Skip to main content
SpringerLink
Log in

Clinical significance of psychiatric comorbidity in children and adolescents with obsessive–compulsive disorder: subtyping a complex disorder

  • Original Paper
  • Published:
European Archives of Psychiatry and Clinical Neuroscience Aims and scope Submit manuscript

Abstract

A promising approach in relation to reducing phenotypic heterogeneity involves the identification of homogeneous subtypes of OCD based on age of onset, gender, clinical course and comorbidity. This study aims to assess the sociodemographic characteristics and clinical features of OCD patients in relation to gender and the presence or absence of another comorbid disorder. The sample comprised 112 children and adolescents of both sexes and aged 8–18 years, all of whom had a diagnosis of OCD. Overall, 67 % of OCD patients had one comorbid diagnosis, 20.5 % had two such diagnoses and 2.6 % had three comorbid diagnoses. The group of OCD patients with a comorbid neurodevelopmental disorder had significantly more family history of OCD in parents (p = .049), as compared with the no comorbidity group and the group with a comorbid internalizing disorder, and they also showed a greater predominance of males (p = .013) than did the group with a comorbid internalizing disorder. The group of OCD patients with internalizing comorbidity had a later age of onset of OCD (p = .001) compared with both the other groups. Although the initial severity was similar in all three groups, the need for pharmacological treatment and for hospitalization due to OCD symptomatology was greater in the groups with a comorbid neurodevelopmental disorder (p = .038 and p = .009, respectively) and a comorbid internalizing disorder (p = .008 and p = .004, respectively) than in the group without comorbidity. Our findings suggest that two subtypes of OCD can be defined on the basis of the comorbid pathology presented. The identification of different subtypes according to comorbidity is potentially useful in terms of understanding clinical variations, as well as in relation to treatment management and the use of therapeutic resources.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, V edn. APA, Washington, DC

    Google Scholar 

  2. Fontenelle LF, Mendlowicz MV, Versiani M (2006) The descriptive epidemiology of obsessive–compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 30:327–337. doi:10.1016/j.pnpbp.2005.11.001

    Article  PubMed  Google Scholar 

  3. Micali N, Heyman I, Perez M et al (2010) Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents. Br J Psychiatry 197:128–134. doi:10.1192/bjp.bp.109.075317

    Article  CAS  PubMed  Google Scholar 

  4. Stewart SE, Geller DA, Jenike M et al (2004) Long-term outcome of pediatric obsessive–compulsive disorder: a meta-analysis and qualitative review of the literature. Acta Psychiatr Scand 110:4–13. doi:10.1111/j.1600-0447.2004.00302.x

    Article  CAS  PubMed  Google Scholar 

  5. Mataix-Cols D, Wooderson S, Lawrence N et al (2004) Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive–compulsive disorder. Arch Gen Psychiatry 61:564–576. doi:10.1001/archpsyc.61.6.564

    Article  PubMed  Google Scholar 

  6. Alsobrook JP II, Leckman JF, Goodman WK et al (1999) Segregation analysis of obsessive–compulsive disorder using symptom-based factor scores. Am J Med Genet 88:669–675

    Article  Google Scholar 

  7. Mataix-Cols D, do Rosario-Campos MC, Leckman JF (2005) A multidimensional model of obsessive–compulsive disorder. Am J Psychiatry 162:228–238. doi:10.1176/appi.ajp.162.2.228

    Article  PubMed  Google Scholar 

  8. Leckman JF, Bloch MH, King RA (2009) Symptom dimensions and subtypes of obsessive–compulsive disorder: a developmental perspective. Dialogues Clin Neurosci 11:21–33

    PubMed  PubMed Central  Google Scholar 

  9. Taylor S (2011) Early versus late onset obsessive–compulsive disorder: evidence for distinct subtypes. Clin Psychol Rev 31:1083–1100. doi:10.1016/j.cpr.2011.06.007

    Article  PubMed  Google Scholar 

  10. de Mathis MA, de Alvarenga P, Funaro G et al (2011) Gender differences in obsessive–compulsive disorder: a literature review. Rev Bras Psiquiatr 33:390–399

    Article  PubMed  Google Scholar 

  11. Miguel EC, Leckman JF, Rauch S et al (2005) Obsessive–compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry 10:258–275. doi:10.1038/sj.mp.4001617

    Article  CAS  PubMed  Google Scholar 

  12. Ruscio AM, Stein DJ, Chiu WT, Kessler RC (2010) The epidemiology of obsessive–compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 15:53–63. doi:10.1038/mp.2008.94

