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Phenomenology of patients with early- and adult-onset obsessive-compulsive disorder

Published online by Cambridge University Press:  11 October 2011

Umberto Albert
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino Clinica Psichiatrica, Università degli Studi di Trieste, Trieste
Chiara Picco
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Giuseppe Maina
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Federica Forner
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Eugenio Aguglia
Affiliation:
Clinica Psichiatrica, Università degli Studi di Trieste, Trieste
Filippo Bogetto
Affiliation:
Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università degli Studi di Torino, Torino
Corresponding
E-mail address:

Summary

Objective – To evaluate potential differences in socio-demographic and clinical characteristics (obsessivecompulsive symptomatology, axis I and II comorbidity) between OCD adults with an early age at onset (≤18 years) and later onset, (≤18 yrs). Design – Clinical controlled study. Setting – Anxiety and Mood Disorders Unit, Department of Neuroscience, University of Turin. Methods – We included 149 subjects with a principal diagnosis of OCD (DSM-IV) and a Y-BOCS total score ≤ 16 All patients underwent a semistructured clinical interview aimed at investigating sociodemographic characteristics and clinical features of the disorder. Lifetime Axis I comorbidity, according to DSM-IV criteria, was investigated with a structured interview following Othmer & Othmer guidelines (1994; 1999). Personality disorders were assessed using the Structured Clinical Interview for DSM-IV Axis II Disorders (SCID-II). Results – 39 patients referred age at onset of OCD before 18 years (earlyonset group) and 110 patients at 18 years or later (later-onset group). Significant differences were found between the two groups: early-onset subjects are characterized by a preponderance of males, a chronic course of illness and a strong association with Schizotypal Personality Disorder. Discussion – When subtyping OCD according to age at onset we found significant differences which suggest a possible heterogeneity of the disorder. Our results seem to confirm that early-onset OCD may represent a more severe subgroup, with clinical characteristics such as the chronic course and the high association with Schizotypal PD which are significant in order to apply specific therapeutic strategies.

Riassunto

Scopo – Valutare eventuali differenze nelle caratteristiche sociodemografiche e cliniche (sintomatologia ossessivo–compulsiva, la comorbidità di Asse I e la comorbidità di Asse II) in soggetti adulti con disturbo ossessivo–compulsivo ad esordio precoce (>18 anni) e in eta adulta (≤18 anni). Disegno – Studio clinico controllato. Setting – Servizio per i disturbi depressivi e d'ansia, Dipartimento di Neuroscienze, Università di Torino. Metodo – Sono stati inclusi nello studio 149 pazienti adulti con diagnosi di DOC (DSM–IV) e un punteggio Y–BOCS totale <16.1 soggetti sono stati valutati attraverso un'intervista semi–strutturata diretta ad indagare le caratteristiche socio–demografiche é cliniche. La comorbidita longitudinale di Asse I, secondo i criteri del DSM–IV, è stata valutata attraverso un'intervista clinica strutturata diretta secondo le indicazioni di Othmer & Othmer (1994; 1999): particolare attenzione è stata rivolta alia rilevazione dei disturbi dello spettro ossessivo–compulsivo (Hollander et al, 1996; 1997). Per l'analisi della comorbidita con i disturbi di personalitá è stata utilizzata la Structured Clinical Interview for DSM–IV Axis II Disorders (SCID–II). Risultati – 39 pazienti (26.2%) hanno presentato l'esordio del DOC prima dei 18 anni (early–onset) e 110 pazienti (73.8%) hanno presentato l'esordio del DOC dopo i 18 anni (later–onset). Sono state rilevate differenze significative tra i due gruppi di confronto: i soggetti con esordio precoce presentano una predominanza del sesso maschile, un decorso cronico del disturbo e l'associazione con il disturbo schizotipico di personalità. Conclusioni – Suddividendo il campione secondo l'eta di esordio del disturbo abbiamo rilevato alcune differenze significative nell'espressivita del DOC che indicano una possibile eterogeneita del disturbo, meritevole di ulteriori approfondimenti. In particolare, il rilievo nel gruppo ad esordio precoce di un decorso prevalentemente cronico e soprattutto di una specifica associazione con il disturbo schizotipico di personalita appare significativo ai fini dell'impostazione di specifiche strategic terapeutiche.

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Copyright
Copyright © Cambridge University Press 2002

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