Towards a definitive symptom structure of obsessive-compulsive disorder: A factor and network analysis of 87 distinct symptoms in 1366 individuals

Background The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques. Methods A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM). Results Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e. had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables. Conclusions Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology and treatment of OCD. © 2021 The Author(s). Published by Cambridge University Press

Effect of gender differences on impulsivity in adolescents with attention-deficit/hyperactivity disorder

Amaç: Dürtüsellik özellikle dikkat-eksikliği/hiperaktivite bozukluğunun (DEHB) ana belirti kümelerinden biri olarak kabul edilmektedir. Bu çalışmada DEHB tanısı konan ergenlerde cinsiyet farklılıklarının dürtüsellik üzerine etkilerinin araştırılması planlanmıştır. Yöntem: 01.01.2016-01.05.2016 tarihleri arasında Erenköy Ruh ve Sinir Hastalıkları Eğitim ve Araştırma Hastanesi Çocuk ve Ergen Psikiyatri Polikliniği'nde DEHB tanısı konan 156 ergen (91 erkek, 65 kadın) bu araştırmanın örneklem grubunu oluşturmaktadır. Çalışmaya katılan ergenler Barratt Dürtüsellik Ölçeğini (BIS-11), anne-babalar SNAP DEHB Ölçeğini doldurmuşlardır. Bulgular: Katılımcıların %41.7'sı (s=65) kadın, %58.3'ü (s=91) erkektir. Kızların yaş ortalaması 14.3±1.7 yıl, erkeklerin yaş ortalaması 14.4±1.7 yıldır. BIS11 toplam dürtüsellik ortalama puanı, motor alt test dürtüsellik ortalama puanı ve dikkate bağlı dürtüsellik alt test ortalama puanı kadınlarda erkeklere göre anlamlı oranda daha yüksek bulunmuştur. Çoklu doğrusal regresyon analizinde bağımsız değişken olarak cinsiyet, toplam dürtüsellik, motor dürtüsellik, dikkate bağlı dürtüsellik puanı ile ilişkili bulunmuştur. Sonuç: Bu çalışmada DEHB'li kız ergenlerin BIS-11 ile ölçülen toplam dürtüsellik, motor dürtüsellik ve dikkate bağlı dürtüsellik puanları DEHB'li erkek ergenlere göre daha yüksek bulunmuştur. Önceki çalışmalarda cinsiyet ve dürtüsellik ilişkisi ile ilgili tutarlı sonuçlar bulunmamıştır. Bu çalışma klinik örneklemde kadın cinsiyetinde daha fazla dürtüsellik olduğunu gösteren çalışmaların sonuçlarını desteklemektedir.Objective: Impulsiveness has been considered the core symptom of attention-deficit/hyperactivity disorder (ADHD). In this study, we aimed to assess effect of gender differences on impulsivity in adolescents diagnosed with ADHD. Methods: One hundred and fifty-six adolescents (91 males, 65 females) who were admitted to the Erenköy Research and Training Hospital for Psychiatry and Neurology Child and Adolescent Clinic between 01.01.2016 and 01.05.2016 and diagnosed with ADHD were recruited to participate in this study. Adolescents filled out Barratt Impulsiveness Scale and parents completed the SNAP IV ADHD Scale. Results: Of the participants, 41.6% (n=65) were female and 58.3% (n=91) were male. The mean age of girls was 14.3±1.7 years, and the mean age of boys was 14.4±1.7 years. The Barratt impulsivity mean total scores, the Barratt attentive impulsivity subscale mean scores, and the Barratt motor impulsivity subscale mean scores were significantly higher in the female ADHD group than in the male ADHD group. In multiple linear regression analysis, gender was significantly correlated with the Barratt impulsivity total mean score, the Barratt attentive impulsivity mean score, and the Barratt motor impulsivity mean score. Conclusion: The finding of greatest interest in this analysis is that the adolescent girls who were diagnosed with ADHD had greater attentive and motor impulsivity scores than boys as measured by the BIS-11. Although, some previous research reported inconsistent findings of impulsivity levels by gender, our findings confirm prior reports of higher impulsivity in the female clinical population