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Bryńska A, Wolańczyk T (2005) Epidemiology and phenomenology of obsessive–compulsive disorder in non-referred young adolescents: a Polish perspective. Eur Child Adolesc Psychiatry 14:319–327. doi:10.1007/s00787-005-0478-3

    Article  PubMed  Google Scholar 

  14. Swedo SE, Rapoport JL, Leonard H et al (1989) Obsessive–compulsive disorder in children and adolescents. Clinical phenomenology of 70 consecutive cases. Arch Gen Psychiatry 46:335–341

    Article  CAS  PubMed  Google Scholar 

  15. Geller D, Biederman J, Jones J et al (1998) Is juvenile obsessive–compulsive disorder a developmental subtype of the disorder? A review of the pediatric literature. J Am Acad Child Adolesc Psychiatry 37:420–427. doi:10.1097/00004583-199804000-00020

    Article  CAS  PubMed  Google Scholar 

  16. Delorme R, Golmard J-L, Chabane N et al (2005) Admixture analysis of age at onset in obsessive–compulsive disorder. Psychol Med 35:237–243

    Article  PubMed  Google Scholar 

  17. Rosenberg DR, Keshavan MS (1998) A.E. Bennett Research Award. Toward a neurodevelopmental model of obsessive–compulsive disorder. Biol Psychiatry 43:623–640

    Article  CAS  PubMed  Google Scholar 

  18. Geller DA, Biederman J, Faraone S et al (2001) Developmental aspects of obsessive compulsive disorder: findings in children, adolescents, and adults. J Nerv Ment Dis 189:471–477

    Article  CAS  PubMed  Google Scholar 

  19. Grados MA, Riddle MA, Samuels JF et al (2001) The familial phenotype of obsessive–compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry 50:559–565

    Article  CAS  PubMed  Google Scholar 

  20. Leonard HL, Lenane MC, Swedo SE et al (1992) Tics and Tourette’s disorder: a 2- to 7-year follow-up of 54 obsessive–compulsive children. Am J Psychiatry 149:1244–1251

    Article  CAS  PubMed  Google Scholar 

  21. Rosario-Campos MC, Leckman JF, Mercadante MT et al (2001) Adults with early-onset obsessive–compulsive disorder. Am J Psychiatry 158:1899–1903

    Article  CAS  PubMed  Google Scholar 

  22. Narayanaswamy JC, Viswanath B, Veshnal Cherian A et al (2012) Impact of age of onset of illness on clinical phenotype in OCD. Psychiatry Res 200:554–559. doi:10.1016/j.psychres.2012.03.037

    Article  PubMed  Google Scholar 

  23. Franklin ME, Harrison JP, Benavides KL (2012) Obsessive–compulsive and tic-related disorders. Child Adolesc Psychiatr Clin N Am 21:555–571. doi:10.1016/j.chc.2012.05.008

    Article  PubMed  PubMed Central  Google Scholar 

  24. Coffey BJ, Miguel EC, Biederman J et al (1998) Tourette’s disorder with and without obsessive–compulsive disorder in adults: are they different? J Nerv Ment Dis 186:201–206

    Article  CAS  PubMed  Google Scholar 

  25. Lewin AB, Chang S, McCracken J et al (2010) Comparison of clinical features among youth with tic disorders, obsessive–compulsive disorder (OCD), and both conditions. Psychiatry Res 178:317–322. doi:10.1016/j.psychres.2009.11.013

    Article  PubMed  PubMed Central  Google Scholar 

  26. Geller DA, Biederman J, Griffin S et al (1996) Comorbidity of juvenile obsessive–compulsive disorder with disruptive behavior disorders. J Am Acad Child Adolesc Psychiatry 35:1637–1646. doi:10.1097/00004583-199612000-00016

    Article  CAS  PubMed  Google Scholar 

  27. Masi G, Millepiedi S, Perugi G et al (2010) A naturalistic exploratory study of the impact of demographic, phenotypic and comorbid features in pediatric obsessive–compulsive disorder. Psychopathology 43:69–78. doi:10.1159/000274175

    Article  PubMed  Google Scholar 

  28. Sheppard B, Chavira D, Azzam A et al (2010) ADHD prevalence and association with hoarding behaviors in childhood-onset OCD. Depress Anxiety 27:667–674. doi:10.1002/da.20691

    Article  PubMed  PubMed Central  Google Scholar 

  29. Cavanna AE, Servo S, Monaco F, Robertson MM (2009) The behavioral spectrum of Gilles de la Tourette syndrome. J Neuropsychiatry Clin Neurosci 21:13–23. doi:10.1176/appi.neuropsych.21.1.13

