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It has been suggested that maladaptive metacognition (beliefs and strategies) is related to the development and maintenance of obsessive-compulsive disorder (OCD). The aims of the study were to explore whether subgroups of pediatric OCD patients could be identified based on self-reported generic metacognition, and to compare these potential subgroups with a non-clinical control group. Additionally, differences between subgroups were examined across demographic (age and sex) and clinical characteristics (OCD severity and insight, types of OCD symptoms, and co-occurring symptoms). The study included a pooled sample of 157 pediatric OCD patients (age 7–18 years) and 58 non-clinical controls. Latent profile analyses supported a model with three profiles characterized by low, moderate, and high levels of maladaptive metacognition relative to the control group. Children and adolescents with higher age, greater OCD severity, specific OCD symptoms (e.g., aggressive, sexual, somatic, religious, and self-rated obsessing symptoms), and/or co-occurring internalizing symptoms (including anxiety and depressive symptoms) had a higher probability of belonging to a group with higher levels of maladaptive metacognition. The emergent profiles indicate heterogeneity in metacognition and clinical expression among children and adolescents with OCD, suggesting that generic metacognition could be a possible treatment target for some of these patients.

Knowledge on adverse events in psychotherapy for youth with OCD is sparse. No official guidelines exist for defining or monitoring adverse events in psychotherapy. Recent recommendations call for more qualitative and quantitative assessment of adverse events in psychotherapy trials. This mixed methods study aims to expand knowledge on adverse events in psychotherapy for youth with OCD.

Research on functional impairment in obsessive–compulsive disorder (OCD) based on standardized measurement lags behind compared to its prominence in diagnostic classification systems. Our aim was to evaluate the psychometric properties of the Child Obsessive Compulsive Impact Scale – Revised (COIS-R), which is a measure of OCD-related functional impairment. The sample consisted of 396 Danish, Swedish, and Norwegian youth diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (48.9% boys; mean age 12.9, SD=2.7). We used confirmatory factor analysis to evaluate the initial four-factor structure of the parent-reported measure (Daily Living Skills, School, Social, Family/Activities) and the three-factor structure of the child-reported measure (School, Social, Activities). We used the robust weighted least squares mean- and variance-adjusted estimator as applied in the MPLUS program (version 7.2). The parent-report format showed acceptable fit and the structure was equivalent across gender, age, and country. The child-report format showed poor fit and equivalent results across gender, age, and country. These findings indicate that the fit for the COIS-R original factor structure was acceptable for the parent-report but not for the child-report. The measure would benefit from revisions such as split sample procedure factor analyses with a large cross-cultural sample.

Hypochondriasis, now often designated as health anxiety, is important in terms of prevalence, levels of suffering, and health services cost in adults. Whereas the DSM-IV-TR suggests that the condition primarily begins in adulthood, retrospective reports point to a possible origin in childhood with onset as early as preschool age. However, little research has addressed health anxiety in children. In the present study we explored parental-reported health anxiety symptoms (HAS) and their association with physical and mental health in a population-based sample of 5- to 7-year-old children.

The etiologies of autism spectrum disorder and many neurodevelopmental disorders are largely unknown. The detection of a seasonal variation of birth of children diagnosed with a certain disorder could suggest etiological factors that follow a seasonal pattern. We examined the seasonal variation of births of children diagnosed with any of 4 common childhood neuropsychiatric disorders: autism spectrum disorder, hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder.

OBJECTIVES To examine trends in autism (autism spectrum disorder and childhood autism) in the context of 3 additional childhood neuropsychiatric disorders: hyperkinetic disorder, Tourette syndrome, and obsessive-compulsive disorder. DESIGN Population-based cohort study. SETTING Children were identified in the Danish Medical Birth Registry. Relevant outcomes were obtained via linkage with the Danish National Psychiatric Register, which included reported diagnoses through 2004 by psychiatrists using diagnostic criteria from the International Statistical Classification of Diseases, 10th Revision. PARTICIPANTS All children born in Denmark from 1990 through 1999, a total of 669 995 children. MAIN OUTCOME MEASURES Cumulative incidence proportion by age, stratified by year of birth, for each disorder. RESULTS Statistically significant increases were found in cumulative incidence across specific birth years for autism spectrum disorder, childhood autism, hyperkinetic disorder, and Tourette syndrome. No significant change in cumulative incidence was observed for obsessive-compulsive disorder. CONCLUSIONS Recent increases in reported autism diagnoses might not be unique among childhood neuropsychiatric disorders and might be part of a more widespread epidemiologic phenomenon. The reasons for the observed common pattern of change in reported cumulative incidence could not be determined in this study, but the data underscore the growing awareness of and demand for services for children with neurodevelopmental disorders in general.--

