Early onset obsessive–compulsive disorder: the biological and clinical phenotype

Abstract

Moving from a behavioral-based to a biological-based classification of mental disorders is a crucial step toward a precision-medicine approach in psychiatry. In the last decade, a big effort has been made in order to stratify genetic, immunological, neurobiological, cognitive, and clinical profiles of patients. Making the case of obsessive–compulsive disorder (OCD), a lot have been made in this direction. Indeed, while the Diagnostic and Statistical Manual of Mental Disorders (DSM) diagnosis of OCD aimed to delineate a homogeneous group of patients, it is now clear that OCD is instead an heterogeneous disorders both in terms of neural networks, immunological, genetic, and clinical profiles. In this view, a convergent amount of literature, in the last years, indicated that OCD patients with an early age at onset seem to have a specific clinical and biological profile, suggesting it as a neurodevelopmental disorder. Also, these patients tend to have a worse outcome respect to adult-onset patients and there is growing evidence that early-interventions could potentially improve their prognosis. Therefore, the aim of the present paper is to review the current available genetic, immunological, neurobiological, cognitive, and clinical data in favor of a more biologically precise subtype of OCD: the early-onset subtype. We also briefly resume current available recommendations for the clinical management of this specific population.

Exploring Association Between Serotonin and Neurogenesis Related Genes in Obsessive-Compulsive Disorder in Chinese Han People: Promising Association Between DMRT2, miR-30a-5p, and Early-Onset Patients

“…Though serotonin disturbance is the most studied etiological theory in OCD, serotonin-related genes may cooperate with other neurotransmitter-related genes. Clinically, EO-OCD patients were thought to be less responsive to serotonin reuptake inhibitor therapy, requiring an augmentation treatment with antipsychotics (6). Neuroimaging data about serotonin transporter availability also suggested less serotonergic pathology in EO-OCD than LO-OCD (64), indicating more exploration from other perspectives.…”

“…After stratified analysis by age of onset, some clearer clues appeared. Early-onset OCD (EO-OCD), as a putative subtype of OCD, is increasingly regarded to have unique biological characteristics (6). Given its higher heritability and distinct comorbidity patterns, EO-OCD was more suggested to be a neurodevelopmental disorder caused by the perturbation in neurodevelopment processes than late-onset OCD (LO-OCD) (7).…”

Phenotypic Impact of Rare Potentially Damaging Copy Number Variation in Obsessive-Compulsive Disorder and Chronic Tic Disorders

“…Research suggests that patients with childhood-onset OCD have different clinical and biological profiles than those with adult-onset OCD, and that childhood-onset OCD is associated with less favorable clinical outcomes [ 8 ]. There is also evidence of a further increased familial risk associated with childhood-onset OCD; analysis from childhood-onset samples estimates heritability of OCD to be around 45–61% for obsessive-compulsive symptoms [ 9 ], compared to heritability estimates of around 30–40% for adults [ 9 , 10 , 11 ].…”

Visuomotor Activation of Inhibition-Processing in Pediatric Obsessive Compulsive Disorder: A Magnetoencephalography Study

“…The lifetime prevalence of the disorder is 2.3% in the general population and it affects up to 2% of children and youth ( 3 , 4 ). The average age of onset for pediatric OCD is 11 years of age ( 5 – 7 ). Earlier symptom onset has been associated with increased illness severity and persistence ( 8 ).…”