    Article  PubMed  Google Scholar 

  30. Lebowitz ER, Motlagh MG, Katsovich L et al (2012) Tourette syndrome in youth with and without obsessive compulsive disorder and attention deficit hyperactivity disorder. Eur Child Adolesc Psychiatry 21:451–457. doi:10.1007/s00787-012-0278-5

    Article  PubMed  PubMed Central  Google Scholar 

  31. Wanderer S, Roessner V, Freeman R et al (2012) Relationship of obsessive–compulsive disorder to age-related comorbidity in children and adolescents with Tourette syndrome. J Dev Behav Pediatr 33:124–133. doi:10.1097/DBP.0b013e31823f6933

    PubMed  Google Scholar 

  32. Evans DW, Lewis MD, Iobst E (2004) The role of the orbitofrontal cortex in normally developing compulsive-like behaviors and obsessive–compulsive disorder. Brain Cogn 55:220–234. doi:10.1016/S0278-2626(03)00274-4

    Article  PubMed  Google Scholar 

  33. Marsh R, Maia TV, Peterson BS (2009) Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. Am J Psychiatry 166:664–674. doi:10.1176/appi.ajp.2009.08091354

    Article  PubMed  PubMed Central  Google Scholar 

  34. Rauch SL, Whalen PJ, Curran T et al (2001) Probing striato-thalamic function in obsessive–compulsive disorder and Tourette syndrome using neuroimaging methods. Adv Neurol 85:207–224

    CAS  PubMed  Google Scholar 

  35. Grados MA (2010) The genetics of obsessive–compulsive disorder and Tourette syndrome: an epidemiological and pathway-based approach for gene discovery. J Am Acad Child Adolesc Psychiatry 49:810–9, 819.e1–2. doi:10.1016/j.jaac.2010.04.009

  36. Davis LK, Yu D, Keenan CL et al (2013) Partitioning the heritability of Tourette syndrome and obsessive compulsive disorder reveals differences in genetic architecture. PLoS Genet 9:e1003864. doi:10.1371/journal.pgen.1003864

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hanna GL, Piacentini J, Cantwell DP et al (2002) Obsessive–compulsive disorder with and without tics in a clinical sample of children and adolescents. Depress Anxiety 16:59–63. doi:10.1002/da.10058

    Article  PubMed  Google Scholar 

  38. Müller SV, Johannes S, Wieringa B et al (2003) Disturbed monitoring and response inhibition in patients with Gilles de la Tourette syndrome and co-morbid obsessive compulsive disorder. Behav Neurol 14:29–37

    Article  PubMed  Google Scholar 

  39. Ivarsson T, Melin K, Wallin L (2008) Categorical and dimensional aspects of co-morbidity in obsessive–compulsive disorder (OCD). Eur Child Adolesc Psychiatry 17:20–31. doi:10.1007/s00787-007-0626-z

    Article  PubMed  Google Scholar 

  40. Langley AK, Lewin AB, Bergman RL et al (2010) Correlates of comorbid anxiety and externalizing disorders in childhood obsessive compulsive disorder. Eur Child Adolesc Psychiatry 19:637–645. doi:10.1007/s00787-010-0101-0

    Article  PubMed  PubMed Central  Google Scholar 

  41. Bienvenu OJ, Samuels JF, Wuyek LA et al (2012) Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med 42:1–13. doi:10.1017/S0033291711000742

    Article  CAS  PubMed  Google Scholar 

  42. Nestadt G, Samuels J, Riddle MA et al (2001) The relationship between obsessive–compulsive disorder and anxiety and affective disorders: results from the Johns Hopkins OCD Family Study. Psychol Med 31:481–487

    Article  CAS  PubMed  Google Scholar 

  43. Storch EA, Lewin AB, Larson MJ et al (2012) Depression in youth with obsessive–compulsive disorder: clinical phenomenology and correlates. Psychiatry Res 196:83–89. doi:10.1016/j.psychres.2011.10.013

    Article  PubMed  Google Scholar 

  44. Denys D, Tenney N, van Megen HJGM, de Geus F (2004) Axis I and II comorbidity in a large sample of patients with obsessive–compulsive disorder. J Affect Disord 80(2–3):155–162

    Article  PubMed  Google Scholar 

  45. Grados MA, Mathews CA (2008) Latent class analysis of gilles de la Tourette syndrome using comorbidities: clinical and genetic implications. Biol Psychiatry 64:219–225. doi:10.1016/j.biopsych.2008.01.019