In a European, multicenter, double-blind study, 244 adolescents, 13 to 18 years old, with major depression were randomized to treatment with citalopram (n = 124) or placebo (n = 120). One third of the patients in both groups withdrew from the study. No significant differences in improvement of scores from baseline to week 12 between citalopram and placebo were found. The response rate was 59% to 61% in both groups according to the Schedule for Affective Disorders and Schizophrenia for school-aged children-Present episode version (Kiddie-SADS-P) (depression and anhedonia scores ≤2) and Montgomery Åsberg Depression Rating Scale (MADRS) (≥50% reduction). Remission (MADRS score ≤12) was achieved by 51% of patients with citalopram and 53% with placebo. A post hoc analysis revealed that more than two thirds of all patients received psychotherapy during this study. For those patients not receiving psychotherapy, there was a higher percentage of Kiddie-SADS-P responders with citalopram (41%) versus placebo (25%) and a significantly higher percentage of MADRS responders and remitters with citalopram (52% and 45%, respectively) versus placebo (22% and 19%, respectively). Mild to moderate treatment-emergent adverse events were reported in 75% citalopram and 71% of placebo patients, most commonly headache, nausea, and insomnia. Serious adverse events occurred in 14% to 15% in both groups. Suicide attempts, including suicidal thoughts and tendencies, were reported by 5 patients in the placebo group and by 14 patients in the citalopram group (not significant) with no pattern with respect to duration of treatment, time of onset, or dosage. In contrast, the suicidal ideation (Kiddie-SADS-P) single item showed worsening more frequently in the placebo (18%) than in the citalopram group (8%).

Obsessive–compulsive disorder is a far from rare neuropsychiatric disorder in children and adolescents which affects approximately 1–1.5% of the pediatric population. Obsessive–compulsive disorder is defined by the presence of obsessions and/or compulsions. It often takes a chronic course with either persistent, constantly distressing obsessive–compulsive symptoms or a waxing and waning course. The best documented and most efficient treatment is cognitive behavioural therapy and antidepressant medication with serotonin specific agents. In most cases, an improvement rate of 20–50% is reported following medication alone.

Obsessive-compulsive disorder (OCD) is now recognized as a frequent and disabling disorder among children and adolescents. The phenomenology is similar to adult OCD, but several reports have indicated that compulsions are more prominent in children and that children are more inclined than adults to include their family surroundings in ritualistic behavior. It is also clear that young children engage in a significant amount of repetitive, ritualistic compulsive activity that appears to be a normal part of their behavioral repertoire.Although the cause of childhood-onset OCD is unknown, many factors are likely to contribute to the heterogenous clinical phenotypes, including both genetic and environmental factors. The neurobiological circuitry involved in childhood-onset OCD is likely to involve alterations to the same cortico-striatothalamic circuitry implicated in adult OCD, but the develop-mental differences have yet to be fully delineated. The treatment response patterns of adults and children are generally inconsis-tent with each other, and specific OCD subtypes may also respond differentially.Phenotypic characterization can be undertaken either categorically, as seen with traditional diagnostic categories, or dimensionally. Extended phenotypes can be defined in terms of symptoms and course of the illness, or neuroimaging and neurobiologic study findings, or treatment responses. Phenotypic characterization must also reflect an understanding of the rituals and repetitive behaviors that are associated with normal development. (A proposed categorization of OCD subtypes appears in the “Table library.”)

Sexual obsessions occur in pediatric and adult OCD including thoughts about sexual acts with family members, sexually inappropriate behavior, or homosexual orientation. They may remain undiagnosed because of embarrassment to report thoughts that are perceived as unacceptable. Prevalence studies of sexual obsessions in pediatric populations are rare. The present study investigated prevalence of sexual obsessions and treatment outcome compared to youth with OCD without sexual obsessions in a large sample. Sexual obsessions and OCD severity were assessed with the Children’s Yale-Brown Obsessive- Compulsive Scale in all 269 participants of the Nordic Longterm OCD Treatment study (mean age 12.8 years, 48.7% boys) at baseline, after treatment and three years follow-up. Treatment consisted in individual manualized CBT with exposure and response prevention. Patients with and without sexual obsessions were compared on clinical characteristics and treatment outcomes. Sexual obsessions were reported by 18%, those with sexual obsessions were slightly older (13.5 versus 12.7 years). Both groups had no difference in treatment outcome, suggesting that if addressed, the response to CBT is similar in sexual, as in other obsessions. Clinicians need to be aware that children may need help to disclose and to identify these thoughts as obsessions to address them in treatment.