Empathy and facial expression recognition in children with and without attention-deficit/hyperactivity disorder: Effects of stimulant medication on empathic skills in children with attention-deficit/hyperactivity disorder

WOS: 000403320200007PubMed ID: 28332851Objective: The aim of this study was to compare children and adolescents with attention-deficit/hyperactivity disorder (ADHD) to healthy children and adolescents in terms of state and trait empathy and emotion expression recognition skills. The goal was also to determine whether there are changes in emotion recognition and empathy measures in children with ADHD after methylphenidate (MPH) treatment. Methods: The research sample consisted of outpatient drug-naive children and adolescents between the age of 8 and 14 years (n = 65) with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, 4th ed. criteria, and healthy children and adolescents of the same age (n = 61). Scores of the oppositional problems (OPs) and conduct problems (CPs) were obtained to evaluate their impact on children's empathy skills with the Child Behavior Checklist. Self-reported (Bryant Index of Empathy, BEI) and parent-reported (Griffith Empathy Measurement-Parent Rating, GEM-PR) scales were used to evaluate trait empathy. The Empathy Response Task (ERT) was used to evaluate state empathy, and the Diagnostic Analysis of Nonverbal Accuracy-2 (DANVA-2) was used to evaluate facial expression recognition skills. The scales and tests were repeated after 12 weeks of MPH treatment in the ADHD group. Results: There were no significant statistical differences in trait empathy skills evaluated by parent-reported and self-reported measures, ERT, and DANVA-2 scores. In self-reported measures, the girls had higher scores than boys. From the results of the regression analysis, it was concluded that OPs were not associated with the measures. However, CPs were associated with the scores of the BEI, GEM-PR, and the match scores of the ERT. The average dosage of MPH in the group with ADHD was 0.83 +/- 0.21 mg/(kg.d). While there was no change in the BEI and GEM-PR scores after 12 weeks of treatment, there was a significant increase in the ERT interpretation subscore and a significant decrease in the recognition error of anger and sadness expressions in the DANVA-2. Conclusions: The findings of our study suggest that children with ADHD have similar levels of trait and state empathy skills and facial expressions as healthy controls and CPs negatively affect their empathy skills. MPH treatment does not change trait empathy skills, yet there are some improvements in state empathy skills

Factors related to diagnostic persistence of attention deficit/hyperactivity disorder in Turkish children and adolescents

Ayaz, Muhammed (Arel Author)Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most frequently occurring mental disorders in children and adolescents. The purpose of this study was to determine diagnostic persistence three years after the first clinical evaluation and to investigate the factors relating to diagnostic persistence in children and adolescents with ADHD. Methods: The study included 183 children and adolescents who were evaluated in the first admission. Of 183 children and adolescents, 142 children and adolescents were evaluated in the second admission and only the data of 142 children and adolescents were analysed in the study. Diagnostic persistence was defined as having met the full criteria for ADHD on second evaluation. Symptom severity of ADHD was determined using the Turgay DSM-IV-based Child and Adolescent Behavior Disorders Screening and Rating Scale-Parents Form (T-DSM-IV-S). Intelligence level was assessed through the Wechsler Intelligence Scale for Children-Revised. Results: Of the children included in the study, 77.5% (n?=?110) were determined to have ADHD diagnostic persistence. Low intelligence levels, younger age and higher T-DSM-IV-S inattention and conduct disorder scores were associated with diagnostic persistence. ADHD diagnosis in children and adolescents tends to continue at high rates. Conclusions: Determination of the risks related to ADHD diagnostic persistence may contribute to improved treatment planning and interventions

Cinsel istismara uğrayan çocuk ve ergenlerde klinik özellikler ve intihar girişimi ile ilişkili risk etmenleri

