Early recognition of obsessive-compulsive disorder.

The early course in clinical and neurobiological terms of obsessive-compulsive disorder (OCD) is almost completely unknown. The disease often begins in early childhood and adolescence, but the first behavioral changes and symptoms preceding OCD have not been assessed to date. In this retrospective approach, 40 patients with OCD (23 females/17 males; 39.4 [10.1] years old in average; with scores on the Yale-Brown Obsessive-Compulsive Scale [Y-BOCS] of 19 [9.3]) were given an author-developed questionnaire. Twenty-three patients reported first changes before having reached the age of 20 years. Rather unspecific symptoms such as "anxiety" and "lacking self-trust" seem to have been more frequent as first signs of developing OCD. Further specific symptoms indicating OCD were "enhanced feeling of responsibility," "exact attention concerning details," "being eager for order and cleanness," "difficulties with decisions," and "repetitive controlling," but were less remembered. There was no significant relationship between these first changes and later OCD-related psychopathology as measured with the Y-BOCS, but there was a relationship with later depressive comorbidity (Hamilton Depression Rating Scale). This substantiates the view that OCD-similar to other psychiatric disorders such as schizophrenia and bipolar disorder-seems to be characterized by a psychopathologically less specific prodrome with rather depressive symptoms. However, this was a retrospective study with preliminary data, which has to be replicated prospectively with a larger sample.