Variation in obsessive-compulsive symptoms between children and adults

The complexity and diversity of clinical manifestations of obsessive-compulsive disorder have intrigued psychiatrists for a long time. Various differences have been noted in the presentation of obsessive-compulsive disorder of different age group. It was aimed to assess the variations of presentation of symptoms in children and adults in a tertiary level hospital. This study was done in an outpatient department from May 2015 to April 2017. Four hundred patients were included in the study consecutively after considering the inclusion and exclusion criteria. Respondents were interviewed with a semi-structured questionnaire which includes demographic variables, psychiatric diagnoses (DSM-IV-TR) and Y-BOCS symptom checklist. Obsessive-compulsive disorder started before adulthood in 41.5% of patients and onset after 18 years was found to be 58.5%. In this study, cases of obsessions, dirt and contamination was seen to predominate in both early- and late-onset obsessive compulsive disorder (68.3 and 71.4% respectively) and among the cases of compulsions, cleaning variety was found to be highest in both early- and late-onset (65.8 and 73.3% respectively). Age should be taken into account when evaluating obsessive compulsive disorder patients. The results suggest that more studies are necessary to determine whether in fact, it defines a homogeneous and particular group in obsessive-compulsive disorder.


Introduction
Obsessive-compulsive disorder is a chronic debilitating psychiatric disorder, which affects about 1-3% of the population worldwide.2][3][4][5] Epidemiological studies conducted in several countries reported the current prevalence around 1% and lifetime prevalence ranging from 2 to 3%. 3,4 hese figures make obsessivecompulsive the fourth most common psychiatric diagnosis after phobias, substance-related disorder and major depressive disorder.Epidemiological studies in Europe, Asia and Africa have confirmed these rates across the cultural boundaries. 6sessive-compulsive symptoms are remarkably diverse, and the clinical presentation can vary significantly. 7The age at onset of obsessive -compulsive disorder is an important factor in subtyping it.Early onset is associated with the predominance of symmetry/exactness and religious obsessions, and hoarding, repeating, counting and tapping kind of compulsions; a higher frequency of compulsions not preceded by obsessions; a higher frequency of sensory phenomena; and greater severity of obsessivecompulsive disorder symptoms along with a chronic course. 8-13Presentation of symptoms can vary due to the age of the patient and different developmental phases.Previous studies that compared early-and late-onset obsessive-compulsive disorder had relatively smaller sample sizes. 9, 10, 14A large sample in this study would not only confirm the findings of previous studies but also help examine crosscultural similarities and differences if any.Authors aimed to assess the variations of obsessive-compulsive disorder symptom presentation in children and adults in a referral level hospital in Dhaka city.

Cite this arti le:
Algi S, Arafat SMY, Kushal SA, Ah ed SN, Saji MWH.Variatio i o sessi eo pulsi e sy pto s et ee hildre a d adults.Ba ga a dhu Sheikh Muji Med U i J.

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The opyright of this arti le is retai ed y the author s [Atri utio CC-By .] A aila le at: .a glajol.ifo

Results
The result showed that, out of 400 patients with obsessive-compulsive disorder, 58.8% were males and 41.5% were females.The onset of obsessivecompulsive disorder before adulthood (18 years) was found in 41.5% of patients and onset after 18 years was found to be 58.5%.Among the clinical variables, the onset before 18 years was more in males (45.5%) than females (35.8%).
In this study cases of obsessions, dirt and contamination were seen to predominate in both early-and late-onset obsessive-compulsive disorder (68.3 and 71.4% respectively).This was followed by religious and sexual obsession in both early-and late-onset obsessive-compulsive disorder (Table I).
Among the cases of compulsions, cleaning variety was found to be highest in both early-and lateonset (65.8 and 73.3% respectively).This was followed by compulsion in the form of checking and orderliness in both early-and late-onset obsessive-compulsive disorder.Dirt and contamination were found to be highest among the age group 31-40 years, religious obsession in 31-40 years and sexual obsession in 41-50 year age group (Table I).

Discussion
In our study, obsessive-compulsive disorder started before 18 years among 41.5% of patients and onset after 18 years was found to be 58.5%.It was also found in our study that, age of onset of male patients was early.
Among the distributions of these two studies differences in the distribution of obsessivecompulsive disorder symptoms were noticed in the child and adolescent age group.Whenever possible, a family member was consulted about the age of obsessive-compulsive disorder onset in order to reduce the recall bias.Moreover, all patients were ascertained through specialized obsessive-compulsive disorder clinic, and they could be more likely to have comorbid conditions or more severe forms of obsessive-compulsive disorder.Therefore, the current findings may not apply to obsessive-compulsive disorder patients who are not in treatment (community samples) and it is also unclear how generalizable are our findings to other countries and cultures.

Conclusion
Dirt and contamination were seen as prominent obsessions in both age groups of obsessive-compulsive disorder patients with few variations.Similarly cleaning variety was found to be highest in the age groups with slight variation in percentages.Age is a relevant factor that should be taken into account when evaluating obsessive-compulsive disorder patients to determine the clinical presentation and course, and may be considered to define more homogeneous subgroups.

adults Sultana Algin, S. M. Yasir Arafat, Sayedul Ashraf Kushal, Sumaiya Nausheen Ahmed and Mohammad Waliul Hasnat Sajib
nic brain syndrome, mental retardation and acute substance withdrawal.Face-to-face interview was conducted with a semistructured questionnaire which includes demographic variables, psychiatric diagnoses (DSM-IV-TR) and Y-BOCS symptom checklist.The age of onset of obsessive-compulsive disorder was defined as the earliest age that the patient remembered having obsessive-compulsive disorder.Whenever possible, a family member was also interviewed to confirm the patients' information about age of symptom onset.Statistical analysisData were processed and analyzed by Statistical Package for Social Science (SPSS) version 16 and Microsoft Excel 2007.