Elsevier

Biological Psychiatry

Volume 50, Issue 8, 15 October 2001, Pages 559-565
Biological Psychiatry

Original article
The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study

https://doi.org/10.1016/S0006-3223(01)01074-5Get rights and content

Abstract

Background: Obsessive-compulsive disorder (OCD) and tic disorders have phenomenological and familial-genetic overlaps. An OCD family study sample that excludes Tourette’s syndrome in probands is used to examine whether tic disorders are part of the familial phenotype of OCD.

Methods: Eighty case and 73 control probands and their first-degree relatives were examined by experienced clinicians using the Schedule for Affective Disorders and Schizophrenia-Lifetime Anxiety version. DSM-IV psychiatric diagnoses were ascertained by a best-estimate consensus procedure. The prevalence and severity of tic disorders, age-at-onset of OCD symptoms, and transmission of OCD and tic disorders by characteristics and type of proband (OCD + tic disorder, OCD − tic disorder) were examined in relatives.

Results: Case probands and case relatives had a greater lifetime prevalence of tic disorders compared to control subjects. Tic disorders spanning a wide severity range were seen in case relatives; only mild severity was seen in control relatives. Younger age-at-onset of OCD symptoms and possibly male gender in case probands were associated with increased tic disorders in relatives. Although relatives of OCD + tic disorder and OCD − tic disorder probands had similar prevalences of tic disorders, this result is not conclusive.

Conclusions: Tic disorders constitute an alternate expression of the familial OCD phenotype.

Introduction

Obsessive-compulsive disorder (OCD) and tic disorders have epidemiologic Apter et al 1993, Zohar et al 1992, family genetic Leckman and Chittenden 1990, Pauls et al 1986, Pauls et al 1995 and phenomenological George et al 1993, Leckman and Cohen 1999 bidirectional overlaps. An additional similarity is the early age-at-onset of both disorders (Nestadt et al 2000b, Pauls et al 1995 Singer et al 1991). In a previous family study of OCD, Pauls et al (1995) found a 4.6% prevalence of tics, specifically chronic tics and Tourette’s syndrome (TS), in OCD case relatives compared to 1.0% in control relatives; however, this study did not exclude severe tic disorders in probands, such as Tourette’s syndrome, making it difficult to draw conclusions regarding the familial OCD phenotype. In this article, the familial relationship between OCD and tic disorders is examined in an OCD family study sample that excludes probable and definite TS in probands.

Section snippets

Methods and materials

The Hopkins OCD Family Study methodology has been reported previously (Nestadt et al 2000b). Patients treated for OCD were recruited from five adult psychiatric clinics in Baltimore and Washington D.C. over a period of 3 years. A random sample was selected from a roster of patients attending the five clinics using a random number program. The protocol was approved by the Joint Committee on Clinical Investigation of the Johns Hopkins University School of Medicine. Of 98 subjects selected with

Frequency and severity of tic disorder

There were 5 case probands with positive lifetime tic disorders; all had DSM-III-R CMVT (6.5%). DSM-IV impairment criteria were not met for any tic disorder in case probands, but DSM-III-R criteria were met. None of the control probands had a tic disorder by DSM-III-R or DSM-IV criteria (0%) (Fischer’s exact test = 0.06, two-tailed; p = .04, one-tailed). Case probands had YGTSS tic severity scores (range, 0–50) of 6–12, with a median of 7. Four subjects had YGTSS scores of 6–8 (0–10: minimal

Discussion

Lifetime tic disorders are more frequent in OCD probands than in control probands, and in OCD case relatives compared to control relatives, confirming previous reports of the association of tic disorders and OCD. Further, the spectrum of severity of tic disorders was present only in case relatives (three cases of moderate-severe tic disorder by YGTSS; one transient tic disorder, and two cases of TS), but not in control relatives. First-degree relatives with OCD + tic disorder also have an

Acknowledgements

This research was supported by NIH Grants RO1 MH50214 and by NIH, NCRR, OPD-GCRC RR00052.

The authors wish to acknowledge Ms. Margaret Dees for her assistance in the research project.

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