    Article  PubMed  PubMed Central  Google Scholar 

  46. Mathews CA, Grados MA (2011) Familiality of Tourette syndrome, obsessive–compulsive disorder, and attention-deficit/hyperactivity disorder: heritability analysis in a large sib-pair sample. J Am Acad Child Adolesc Psychiatry 50:46–54. doi:10.1016/j.jaac.2010.10.004

    Article  PubMed  PubMed Central  Google Scholar 

  47. Krueger RF, Finger MS (2001) Using item response theory to understand comorbidity among anxiety and unipolar mood disorders. Psychol Assess 13:140–151

    Article  CAS  PubMed  Google Scholar 

  48. Stewart SE, Jenike MA, Keuthen NJ (2005) Severe obsessive–compulsive disorder with and without comorbid hair pulling: comparisons and clinical implications. J Clin Psychiatry 66:864–869

    Article  PubMed  Google Scholar 

  49. Peterson BS, Pine DS, Cohen P, Brook JS (2001) Prospective, longitudinal study of tic, obsessive–compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. J Am Acad Child Adolesc Psychiatry 40:685–695. doi:10.1097/00004583-200106000-00014

    Article  CAS  PubMed  Google Scholar 

  50. Leckman JF, Rauch SL, Mataix-Cols D (2007) Symptom dimensions in obsessive–compulsive disorder: implications for the DSM-V. CNS Spectr 12(376–87):400

    Google Scholar 

  51. Hasler G, LaSalle-Ricci VH, Ronquillo JG et al (2005) Obsessive–compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res 135:121–132. doi:10.1016/j.psychres.2005.03.003

    Article  PubMed  Google Scholar 

  52. American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, 4th edn. APA, Washington, DC

    Google Scholar 

  53. Kaufman J, Birmaher B, Brent D et al (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021

    Article  CAS  PubMed  Google Scholar 

  54. Ulloa RE, Ortiz S, Higuera F et al (2006) Interrater reliability of the Spanish version of schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL). Actas Esp Psiquiatr 34:36–40

    CAS  PubMed  Google Scholar 

  55. Obsessive–compulsive disorder: core interventions in the treatment… PubMed–NCBI. http://www.ncbi.nlm.nih.gov/pubmed/?term=Obsessive-compulsive+disorder%3A+core+interventions+in+the+treatment+of+obsessive-compulsive+disorder+and+body+dysmorphic+disorder

  56. Practice parameter for the assessment and treatment of children and adolescents with obsessive–compulsive disorder. J Am Acad Child Adolesc Psychiatry 51:98–113 (2012). doi:10.1016/j.jaac.2011.09.019

  57. de Hollingshead AB, Redlich FC (1958) Social class and mental illness: a community study. BOOK. doi:10.1111/j.1939-0025.1959.tb00180.x

    Google Scholar 

  58. Scahill L, Riddle MA, McSwiggin-Hardin M et al (1997) Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 36:844–852. doi:10.1097/00004583-199706000-00023

    Article  CAS  PubMed  Google Scholar 

  59. Leckman JF, Grice DE, Boardman J et al (1997) Symptoms of obsessive–compulsive disorder. Am J Psychiatry 154:911–917

    Article  CAS  PubMed  Google Scholar 

  60. Foa EB, Coles M, Huppert JD et al (2010) Development and validation of a child version of the obsessive compulsive inventory. Behav Ther 41:121–132. doi:10.1016/j.beth.2009.02.001

    Article  PubMed  Google Scholar 

  61. Kovacs M (1985) The children’s depression, inventory (CDI). Psychopharmacol Bull 21:995–998

    CAS  PubMed  Google Scholar 

  62. Birmaher B, Khetarpal S, Brent D et al (1997) The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry 36:545–553. doi:10.1097/00004583-199704000-00018

    Article  CAS  PubMed  Google Scholar 

  63. Mitchell KS, Wolf EJ, Reardon AF, Miller MW (2014) Association of eating disorder symptoms with internalizing and externalizing dimensions of psychopathology among men and women. Int J Eat Disord 47:860–869. doi:10.1002/eat.22300

    Article  PubMed  PubMed Central  Google Scholar 

  64. Sheehan DV, Lecrubier Y, Sheehan KH et al (1998) The Mini-International Neuropsychiatric Interview (M.I.N.I.): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry 59(Suppl 2):22–33 (quiz 34–57)

