File Name: clinical obsessive compulsive disorders in adults and children .zip
Metrics details. Paediatric obsessive-compulsive disorder OCD is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment.
Obsessive-compulsive in child and adolescents: An update. Part two. Salud Ment [online]. ISSN During the last years obsessive-compulsive disorder OCD has been reported with increased prevalence in pediatric population; this is due to the development of more specific assessment methods.
This evolution in the evaluation tools has given rise to the possibility of characterizing OCD presentation in children and adolescents. In childhood, OCD is a chronic and distressing disorder that can lead to severe impairments in social, academic and family functioning. Current diagnosis criteria for pediatric OCD are the same than those used in adults. During all life span, obsessive and compulsive symptoms are necessary to establish the presence of the disorder.
There are several different clinical manifestations among age groups, different evolution among children, adolescents and adults; all these represent a diagnostic and therapeutic challenge for the clinician. Several classifications incorporate pediatric OCD, especially those related to the familiar presentation form and patterns of comorbidity, mainly with tics disorders.
These findings support the notion that tics disorders are the comorbidity more closely related with early-onset OCD, giving elements to consider this association as a specific pediatric OCD subtype.
In this age group population, comorbidity has been reported as high as in adulthood; some diagnoses are especially prevalent during childhood and others during adolescence. On the whole, anxiety disorders are frequent with OCD, generalized anxiety disorder, panic attack, social phobia and anxiety separation disorder.
Comorbidity related with affective disorders is high too. Bipolar disorder BD is another frequent comorbid entity with great clinical relevance.
Adults with OCD and BD comorbidity have more frequent episodic form, a greater number of concurrent mayor depressive episodes and a higher rate of religious or sexual obsessions. Other comorbid diagnoses frequently reported in this early-onset OCD population are externalizing disorders as attention deficit hyperactivity disorder ADHD and oppositional defiant disorder ODD.
There is a consistent preponderance of males in most epidemiological studies. A valid and reliable clinical interview is needed to establish differential diagnosis among OCD and other compulsive behaviors and intrusive thoughts present in disorders like anorexia nervosa, body dysmorphic disorder, hypochondrias, tics disorders and impulse control disorders. All these categories have been considered as part of the obsessive-compulsive disorders spectrum. It is important to establish the difference between obsessions with poor insight common in early-onset OCD and overvalued ideas or delusions.
Pervasive disorders as autism and Asperger syndrome frequently show stereotyped behaviors which may be considered as obsessive-compulsive symptoms. The diagnostic evaluation of children and adolescents with OCD includes a careful assessment and review of current and past obsessive-compulsive symptoms and comorbid conditions.
For children who do not regard their symptoms as excessive, information from parents, and if possible from teachers, is essential to identify the range of symptoms, severity and context. Many children and adolescents feel confused and embarrassed with their symptoms.
It is important to dedicate time to build a true clinical alliance to elicit the story of their symptoms, as well as the impact on a child's thoughts and feelings. There are several useful instruments to establish OCD diagnosis and severity in children and adolescents. Self-report questionnaires have been used to identify the presence and severity of OCD symptoms.
Clinician-administered interviews may be a more reliable method to identify obsessive-compulsive disorders in youth.
The initial CY-BOCS section consists of a symptom checklist covering a comprehensive array of obsessions and compulsions. The severity score is derived from the second section of the measure in which global rating of time spent, interference, distress, resistance and control associated with obsessions and compulsions are generated. Separate scores are obtained for obsessions and compulsions, which, when combined, yield a total severity score of a maximum 40 points. Scores greater than or equal to 16 indicate clinically significant OCD in children and adolescents.
The knowledge we now have about pediatric OCD pharmacotherapy is better. Several studies have demonstrated the efficacy of clorimipramine. This was the first agent approved for use in pediatric populations with OCD. Subsequent multisite randomized, placebo-controlled trials of selective reuptake inhibitors SSRIs have also demonstrated significant efficacy in pediatric population.
The most common adverse effects of SSRIs are nausea, insomnia, activation and headache. These effects are transient and most children tolerate them. The availability and effectiveness of SSRI have changed dramatically the OCD treatment, and neurobiological and neuroimaging advances have supported their use.
Many children and adolescents with OCD need multiple treatments including cognitive behavior therapy CBT , pharmacologic treatment, parental, family and teachers training. These interventions need to be applied by experts in order to be effective. Palabras llave : Obsessive-compulsive disorder; children and adolescents; comorbidity; assessment; treatment.
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Obsessive-compulsive in child and adolescents: An update. Part two. Salud Ment [online]. ISSN During the last years obsessive-compulsive disorder OCD has been reported with increased prevalence in pediatric population; this is due to the development of more specific assessment methods. This evolution in the evaluation tools has given rise to the possibility of characterizing OCD presentation in children and adolescents.
Obsessive—compulsive disorder OCD is a mental disorder in which a person has certain thoughts repeatedly called "obsessions" or feels the need to perform certain routines repeatedly called "compulsions" to an extent which generates distress or impairs general functioning. The cause is unknown. Treatment involves psychotherapy , such as cognitive behavioral therapy CBT , and sometimes antidepressants , such as selective serotonin reuptake inhibitors SSRIs or clomipramine. Obsessive—compulsive disorder affects about 2. OCD can present with a wide variety of symptoms. Certain groups of symptoms usually occur together.
Click on image for details. Context: Data from the Western countries suggest that obsessive-compulsive disorder OCD in children and adolescents is associated with male preponderance, comorbid neurodevelopmental disorders, and high family loading. However, data are limited from the developing countries with respect to the demographic and clinical characteristics of OCD in children and adolescents. Setting and Design: This was a cross-sectional study, conducted in outpatient treatment setting, across six centers in India. Results: The sample was largely male with a moderate illness severity.
В сердцах он швырнул трубку на рычаг. - Черт! - Фонтейн снова схватил трубку и набрал номер мобильника Стратмора. На этот раз послышались длинные гудки. Фонтейн насчитал уже шесть гудков. Бринкерхофф и Мидж смотрели, как он нервно шагает по комнате, волоча за собой телефонный провод. Директор АНБ напоминал тигра на привязи. Лицо его все сильнее заливалось краской.
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