Amaç: Çalışmamızda kliniğimize adli rapor istemi ile yönlendirilen cinsel istismara uğramış çocuk ve ergenlerin sosyodemografik özellikleri, zeka düzeyleri, istismar sonrası gelişen ruhsal bozuklukların, intihar girişimi varlığının ve ilişkili risk etmenlerinin değerlendirilmesi amaçlanmıştır. Yöntem: Adli makamlarca Temmuz 2011-Haziran 2012 tarihleri arasında cinsel istismara uğramış ve adli rapor düzenlenmesi istemi ile çocuk ve ergen psikiyatrisi polikliniğine yönlendirilen 3-17 yaşları arasındaki 157 olgunun dosya bilgileri geriye dönük olarak incelenmiştir. Bulgular: Cinsel istismara uğramış 157 çocuk ve ergenin %83,4’ı kız, %16.6’sı erkektir. Olguların başvuru sırasında yapılan değerlendirilmelerinde % 87.9 oranında ruhsal bozukluk belirlenmiştir. En sık görülen ruhsal bozukluk travma sonrası stres bozukluğudur (TSSB) (%36.9). Toplam 22 (% 14) olguda istismar sonrası intihar girişimi saptanmıştır. Zorlama ile vajinal-anal-oral penetrasyon şeklinde cinsel istismara uğrama, depresif bozukluk ve TSSB tanılarının varlığının intihar girişimi riskini anlamlı oranda artırdığı belirlenmiştir (sırasıyla OR: 3.24, 4.05, 6.78 p= 0.045, 0.03, 0.004). Sonuç: Olguların büyük bir kısmında bir ruhsal bozukluk geliştiği görülmüştür. En sık görülen ruhsal bozukluk TSSB’dir. Cinsel istismar mağduru çocuk ve ergenlerin ruhsal değerlendirmesinde intihar riskinin sorgulanıp müdahale yaklaşımlarının buna göre belirlenmesi gerekmektedir

Family functioning in attention deficit hyperactivity disorder with or without oppositional defiant disorder/conduct disorder comorbidity

