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Obsessive-compulsive disorder in children and adolescents. A review of the literature

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Abstract

The literature on obsessive-compulsive disorder (OCD) in children and adolescents is reviewed. On the basis of the epidemiological data it is concluded that OCD is far more common among children and adolescents than was previously believed. However, good epidemiological studies in other parts of the world than the US are still needed. Follow-up studies of the course of OCD with a childhood onset are still very few in number. Recent studies show that OCD is a disabling disorder for many of the patients, also in adult life, but that a considerable proportion of the patients seems to “recover” from their obsessions and compulsions in adulthood. There are indications that treatment response in childhood, parental psychopathology, and severity of the OCD migh predict the outcome. The biological aspects of OCD are reviewed. The serotonin transmitter system seems to be involved in the pathogenesis of adult as well as childhood OCD. Additionally, most studies demonstrate a high degree of neuropsychological and neurological deficits in children with OCD. Comorbidity in childhood, and the concept of OCD spectrum disorders are presented. Childhood OCD seems to be associated with depression, eating disorders, anxiety disorders, and empathy disorder, whereas there seems to be no convincing relation between OCD and schizophrenia.

Résumé

La littérature concernant les troubles obsessifs compulsifs (TOC) chez les enfants et les adolescents est passée en revue. Sur la base de données épidémiologiques, il est conclu que les TOC sont plus communs chez les enfants et les adolescents qu’on le pensait précédemment. Cependant de bonnes études épidémiologiques en dehors des USA sont encore nécessaires. Les études sur le devenir des TOC avec début dans l’enfance sont encore très peu nombreuses. Des études récentes montrent que les TOC sont un trouble handicapant pour beaucoup de ces patients, également dans leur vie adulte, mais qu’une proportion considérable de ces patients semblent “guérir” de leurs obsessions et compulsions à l’âge adulte. Il existe des incides que la réponse au traitement dans l’enfance, la psychopathologie parentale, et la sévérité des TOC puissent prédire le devenir. Le aspects biologiques des TOC sont passer en revue. Le système transmetteur sérotinergique semble impliqué dans la pathogénèse des TOC de l’adulte comme de l’enfant. De plus la plupart des études montre un degré élevé de déficits non neuropsychologiques et neurologiques chez les enfants avec TOC. La comorbidité dans l’enfance et le concept du spectre de TOC sont présentés. Les TOC de l’enfance semblent associés avec la dépression, les troubles du comportement alimentaire, les troubles anxieux, les troubles de l’empathie, tandis qu’il ne semble pas exister de relation pubertaire entre TOC et schizophrénie.

Zusammenfassung

Die Literatur zu Zwangsstörungen im Kindes- und Jugendalter wird zusammengefaßt. Anhand der epidemiologischen Daten wird gefolgert, daß Zwangsstörungen weitaus häufiger bei Kindern und Jugendlichen sind, als früher angenommen wurde. Jedoch werden weiterhin gute epidemiologische Studien außerhalb der Vereinigten Staaten benötigt. Es existieren bislang nur wenige Katamnesestudien zu Zwangsstörungen mit Beginn im Kindesalter. Neuere Untersuchungen zeigen, daß Zwangsstörungen mit einer schweren Beeinträchtigung für die Patienten—auch im Erwachsenenalter—einhergehen. Ein beträchtlicher Teil der Patienten scheint sich jedoch von ihren Zwangsgedanken und Zwangshandlungen im Erwachsenenalter zu “erholen”. Es gibt Hinweise dafür, daß das Ansprechen auf die Behandlung im Kindesalter, die elterliche Psychopathologie und der Schweregrad der Zwangsstörung von prognostischer Bedeutung sind. Biologische Aspekte zu Zwangsstörungen werden übersichtlich dargestellt. Das Serotonin-Transmittersystem scheint in der Pathogenese von Zwangsstörungen sowohl bei Erwachsenen als auch bei Kindern beteiligt zu sein. Zusätzlich weisen viele Studien einen hohen Grad an neuropsychologischen und neurologischen Auffälligkeiten bei Kindern mit Zwangsstörungen nach. Die Komorbidität und das Spektrumskonzept zu Zwangsstörungen werden vorgestellt. Zwangsstörungen im Kindesalter scheinen mit Depressionen, Eßstörungen, Angststörungen und Empathiestörungen assoziiert zu sein. Es gibt jedoch keine überzeugende Beziehung zwischen Zwangsstörungen und Schizophrenie.

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    Per Hove Thomsen

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Thomsen, P.H. Obsessive-compulsive disorder in children and adolescents. A review of the literature. European Child & Adolescent Psychiatry 3, 138–158 (1994). https://doi.org/10.1007/BF02720322

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