评估，是这些青少年的总症状负担的很大一部分。我们的数据表明，贡献的不同途径的女孩和男孩的几个共病问题一起强迫症的严重程度。
Obsessive-compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms and is often associated with other psychiatric problems. The present study examines OCD versus co-morbid symptom patterns in OCD in children and adolescents in order to investigate the presence of diagnostic heterogeneity. Subjects and methods A total of 113 outpatients with primary OCD participated. The patients' and primary caretakers' responses on semi-structured interviews (child version of Schedule for Affective Disorders and Schizophrenia and the Children's Yale-Brown Obsessive Compulsive Scale) and parents' responses on the Child Behaviour Checklist were used in the study. Psychiatric diagnoses were related to CBCL syndrome scores and CBCL scores were compared with the Swedish normative data. Results Co-morbid diagnoses were very common and only one out of five patients had only OCD. The most common group was the neuropsychiatric disorders (47%) where tic disorders were most common (27%), especially among boys (40.8%; P = .006, Fisher's exact test). Also anxiety disorders were common (39.8%) as were affective disorders (24.8%) neither with any gender differences. Diagnoses of disruptive disorders were less common (8.8%), almost exclusively of the oppositional kind (ODD) (8.8%). From the dimensional point of view using the CBCL, patients with OCD scored higher than Swedish youngster generally do, and some gender differences were seen in that girls scored higher on anxiety and depression while both girls and boys had high scores on thought problems, attention problems and especially aggressive behaviour. Comorbidities explained from 25 to 50% scores of the CBCL sub-syndrome scales, often with both main effects and through complex patterns of interaction with gender, OCD-severity and other co-morbid problems. Conclusions While co-morbid problems is an important facet of OCD, sub-syndromal levels of symptoms that can be assessed using a dimensional approach, is a large part of the total symptom burden in these youngsters. Our data indicate contributions of different pathways for girls and for boys for several comorbid problems together with OCD-severity.