Thomsen PH. Child and adolescent psychiatric inpatients in Denmark. Demographic and diagnostic characteristics of children and adolescents admitted from 1970 to 1986. A register-based study.From 1970 to 1986 the total number of admissions to psychiatric children's hospitals in Denmark increased from 88 per year to 315 per year as a result of the expansion of the child psychiatric service. This means an increase in incidence from 0.11 per 100,000 per year to 0.38 per 100,000 per year of children aged 5 to 16 years becoming psychiatric inpatients. In the same period there were only minor changes in the diagnostic pattern within the field of child psychiatry in Denmark. The commonest diagnosis is adjustment disorder. The second most frequent diagnosis, neurosis, has been rather constant in number, whereas the frequency of the diagnosis of conduct disorder has decreased in boys. The hypothesis that more outpatient activities would result in more inpatients with "heavier" psychiatric diagnoses could not be verified by the study. On the contrary, the number of psychotic patients decreased in the examined period.

This study is retrospective and based on the charts of 146 patients (72 boys and 74 girls) admitted to a Danish adolescent psychiatric department in the period 1976 to 1986. Reasons for admission, previous treatment, and arrangements at discharge are presented. The commonest reason for admission was conduct disorder resulting in truancy (30%). About 28% were referred with conditions of anxiety, phobias, and obsessions as major problems. No significant differences between boys and girls emerged, except for eating disorders, in which girls predominated. Almost half of the adolescents had consulted a school psychologist before referral to psychiatric hospital. More boys than girls had been in a day and night institution before referral. About 50% of the patients returned to their home at discharge. About 35% were referred to an institution, a youth pension, or professional family care. The reasons for admission to a psychiatric hospital and the need for further psychiatric treatment after discharge are discussed.

War stress in a transgenerational perspective. Norwegian concentration camp survivors and two other resistance groups and their children. A comparative investigation.Doctoral dissertation, Department Group of Psychiatry, University of Oslo; Division of Disaster Psychiatry, Gaustad, University of Oslo/The Armed Forces Joint Medical Service; Oslo, Norway, 1996. ISBN 82-91049-09-2.Psykoanalyse mellom psykiatri og psykologi.Psykoanalyse mellom psykiatri og psykologi.Høyskoleforlaget, Kristiansand, 1996. 280 sider.Når tanker bliver til tvang. Børn og unge med tvangsymptomerHans Reitzels Forlag, Kaøbenhavn, 1996. ISBN87-412-2856-1, 128 sider, pris DKK 160.Når tanker bliver til tvangPer Hove ThomscnHans Reitzels Forlag, København, 1996. ISBN87-412-2856-1. 128 sider. DK 160.Continuity of care and patient satisfaction. Development and evaluation of methods for quality assessment of psychiatric carePh.D dissertation, Department of Psychiatric Demography, Aarhus Psychiatric Hospital, Risskov, Denmark, 1996. 197 pages.This summary was first published in Ugeskr Laeger 1996;158:433.The epidemiology of anxiety and depressive syndromes. A prospective, longitudinal study of a geographically defined, total population: The Lund by StudyDoctoral dissertation, Department of Psychiatry, Lund University Hospital, Lund, Sweden, 1996. 105 pages.ISBN 91-628-2145-8Exploring psychotherapy group cultures. Essays on group theory and the development of Matrix representation grid, a method for observing therapeutic group processes Göran AhlinDoctoral dissertation, Section for Clinical Alcohol and Drug Addiction Research, Magnus Huss clinic, Karolinska Institutet, Stockholm, 1996. ISBN 91-628-1887-2.Transmethylation mechanisms in dementia, schizophrenia and bipolar disordersDoctoral dissertation, Department of Medical Pharmacology, Uppsala University, Uppsala, 1996. ISBN 91-554-3761-3.Child psychiatric short-term inpatient treatment. A prospective study on content and outcomeAndre Sourander, M.D., Ph.D. Doctoral Dissertation, Department of Child Psychiatry, Turku University, Turku, Finland, 1995. bales Universitatis Turkuensis, D:205. ISBN 951-29-0584-1.Post-traumatic Stress Disorder and Suicidal Behaviour in Immigrants to Sweden. An Epidemiological, Cross-cultural and Psychiatric StudyDoctoral dissertation, Psychiatric SectionKarolinska Hospital, Stockholm, 1996. ISBN 91-628-1984-4.