    PubMed  Google Scholar 

  65. Leonard HL, Swedo SE, Rapoport JL et al (1992) Tourette syndrome and obsessive–compulsive disorder. Adv Neurol 58:83–93

    CAS  PubMed  Google Scholar 

  66. Coskun M, Zoroglu S, Ozturk M (2012) Phenomenology, psychiatric comorbidity and family history in referred preschool children with obsessive–compulsive disorder. Child Adolesc Psychiatry Ment Health 6:36. doi:10.1186/1753-2000-6-36

    Article  PubMed  PubMed Central  Google Scholar 

  67. Hettema JM (2008) What is the genetic relationship between anxiety and depression? Am J Med Genet C Semin Med Genet 148C:140–146. doi:10.1002/ajmg.c.30171

    Article  PubMed  Google Scholar 

  68. Nestadt G, Di CZ, Riddle MA et al (2009) Obsessive–compulsive disorder: subclassification based on co-morbidity. Psychol Med 39:1491–1501. doi:10.1017/S0033291708004753

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Riddle MA, Scahill L, King R et al (1990) Obsessive compulsive disorder in children and adolescents: phenomenology and family history. J Am Acad Child Adolesc Psychiatry 29:766–772. doi:10.1097/00004583-199009000-00015

    Article  CAS  PubMed  Google Scholar 

  70. Geller DA, Biederman J, Faraone SV et al (2002) Attention-deficit/hyperactivity disorder in children and adolescents with obsessive–compulsive disorder: fact or artifact? J Am Acad Child Adolesc Psychiatry 41:52–58. doi:10.1097/00004583-200201000-00011

    Article  PubMed  Google Scholar 

  71. Walitza S, Zellmann H, Irblich B et al (2008) Children and adolescents with obsessive–compulsive disorder and comorbid attention-deficit/hyperactivity disorder: preliminary results of a prospective follow-up study. J Neural Transm 115:187–190. doi:10.1007/s00702-007-0841-2

    Article  CAS  PubMed  Google Scholar 

  72. Brem S, Grünblatt E, Drechsler R et al (2014) The neurobiological link between OCD and ADHD. Atten Defic Hyperact Disord 6:175–202. doi:10.1007/s12402-014-0146-x

    Article  PubMed  PubMed Central  Google Scholar 

  73. Palumbo D, Maughan A, Kurlan R (1997) Hypothesis III. Tourette syndrome is only one of several causes of a developmental basal ganglia syndrome. Arch Neurol 54:475–483

    Article  CAS  PubMed  Google Scholar 

  74. Piacentini J, Bergman RL, Keller M, McCracken J (2003) Functional impairment in children and adolescents with obsessive–compulsive disorder. J Child Adolesc Psychopharmacol 13(Suppl 1):S61–S69. doi:10.1089/104454603322126359

    Article  PubMed  Google Scholar 

  75. De Mathis MA, Diniz JB, Hounie AG et al (2013) Trajectory in obsessive–compulsive disorder comorbidities. Eur Neuropsychopharmacol 23:594–601. doi:10.1016/j.euroneuro.2012.08.006

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

This research was funded by the Marató-TV3 Foundation (Grant 091710). Dr. A. Ortiz has received a research grant from Hospital Clínic de Barcelona (HCB). The authors thank the Language Advisory Service of the University of Barcelona, Spain, for manuscript revision. Our special thanks go to the participating subjects and their families.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry and Psychology, Institute of Neurosciences, C/Villaroel 170, Hospital Clínic Universitari, Barcelona, 08036, Spain

    A. E. Ortiz, A. Morer, E. Moreno, M. T. Plana, C. Cordovilla & L. Lázaro

  2. Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain

    A. Morer & L. Lázaro

  3. Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Barcelona, Spain

    A. Morer & L. Lázaro

  4. CIBERSAM, Madrid, Spain

    L. Lázaro

Authors
  1. A. E. Ortiz
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. Morer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. E. Moreno
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. T. Plana
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. C. Cordovilla
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. L. Lázaro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. E. Ortiz.

Ethics declarations

Conflict of interest

No authors have any conflict of interest related to this study.

Ethical standards

All human studies have been approved by the ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ortiz, A.E., Morer, A., Moreno, E. et al. Clinical significance of psychiatric comorbidity in children and adolescents with obsessive–compulsive disorder: subtyping a complex disorder. Eur Arch Psychiatry Clin Neurosci 266, 199–208 (2016). https://doi.org/10.1007/s00406-015-0642-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00406-015-0642-9

Keywords

Search

Navigation