University of Milan, Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy.
University of Milan, Department of Mental Health, Department of Biomedical and Clinical Sciences Luigi Sacco, Milan, Italy; "Aldo Ravelli" Center for Neurotechnology and Brain Therapeutic, University of Milan, Milan, Italy.
J Psychiatr Res. 2024 Apr;172:1-8. doi: 10.1016/j.jpsychires.2024.02.009. Epub 2024 Feb 2.
Obsessive-compulsive disorder (OCD) is a prevalent and disabling condition characterized by a wide variety of phenotypic expressions. Several studies have reinforced the hypothesis of OCD heterogeneity by proposing subtypes based on predominant symptomatology, course, and comorbidities. Early-onset OCD (EO) could be considered a neurodevelopmental subtype of OCD, with evidence of distinct neurocircuits supporting disease progression. To deepen the heterogeneous nature of the disorder, we analyzed sociodemographic and clinical differences between the EO and late-onset (LO) subtypes in a large outpatient cohort.
Two hundred and eighty-four patients diagnosed with OCD were consecutively recruited from the OCD Tertiary Clinic at Luigi Sacco University Hospital in Milan. Sociodemographic and clinical variables were analyzed for the entire sample and compared between the two subgroups (EO, age <18 years [n = 117,41.2 %]; LO: late-onset, age ≥18 years [n = 167, 58.8 %]).
The EO group showed a higher frequency of male gender (65 % vs 42.5 %, p < .001), and a higher prevalence of Tic and Tourette disorders (9.4 % vs 0 %, p < .001) compared to the LO group. Additionally, in the EO subgroup, a longer duration of untreated illness was observed (9.01 ± 9.88 vs 4.81 ± 7.12; p < .001), along with a lower presence of insight (13.8 % vs. 7.5 %, p < .05).
The early-onset OCD subtype highlights a more severe clinical profile compared to the LO group. Exploring distinct manifestations and developmental trajectories of OCD can contribute to a better definition of homogeneous subtypes, useful for defining targeted therapeutic strategies for treatment.
强迫症（OCD）是一种普遍且使人丧失能力的疾病，其特征是表现出广泛的多种表型。几项研究通过基于主要症状、病程和共病提出亚型，从而加强了 OCD 异质性的假说。早发性 OCD（EO）可被视为 OCD 的神经发育亚型，有证据表明不同的神经回路支持疾病的进展。为了更深入地了解该疾病的异质性，我们在米兰 Luigi Sacco 大学医院的 OCD 三级诊所连续招募了 284 名被诊断为 OCD 的患者，并对整个样本进行了社会人口统计学和临床变量分析，并比较了两个亚组（EO，年龄<18 岁[n=117，41.2%]；LO：晚发性，年龄≥18 岁[n=167，58.8%]）之间的差异。
我们连续招募了 284 名在米兰 Luigi Sacco 大学医院 OCD 三级诊所就诊的强迫症患者。对所有患者进行社会人口统计学和临床变量分析，并比较两个亚组（EO，年龄<18 岁[n=117，41.2%]；LO：晚发性，年龄≥18 岁[n=167，58.8%]）之间的差异。
EO 组的男性比例（65% vs 42.5%，p<.001）和 Tic 和 Tourette 障碍的患病率（9.4% vs 0%，p<.001）均高于 LO 组。此外，EO 亚组未治疗的疾病持续时间更长（9.01±9.88 岁 vs 4.81±7.12 岁；p<.001），洞察力也更低（13.8% vs. 7.5%，p<.05）。
与 LO 组相比，早发性 OCD 亚型表现出更严重的临床特征。探索 OCD 的不同表现和发展轨迹有助于更好地定义同质亚型，这对于确定针对治疗的靶向治疗策略很有用。
