In community surveys, the results are mixed. The Epidemiological Catchment Area survey ECA , which utilized lay interviewers trained non-professionals to examine more than 18, individuals in five cities reported a similar mean age of onset for men and women identified as OCD cases A similar study in Edmonton, Canada reported a slightly later median age of onset for males age 20 years than females age 19 years. Among 56 individuals in their mids with obsessive-compulsive syndrome identified in a Zurich survey, the mean age of onset was 17 years for males and 19 years for females.
For most adult patients who come to treatment, OCD appears to be a chronic condition. An Italian series by Lensi et al. The conclusions drawn from studies that predate current diagnostic criteria, effective treatments and current patterns of health care utilization should not be applied to today's patients.
The prognosis of children and adolescents who present for treatment appears to be good for half or more. Leonard et al. A 9 -to 14 -year follow-up study reported that 8 of 14 adolescents who had received medication treatment were medication free and did not meet OCD criteria; the other six had experienced a chronic, or a relapsing and then chronic course, reported Bolton, Luckie and Steinberg in Finally, Thomsen and Mikkelsen reported in that a 1. Larger studies from multiple sites are needed to establish accurately the prognosis associated with modern treatment methods.
In community-identified cases, remission, or a course marked by long, symptom-free periods, seems to be the rule. The apparent frequency of this benign course is probably due to the limited diagnostic validity of interviews conducted by lay interviewers and to the large proportion of milder cases in community sample. Patients with OCD are at high risk of having comorbid co-existing major depression and other anxiety disorders.
In Koran et al. On the other hand, hallucinations reappeared and increased progressively from Eighteen months after discharge, he complained of growing anxiety and fluctuating mood.
He also reported that he was not sure whether he was in the real world or was abused by an hallucination. Two years after discharge, the patient was hospitalized with acute pneumonia from which he deceased.
These symptoms appeared shortly at age of 60 years after his family was financially ruined when his firm underwent fraudulent bankruptcy. Thirty years ago, the patient consulted a psychiatrist for anxiety—fearing that he might lose one of his children. There was no other history of psychiatric illness. A few weeks after the bankruptcy and the early obsessive thoughts followed several other symptoms:. He consulted several psychiatrists, with no improvement in symptoms, followed EMDR sessions, consulted a hypnotherapist, and took several SSRI drugs with poor treatment adherence and no benefit.
Gastrointestinal endoscopy was normal. During this one-month stay, the patient's obsession with saliva was considered a delusional symptom. Introduction of paroxetine led to a transient improvement of depression, with no effects on compulsions. Depressive symptoms resumed and additional phobias appeared: fears of water and razors, fear of suffocation. He returned to our psychiatry unit at age 69 years.
Upon admission, he demonstrated anhedonia, negligence, attentional disorder, sleep problems, and morbid thoughts. He suffered from insomnia and fell asleep while seated in a chair, because he feared suffocating while in bed. He fractioned his oral intake into five meals a day. His subjects of conversation were focused on his saliva consistency and swallowing.
Medications were reduced to sertraline mg and olanzapine 7. The diagnosis of DLB was evoked. Blood samples and EKG were normal. Neuropsychological assessment at that time showed:. A brain MRI scan showed cortico-subcortical atrophy and microbleeds. A DaT-scan Figure 2 showed a bilateral presynaptic dopaminergic denervation. SPECT showed a bilateral striatal fixation decrease, centered on the putamen.
Patient 2 was no longer able to do normal social and occupational functions. He did not see his friends anymore. As early as , impaired figure copying overlapping pentagons was observed, as well as troubles in clock drawing. Neuropsychological testing run in our unit showed deficiencies in tests of visuospatial and visuoperceptual ability.
Also, patient 2 presented 1 core clinical feature recurrent visual hallucinations , two supportive clinical features severe sensitivity to antipsychotic agents and depression , one indicative biomarker reduced dopamine transporter uptake in basal ganglia by SPECT and one supportive biomarker relative preservation of medial temporal lobe structures on MRI scan 9.
Here, RBD was suspected, since the patient's wife reported restless nights, during which the patient was agitated. However, we do not have any confirmatory tests for RBD in the medical records.
Cholinergic treatment was initiated with 9. The mood status of the patient greatly improved. Sleep was normalized, even if early awakenings sometimes persisted. Eating behavior improved. Appetite remained modest but was improved compared to the beginning of his hospitalization. Compulsive spitting persisted, but became less frequent, especially when the patient's attention was focused elsewhere. He was discharged after 6 months of stay with levodopa Six months after discharge, he was brought to the emergency room by neighbors because of asthenia, self-neglect, and lack of home maintenance.
Indeed, once alone at home, he was not carrying out the activities of daily life. He did not shop for food, could not complete everyday tasks, such as bathing, dressing appropriately, and preparing simple meals.
Examination on admission revealed that he had stopped taking his medications, was time-disoriented, and had visual hallucinations. After a short stay, he agreed to resume his drug treatment. Home help was debuted to ensure that he was taking his medication on a daily basis, and to provide assistance with bathing, as he tended to neglect self-hygiene otherwise.
Patient 2 remained stable and well as long as he was under the care of home nurses. Some feeling of dysphagia persisted. The last follow-up was at age 72 years: the patient remains concerned about saliva but does not have expectorating rituals anymore. DLB symptoms remain stable. We have described two cases of treatment-resistant and late-onset OCD i. The specific treatment of DLB allowed a partial improvement of obsessive-compulsive symptoms.
