Academic journal article East Asian Archives of Psychiatry

Co-Morbidity of Obsessive-Compulsive Disorder and Other Anxiety Disorders with Child and Adolescent Mood Disorders

Academic journal article East Asian Archives of Psychiatry

Co-Morbidity of Obsessive-Compulsive Disorder and Other Anxiety Disorders with Child and Adolescent Mood Disorders

Article excerpt

Introduction

Obsessive-compulsive disorder (OCD) is a chronic and distressing disorder that leads to significant impairment in academic, social, and family domains of functioning. It is often seen in children and adolescents: the lifetime prevalence of paediatric OCD ranges from 2% to 4%, with a 6-month prevalence of 0.5% to 1%. (1) There is a high rate of psychiatric co-morbidities in childhood OCD; about 50% of those with childhood OCD have multiple co-morbidities and as many as 80% meet the diagnostic criteria of an additional Axis-1 disorder. (2)

Major depression is considered a common occurrence in patients with OCD. Several reports have described the high risk of (hypo)manic switches in juvenile OCD patients treated with tricyclics or selective serotonin reuptake inhibitors, (3,4) implicating a bipolar diathesis in this population. Recent epidemiological studies suggest that co-morbidity between OCD and bipolar disorder (BD) is highly prevalent, with rates as high as 15% to 35%. (5,6) Notwithstanding the emerging literature on co-morbidity between OCD and mood disorders, relatively few systematic data exist on the clinical characteristics of this interface and its treatment. Despite the potential clinical importance of this issue, it has not yet been properly explored. Data on mood disorder-OCD co-morbidity in the juvenile population are much scarce. (7) A recent study to explore bidirectional co-morbidity between BD and OCD in youth and to examine the symptom profile and clinical correlates of these 2 disorders reported that a high rate of co-morbidity (21% of BD subjects and 15% of OCD subjects met DSMIII-R criteria for both disorders) and multiple anxiety disorders, especially generalised anxiety disorder (GAD) and social phobia, were more often present when OCD and BD were co-morbid than otherwise. (8) Similar studies in a juvenile population in India are lacking. Thus, the current study was undertaken to explore the co-morbidity of OCD and other anxiety disorders in children and adolescents with mood disorders.

Methods

Participants

This was a cross-sectional hospital-based study conducted at the Child and Adolescent Psychiatric Unit of the Central Institute of Psychiatry, Ranchi, a tertiary referral centre in eastern India. The study was approved by the institutional ethics committee. The study sample comprised 100 consecutive patients of either gender, aged < 18 years, and diagnosed with mood disorders according to the DSM-IV-TR criteria. (9) Those with co-morbid major medical or neurological illness or mental retardation were excluded from the study. Written informed consent was obtained from the relatives.

Measures

A semi-structured specially designed proforma was used to collect socio-demographic and clinical details. The Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL), (10) a semi-structured diagnostic interview designed to assess current and past episodes of psychopathology in children and adolescents, was used to screen for co-morbid OCD and other anxiety disorders in patients with mood disorders. Diagnoses were scored as definite, probable (> 75% of symptom criteria met), or not present. A score of 2 indicated a subthreshold level of symptomatology, and a score of 3 represented threshold criteria. The clinician-rated Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) (11) was used to assess the severity of obsessivecompulsive (OC) symptoms in those screened positive on K-SADS-PL. In addition, Young Mania Rating Scale (YMRS), (12) Children's Depression Inventory (CDI), (13) Hamilton Anxiety Scale (HAM-A), (14) and Brief Psychiatric Rating Scale for Children (BPRS-C) (15) were used to assess the associated psychopathology. All the assessments were carried out on admission by the first author prior to initiating pharmacotherapy.

Statistical Analysis

The data obtained were analysed using the Statistical Package for the Social Sciences Windows version 16. …

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