Pedro G Alvarenga1, Raony C Cesar2, James F Leckman3, Tais S Moriyama4, Albina R Torres5, Michael H Bloch6, Catherine G Coughlin7, Marcelo Q Hoexter4, Gisele G Manfro8, Guilherme V Polanczyk9, Euripedes C Miguel4, Maria C do Rosario10. 1. Department & Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo 01060-970, SP, Brazil. Electronic address: pedrodealvarenga@gmail.com. 2. Department & Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil. 3. Department & Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil; Child Study Center, Yale School of Medicine, 230, South Frontage Rd, New Haven, CT 06519, USA. 4. Department & Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo 01060-970, SP, Brazil. 5. Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Montenegro s/n, Botucatu 18618970, SP, Brazil. Electronic address: albinatorres@gmail.com. 6. Child Study Center, Yale School of Medicine, 230, South Frontage Rd, New Haven, CT 06519, USA. 7. Department of Neurology, Psychology and Psychiatry, Botucatu Medical School, São Paulo State University (UNESP), Av. Prof. Montenegro s/n, Botucatu 18618970, SP, Brazil. Electronic address: catherine.coughlin@yale.edu. 8. National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo 01060-970, SP, Brazil; Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul (UFRGS), Rua Ramiro Barcelos, 2350, Porto Alegre 90035-903, RS, Brazil. Electronic address: gmanfro@gmail.com. 9. Department & Institute of Psychiatry, University of Sao Paulo Medical School (USP), Rua Dr. Ovídio Pires de Campos, 785, São Paulo 01060-970, SP, Brazil; National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo 01060-970, SP, Brazil. Electronic address: gvp.ez@terra.com.br. 10. National Institute of Developmental Psychiatry for Children and Adolescents, CNPq, Rua. Dr. Ovídio Pires de Campos, São Paulo 01060-970, SP, Brazil; Child and Adolescent Psychiatry Unit (UPIA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), Rua Pedro de Toledo, 590, São Paulo 04038-020, SP, Brazil. Electronic address: mariaceica.rosario@gmail.com.
Abstract
BACKGROUND: Obsessive-compulsive disorder can be expressed as four potentially overlapping obsessive-compulsive symptom (OCS) dimensions (OCSD) ("symmetry/ordering", "contamination/cleaning", "aggressive/sexual/religious" and "collecting/hoarding"). In clinical samples, some dimensions are more familial and associated with increased psychiatric comorbidity and malfunctioning. However, data concerning OCS and OCSD are scarce in non-clinical samples, particularly among children. The present study aims to estimate: (1) the prevalence and sex/age distribution of OCS/OCSD in a community-based sample of schoolchildren; (2) the association between OCS and additional clinical factors; and (3) the degree of familial aggregation of OCS/OCSD. METHODS: OCS and OCSD were evaluated in 9937 Brazilian school-children (6-12 years-old) and their biological relatives using the Family History Screen. Data analyses included gradient estimated equations and post-hoc tests. RESULTS: We included data on 9937 index-children, 3305 siblings (13-18 years-old), and 16,218 parents. Biological mothers were the informants in 87.6% of the interviews. OCS were present in 14.7% of the index-children; 15.6% of their siblings; 34.6% of their mothers and 12.1% of their fathers. The prevalence of OCS and each of the OCSD gradually increased from ages 6 to 12 years. Overall, OCS in children were associated with the presence of other psychiatric symptoms, as well as behavioral/school impairment. OCS and each of the four OCSD aggregated significantly within families. CONCLUSIONS: OCS are prevalent and associated with psychiatric symptoms and clinical impairment among school-aged children. OCSD aggregate within families in a dimension-specific fashion. These findings suggest a natural continuum between OCS and OCD with regard to their dimensional character.
BACKGROUND:Obsessive-compulsive disorder can be expressed as four potentially overlapping obsessive-compulsive symptom (OCS) dimensions (OCSD) ("symmetry/ordering", "contamination/cleaning", "aggressive/sexual/religious" and "collecting/hoarding"). In clinical samples, some dimensions are more familial and associated with increased psychiatric comorbidity and malfunctioning. However, data concerning OCS and OCSD are scarce in non-clinical samples, particularly among children. The present study aims to estimate: (1) the prevalence and sex/age distribution of OCS/OCSD in a community-based sample of schoolchildren; (2) the association between OCS and additional clinical factors; and (3) the degree of familial aggregation of OCS/OCSD. METHODS: OCS and OCSD were evaluated in 9937 Brazilian school-children (6-12 years-old) and their biological relatives using the Family History Screen. Data analyses included gradient estimated equations and post-hoc tests. RESULTS: We included data on 9937 index-children, 3305 siblings (13-18 years-old), and 16,218 parents. Biological mothers were the informants in 87.6% of the interviews. OCS were present in 14.7% of the index-children; 15.6% of their siblings; 34.6% of their mothers and 12.1% of their fathers. The prevalence of OCS and each of the OCSD gradually increased from ages 6 to 12 years. Overall, OCS in children were associated with the presence of other psychiatric symptoms, as well as behavioral/school impairment. OCS and each of the four OCSD aggregated significantly within families. CONCLUSIONS: OCS are prevalent and associated with psychiatric symptoms and clinical impairment among school-aged children. OCSD aggregate within families in a dimension-specific fashion. These findings suggest a natural continuum between OCS and OCD with regard to their dimensional character.
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