Based on the observation of these cases, we suggest a possible link between these two disorders, through the following hypotheses. However, we have only observed a small number of cases, and this question needs to be further assessed in patients with late-onset OCD.
They both had psychiatric family history or clinical history. In a large case series, Weiss et al. Other reports have described cases in which dementia appeared several years after a diagnosis of late-onset OCD 12 , Neural basis might originally have an affinity for occurrence of psychiatric symptoms. Treating patients suffering late-onset psychiatric symptoms by cholinesterase inhibitors could still be discussed, even if they do not fulfill the criteria for DLB. Indeed, a decrease of cholinergic interneurons has been observed in OCD patients' striatum In a recent study, suppression of cholinergic interneurons in rats striatum led to the development of repeated ritualized behavior Several reports have pointed out the possible role of cholinergic disturbance in neuropsychiatric manifestations of dementia 16 , It appears that acetylcholinesterase inhibitors have psychotropic effects and might play a beneficial role in controlling behavioral and psychological symptoms of dementia BPSD such as agitation, apathy, and psychosis Here we suggest exploring these effects to OCD symptoms in future studies.
The main difference between stereotypies and OCD lies in the function of the symptom: relief of distress caused by the obsessive fears for OCD, automaticity without goal for stereotypies.
DLB is associated with fronto-striatal lesions. However, Moheb et al. In contrast, it was possible to discuss the obsessions underlying their compulsions with our patients, and they explained their compulsive behavior by trying to reduce their anxiety.
Further, in fronto-temporal dementia, repetitive behaviors are often associated with disinhibition—especially in social domain 20 , which we never observed in our patients. Impulse Control Disorder could also be evoked as a differential diagnosis. This syndrome shares clinical features with OCD, namely « difficulties resisting the urge to engage in specific behaviors that interfere with functioning » The underlying question is the distinction between impulsivity and compulsivity.
Impulsive behaviors are often comorbid with cluster B personality disorders Further, while compulsivity leads to accomplish an unpleasant ritual in an attempt to alleviate anxiety, impulsivity is generally driven by the desire to obtain pleasure None of our patients had a B-type personality, although we did not use structured clinical interview to assess personality traits or disorders. In both cases, the rituals did not provide any pleasure but relieved negative affect. In our two cases, clinical diagnosis of depressive disorder with delusion could be considered, given the high frequency of somatic delusion in elderly depressed patients.
Late-onset depression often occurs in a context of disability, cognitive dysfunction, and psychosocial adversity Prior to appearance of OCD symptoms, patient 1 had difficulties in his professional activities, and patient 2 faced a dismal professional situation impacting his family. In addition, the depressive symptoms observed in the two patients could be explained as a reaction to a perceived cognitive decline Depression among elderly patients is also known to feature different symptoms than in middle-aged patients, typically including more somatic symptoms 26 , From this viewpoint, the herein described obsessions about gastrointestinal transit and saliva, with consecutive compulsions, could be the consequence of severe depressive episodes among our patients.
However, we think that this interpretation is unlikely, since OCD is rarely observed in late-life depression In a series of elderly MDD patients, only 0. In addition, both patients had obsessions and compulsions long before the first depressive symptoms appeared. McKeith et al. While late-onset major depressive disorder and late-onset psychosis are the most frequently reported presentations in these cases, OCD were not mentioned in this previous review.
Select basic ads. Create a personalised ads profile. Select personalised ads. Apply market research to generate audience insights. Measure content performance. Develop and improve products. List of Partners vendors. Although symptoms of obsessive-compulsive disorder OCD can begin at almost any age, research suggests that there are two distinct periods when OCD symptoms are most likely to appear. Studies differ on the exact age of onset, but generally speaking, the first period occurs during late childhood or early adolescence and the second occurs in the late teens to early 20s.
Interestingly, there may be distinct differences in the symptoms, responses to treatment , overlapping illnesses, brain structure, and thinking patterns of people with early- versus late-onset OCD. One of the biggest differences between early-onset and late-onset OCD is the ratio of males to females.
Studies have consistently found that males are much more likely to develop early-onset OCD than females. It has also been noted that the earlier OCD symptoms appear, the more severe they are. Some research suggests too that the earlier you develop OCD symptoms, the more difficult they can be to treat with both psychological and medical treatments.
However, a study that examined over children with either early-onset OCD before 10 years of age and late-onset OCD 10 years of age or older found that while there were differences in the symptoms between these two types of OCD, there was no difference in the children's response to treatment. It looks like the jury is still out when it comes to treatment response and symptom severity in early-onset versus late-onset obsessive-compulsive disorder.
More research is needed on the topic. Another difference is that people with early-onset OCD often have a gradual appearance of symptoms, whereas people who develop OCD later in life tend to have symptoms that come on quickly since they are usually tied to some sort of trigger, like a stressful life event such as the death of a loved one, loss of a job, or failing out of school.
An exception to this rule is pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections PANDAS , an autoimmune form of OCD that affects only children and in which symptoms appear very quickly. Obsessive-compulsive disorder often occurs with other illnesses, which are called comorbid illnesses.
The brains of people with early-onset versus late-onset OCD may be different from one another as well. Studies have demonstrated that people with late-onset OCD have different patterns of neuropsychological deficits that those with early-onset OCD. It is not yet clear why this is the case and whether this has any impact on treatment.
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