Abstract
From the 1968–1983 Maudsley Hospital database of 5556 children and adolescents, 175 (3.1%) werechildren with obsessions, CWO (i. e. children of normal intelligence with obsessive-compulsive symptoms but without autism, psychosis, substance dependence, or personality or sexual deviance). Acontrolled case record study of a subgroup (100) of theseCWO showed that only 39 were given a diagnosis of OCD; the rest received co-morbid diagnoses. patients with co-morbid diagnoses resembled those with OCD on some clinical and psychosocial measures and, perhaps, should also be regarded as having OCD. Male to female ratio was 1.5∶1, no significant difference existed between the ages of boys and girls, andCWO experienced more time between discovery and presentation of symptoms than children with non-obsessional psychiatric disorders,controls. Suicidal ideation and resistance to compulsions were uncommon. Specific disorders of the basal ganglia and diffuse brain abnormalities were associated with obsessionality.CWO were more likely to come from social class I or II, and experience greater acute psychosocial, intra-familial, and treatment related stresses but not cognitive impairment thancontrols. Treatment outcome was frequently poor. Prospective studies are needed to extend these findings.
Résumé
De la cohorte du Maudsley Hospital 5556 enfants et adolescents suivis de 1968 à 1983, 175 (3,1%) étaient des enfants avec des obsessions CWO (i.e., enfants d'intelligence normale avec des symptômes obsessifs-compulsifs, mais sans autisme, psychose, toxicomanie, déviance sexuelle ou de la personnalité). Une étude contrôlée de cas du sousgroupe (100) de ces CWO a révélé que seuls 39 avaient un diagnostic de TOC; le reste avait un diagnostic de co-morbidité. Les patients avec des diagnostics de co-morbidité ressemblaient aux TOC sur certains paramètres cliniques et psychosociaux et, peut-être, pouvaient être considérés comme ayant un TOC. La ratio garçon-fille était de 1,5; il n'y avait pas de différence significative entre les âges des garçons et des filles et le temps entre l'apparition et la découverte des symptômes était plus long pour les CWO que pour un groupe contrôle avec des troubles psychiatriques non obsessionnels. Les idées de suicide et la résistance aux compulsions étaient inhabituelles. Des anomalies cérébrales diffuses étaient associées avec l'obsessionalité. Les CWO provenaient plutôt des classes sociales I et II et avaient vécu des stress aigus d'ordre psychosocial, familial et liés au traitement, plus importants que le groupe témoin, mais sans difficultés cognitives. Les résultats thérapeutiques étaient habituellement pauvres. Des études prospectives sont nécessaires pour approfondir et étendre ces résultats.
Zusammenfassung
175 (3,1%) der zwischen 1968 und 1983 dokumentierten 5556 Kinder und Jugendlichen des Maudsley-Krankenhauses waren Patienten mit Zwangsphänomenen (d. h. Kinder normaler Intelligenz mit Zwangsgedanken und- handlungen, aber ohne Autismus, Psychose, Drogenabhängigkeit, Persönlichkeitsstörung oder sexueller Devianz). Eine kontrollierte Fallstudie einer Untergruppe (100) dieser Patienten zeigte, daß nur 39 ausschließlich die Diagnose einer Zwangsstörung erhalten hatten. Der Rest erhielt komorbide Diagnosen. Die Patienten mit komorbiden Diagnosen ähnelten denen mit der alleinigen Diagnose einer Zwangsstörung im Hinblick auf einige klinische und psychosoziale Indikatoren und sollten u. U. ebenfalls als von einer Zwangsstörung Betroffene eingestuft werden. Das Geschlechterverhältnis betrug 1,5∶1 zugunsten der Knaben; es gab zwischen den beiden Geschlechtern keinen signifikanten Altersunterschied. Die Zeitspanne zwischen Entdeckung der Symptomatik und der Vorstellung war bei den Kindern mit Zwangsphänomenen länger als bei den Kontrollkindern, die andere psychiatrische Störungen aufwiesen. Suizidgedanken und Widerstand gegenüber Zwangshandlungen waren selten. Spezifische Störungen der Basalganglien und diffuse Hirnstörungen waren mit der Zwangssymptomatik assoziiert. Patienten mit Zwangsphänomenen kamen eher aus den sozialen Schichten I und II. Sie erlebten größere akute psychosoziale, intrafamiliäre und behandlungsbedingte Stressoren als die Kontrollkinder, wohingegen die kognitive Beeinträchtigung nicht die der Kontrollgruppe überstieg. Der Behandlungserfolg war häufig schlecht. Prospektive Studien werden benötigt, um diese Befunde weiter auszubauen und zu erklären.
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Johnson, B.A. The Maudsley's obsessional children: phenomenology, classification, and associated neurobiological and co-morbid features. European Child & Adolescent Psychiatry 2, 192–204 (1993). https://doi.org/10.1007/BF02098578
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DOI: https://doi.org/10.1007/BF02098578