Amaç: Bu çalışmada, Dikkat Eksikliği Hiperaktivite Bozukluğu (DEHB) tanılı çocuk ve ergenlerde Karşıt Olma Karşı Gelme Bozukluğu (KOKGB) ve/ veya Davranım bozukluğu (DB) eşhastalanımı varlığında veya yokluğunda aile işlevselliğinin değerlendirilmesi ve sağlıklı kontrol grubu ile karşılaştırılması amaçlanmıştır. Metod: Çalışmaya, Çocuklar için Duygulanım Bozuklukları ve Şizofreni Görüşme Çizelgesi- Şimdi ve Yaşam boyu Versiyonu-Türkçe Versiyonu (ÇGDŞŞY-T) ile değerlendirilen 8-16 yaş arası 49 DEHB tanılı çocuk ve ergen ve 48 sağlıklı çocuk ve ergen alındı. Aile işlevselliğini 6 boyutta değerlendiren (problem çözme, iletişim, roller, duygusal tepki verebilme, gereken ilgiyi gösterme, davranış kontrolü ve genel işlevler) Aile Değerlendirme Ölçeği (ADÖ) ebeveynler tarafından dolduruldu. Bulgular: DEHB tanısı olan çocukların % 34.7’ sinde eşhastalanım tespit edildi. En sık KOKGB (% 24.5) eşlik etmekteydi. DEHB’ li çocukların ailelerinin, ADÖ’ nün problem çözme, rollerin dağılımı, gereken ilgiyi gösterebilme, davranış kontrolü ve genel işlevler alt ölçeklerinden ‘sağlıksız işlevsellik’ seviyesinde yüksek puan aldıkları görüldü. Bunun yanında DEHB grubu ailelerinin problem çözme davranışı ve genel işlevselliği kontrol grubu ailelerine göre anlamlı düzeyde daha zayıftı ve rollerin dağılımı alanında daha fazla güçlükleri vardı. KOKGB ve/ veya DB eşlik eden DEHB’ li grubun aileleri, aile işlevselliğini değerlendiren tüm alanlarda ‘sağlıksız işlevsellik’ seviyesinde yüksek puanlara sahipti. Aynı zamanda eşhastalanımı olmayan DEHB grubuna göre, genel işlevsellik ve gereken ilgiyi gösterebilme alanlarında anlamlı oranda daha fazla sorun birdirdiler. Tartışma: Bu çalışmada yazın bilgisi ile uyumlu olarak KOKGB ve/veya DB eşhastalanımı olan ve olmayan DEHB tanılı çocuk ve ergenlerin aileleri ADÖ’ de çeşitli alanlarda aile işlevselliğinin bozulduğunu bildirmişlerdir. DEHB’ nin tedavisi özellikle KOKGB veya DB eşhastalanımı varlığında, ebeveynlik becerilerinin ve aile işlevselliğinin arttırılmasını hedef alan müdahale yaklaşımlarını içermelidir.Purpose: The purpose of the study was to examine and compare family functioning in attention deficit and hyperactivity disorder (ADHD) and ADHD comorbid with oppositional defiant disorder ( ODD) or conduct disorder ( CD) with control subjects. Method: Forty nine children and adolescents diagnosed with ADHD and forty eight controls (aged 8-16 years) were assessed with Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version; Parents completed the McMaster Family Assessment Device (FAD) for family functioning which assesses 6 dimensions of family functioning ( problem solving, communication, behavior control, affective involvement, affective responsiveness, and roles and also includes a general functioning subscale. Results: 34.7 % of the ADHD children had comorbid psychiatric disorders, and the major comorbidity was ODD (24.5 %). ADHD families scored high at the level of “unhealthy functioning” in the problem solving, roles, affective involvement, general functioning, and behavior control subscales of FAD. Besides, problem solving behavior and general functioning were significantly poorer than control families and they had more difficulties in area of roles. When DEHB was comorbid with ODD or DB, all areas of family functioning as measured by FAD were scored high at the level of “unhealthy functioning “. Additionally, general functioning and affective responsiveness were significantly poorer than ADHD without ODD or DB comorbidity. Conclusion: Recent studies revealed that ADHD and especially ADHD comorbid with ODD or DB may disrupt family functioning in many ways. In this study, the families of children and adolescents with ADHD and ADHD comorbid with ODD or DB had poorer family functioning in most of the subscales of FAD. Treatment of children and adolescents diagnosed with ADHD especially comorbid with ODD or DB should include parental treatment and intervention addressing parental skills, and family functioning

Psychometric properties of the DY-BOCS in a Turkish sample of children and adolescents

BACKGROUND: Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a promising scale for assessing frequency and severity of symptom dimensions. The main objective of the study was to assess the psychometric properties of the DYBOCS in a large sample of children and adolescents from Turkey. METHODS: We studied 143 children and adolescents, 7–18 years, with well characterized DSM-IV-R OCD, ascertained from seven collaborating university or state hospital sites. We compared the DYBOCS scores with the Children’s Yale-Brown Obsessive-Compulsive Scale (CYBOCS), the Children’s Depression Inventory (CDI), the Yale Global Tic Severity Scale (YGTSS) and the Child Behavior Checklist-6-18 years (CBCL-6-18). RESULTS: The internal consistency of the DY-BOCS symptom dimensions and inter rater agreement of component scores were excellent. The agreement between global DY-BOCS score and the total CY-BOCS score was highly significant (Pearson r = 0.55, p < 0.0001). Severity scores for individual symptom dimensions were independent of one another, only modestly correlating with the global ratings, and were also differentially related to ratings of depression, anxiety and tic severity. CONCLUSION: The DY-BOCS is a reliable and valid instrument for assessing multiple aspects of OCD symptom severity in children and adolescents from Turkey