Genetic aspects of obsessive-compulsive disorder (OCD) are reviewed. The prevalence of OCD is higher than believed previously, probably affecting about 1-3% of the adult population, and the search for etiologic factors has increased. All family studies indicate that OCD in relatives of patients is much more common than the general risk for OCD in the population. and during the past decade some well-conducted family studies, using uniform diagnostic criteria, have been performed. There have been no good twin studies, specifically focusing on OCD. There is still a need for genetic research in the field of OCD and related disorders.

The literature on obsessive-compulsive disorder (OCD) in children and adolescents is reviewed. On the basis of the epidemiological data it is concluded that OCD is far more common among children and adolescents than was previously believed. However, good epidemiological studies in other parts of the world than the US are still needed. Follow-up studies of the course of OCD with a childhood onset are still very few in number. Recent studies show that OCD is a disabling disorder for many of the patients, also in adult life, but that a considerable proportion of the patients seems to “recover” from their obsessions and compulsions in adulthood. There are indications that treatment response in childhood, parental psychopathology, and severity of the OCD migh predict the outcome. The biological aspects of OCD are reviewed. The serotonin transmitter system seems to be involved in the pathogenesis of adult as well as childhood OCD. Additionally, most studies demonstrate a high degree of neuropsychological and neurological deficits in children with OCD. Comorbidity in childhood, and the concept of OCD spectrum disorders are presented. Childhood OCD seems to be associated with depression, eating disorders, anxiety disorders, and empathy disorder, whereas there seems to be no convincing relation between OCD and schizophrenia.

Studies on child and adolescent obsessive-compulsive disorder (OCD) indicate that symptom severity is similar across age, but significant age differences of symptom profile and comorbid disorders have been observed. The current study examines these differences in one of the largest samples to date, and the first sample outside of an English-speaking cultural context. We compared children aged 11 years and younger to adolescents aged 12 years and older from the Nordic Long-Term Obsessive-Compulsive Disorder Treatment Study that included 269 children and adolescents with a primary diagnosis of OCD. The two groups were compared on measures of OCD severity, symptom profile, comorbid symptoms, and functional impairment. Results showed that the younger group had a poorer level of insight, higher rates of ADHD, and disruptive disorders. The older group had higher levels of mental compulsions, miscellaneous obsessions and compulsions, and self-rated functional impairment. No differences were found on the prevalence of anxiety, tic or depressive disorders between the age groups, nor on overall OCD severity. Overall, differences between the age groups were found to be less than in previous research. Defining groups by age of onset and duration of illness rather than age at evaluation did not change results.

Standard assessment of pediatric obsessive-compulsive disorder (OCD) patients includes ratings of insight, avoidance, indecisiveness, sense of responsibility, pervasive slowness, pathological doubting, and obsession-free intervals. The present study aims to identify pre-treatment associations of these clinical features to symptom severity and symptom dimensions as well as to describe and analyze the long-term levels and distribution in different treatment responder groups. Method: Severity ratings as well as clinical feature ratings were evaluated in 268 pediatric OCD patients using the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) at seven time points before, during, and up to three years after first-line cognitive-behavioral therapy. The CY-BOCS auxiliary items were evaluated on the basis of three symptom severity trajectory classes: acute, slow, and limited responders. Results:Insight, avoidance, pervasive slowness, and obsession-free intervals were positively associated with pre-treatment symptom severity. Symptom dimensions were associated with different auxiliary items. At three-year follow-up, the limited responder classhad higher scores than the acuteand slow responder classeson all items except for responsibility. Conclusion:The CY-BOCS auxiliary items are closely related to symptom dimensions and partly to symptom severity. The features appear to be dynamic concepts prone to change, yet, less so in patients showing limited long-term treatment response.

Animal studies have suggested that intrauterine exposure to caffeine in doses corresponding to 10 or more cups of coffee per day in humans may be a risk factor for hyperkinetic disorder and attention-deficit hyperactivity disorder (ADHD). One previous small study in humans found no association between intrauterine exposure to caffeine in doses equivalent to 10 to 12 cups per day and the occurrence of inattention and impulsivity in children aged 7 years. This prospective cohort study evaluated the possible association between intrauterine exposure to coffee in pregnant women and the risk of hyperkinetic disorder and ADHD diagnosed in their offspring at ages ranging between 3 and 12 years. Data were collected from the Aarhus Birth Cohort in Denmark and were linked with 3 Danish longitudinal registers: The Danish Civil Registration System, The Danish Psychiatric Central Register, and The Integrated Database for Labor Market Research. The study population was 24,068 singletons delivered between 1990 and 1998 who had valid information about intrauterine exposure of their mothers to coffee.