1Monash Institute of Cognitive and Clinical Neurosciences,School of Psychological Sciences,Monash University,Clayton,Victoria,Australia.
2Cognitive Neuroscience Unit,School of Psychology,Deakin University,Geelong,Victoria,Australia.
CNS Spectr. 2018 Feb;23(1):51-58. doi: 10.1017/S1092852917000244. Epub 2017 May 10.
We aimed to determine whether individuals with obsessive-compulsive disorder (OCD) and demographically matched healthy individuals can be clustered into distinct clinical subtypes based on dimensional measures of their self-reported compulsivity (OBQ-44 and IUS-12) and impulsivity (UPPS-P).
Participants (n=217) were 103 patients with a clinical diagnosis of OCD; 79 individuals from the community who were "OCD-likely" according to self-report (Obsessive-Compulsive Inventory-Revised scores equal or greater than 21); and 35 healthy controls. All data were collected between 2013 and 2015 using self-report measures that assessed different aspects of compulsivity and impulsivity. Principal component analysis revealed two components broadly representing an individual's level of compulsivity and impulsivity. Unsupervised clustering grouped participants into four subgroups, each representing one part of an orthogonal compulsive-impulsive phenotype.
Clustering converged to yield four subgroups: one group low on both compulsivity and impulsivity, comprised mostly of healthy controls and demonstrating the lowest OCD symptom severity; two groups showing roughly equal clinical severity, but with opposing drivers (i.e., high compulsivity and low impulsivity, and vice versa); and a final group high on both compulsivity and impulsivity and recording the highest clinical severity. Notably, the largest cluster of individuals with OCD was characterized by high impulsivity and low compulsivity. Our results suggest that both impulsivity and compulsivity mediate obsessive-compulsive symptomatology.
Individuals with OCD can be clustered into distinct subtypes based on measures of compulsivity and impulsivity, with the latter being found to be one of the more defining characteristics of the disorder. These dimensions may serve as viable and novel treatment targets.
本研究旨在基于患者报告的强迫症状严重程度（OBQ-44 和 IUS-12）和冲动性（UPPS-P）的维度测量，确定强迫症（OCD）患者和匹配的健康个体是否可以分为不同的临床亚型。
参与者（n=217）包括 103 名临床诊断为 OCD 的患者；79 名根据自我报告（强迫症清单修订版得分等于或大于 21）被认为是“OCD 倾向”的个体；以及 35 名健康对照者。所有数据均于 2013 年至 2015 年期间通过自我报告评估强迫症状和冲动性的不同方面收集。主成分分析揭示了两个广泛代表个体强迫性和冲动性水平的成分。无监督聚类将参与者分为四个亚组，每个亚组代表一种正交的强迫冲动表型的一部分。
聚类收敛到四个亚组：一个组在强迫性和冲动性方面均较低，主要由健康对照者组成，表现出最低的 OCD 症状严重程度；两个组表现出大致相等的临床严重程度，但驱动因素相反（即高强迫性和低冲动性，反之亦然）；最后一个组在强迫性和冲动性方面均较高，记录了最高的临床严重程度。值得注意的是，最大的 OCD 患者亚组的特征是高冲动性和低强迫性。我们的结果表明，冲动性和强迫性都可以介导强迫症的症状。
可以根据强迫性和冲动性的测量将 OCD 患者分为不同的亚型，后者被认为是该疾病的更具定义特征之一。这些维度可能是可行的、新颖的治疗靶点。
