Nestadt G, Samuels J, Riddle M, Bienvenu O J, Liang K Y, LaBuda M, Walkup J, Grados M, Hoehn-Saric R
Department of Psychiatry, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Arch Gen Psychiatry. 2000 Apr;57(4):358-63. doi: 10.1001/archpsyc.57.4.358.
The causes of obsessive-compulsive disorder (OCD) are as yet unknown. Evidence of familial aggregation is one approach for investigating the role of genetics in the etiology of this condition. The current study was conducted to determine ifOCD is familial and to investigate possible familial subtypes.
Eighty case probands were identified in 5 specialty OCD clinics and 73 community control probands were identified by random-digit dialing. These probands and their first-degree relatives (343 case and 300 control relatives) were blinded to group and evaluated by psychiatrists and doctoral-level clinical psychologists using semistructured instruments. Final diagnoses were assigned by a blinded-consensus procedure. The results were analyzed using logistic regression by the method of generalized estimating equations.
The lifetime prevalence of OCD was significantly higher in case compared with control relatives (11.7% vs 2.7%) (P<.001). Case relatives had higher rates of both obsessions and compulsions; however, this finding is more robust for obsessions. Age at onset of obsessive-compulsive symptoms in the case proband was strongly related to familiality (odds ratio, 0.92; confidence interval, 0.85-0.99) (P = .05); no case of OCD symptoms was detected in the relatives of probands whose age at onset of symptoms was 18 years or older. Probands with tics or obsessive-compulsive personality disorder were not more likely to have relatives with OCD than those without these features.
Obsessive-compulsive disorder is a familial disorder. Obsessions are more specific to the phenotype than are compulsions. Age at onset of OCD is valuable in characterizing a familial subtype.
强迫症（OCD）的病因尚不清楚。家族聚集性证据是研究遗传学在该疾病病因中作用的一种方法。本研究旨在确定强迫症是否具有家族性，并调查可能的家族亚型。
在5家专业强迫症诊所识别出80例病例先证者，并通过随机数字拨号识别出73例社区对照先证者。这些先证者及其一级亲属（343例病例亲属和300例对照亲属）对分组情况不知情，由精神科医生和博士水平的临床心理学家使用半结构化工具进行评估。最终诊断通过盲法共识程序确定。结果采用广义估计方程法通过逻辑回归进行分析。
病例亲属中强迫症的终生患病率显著高于对照亲属（11.7%对2.7%）（P<0.001）。病例亲属的强迫观念和强迫行为发生率均较高；然而，这一发现对于强迫观念更为显著。病例先证者强迫症状的发病年龄与家族性密切相关（优势比，0.92；置信区间，0.85 - 0.99）（P = 0.05）；症状发病年龄为18岁或以上的先证者亲属中未检测到强迫症病例。有抽动或强迫型人格障碍的先证者并不比没有这些特征的先证者更有可能有患强迫症的亲属。
强迫症是一种家族性疾病。强迫观念比强迫行为更具表型特异性。强迫症的发病年龄对于确定家族亚型很有价值。
