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Familial studies on obsessive-compulsive disorders (OCD) have suggested that OCD is a heterogeneous condition, with some cases being familial and others being isolated cases in their families. Nevertheless, no studies evaluated whether there are clinical differences between OCD cases with and without a familial component. The current report presents data on the prevalence of OCD in first-degree relatives of OCD probands and compares phenomenological characteristics of familial and non-familial OCD types. The family study and the family history methods were used to estimate the prevalence of OCD in first-degree relatives of 74 OCD probands. A statistical comparison between OCD probands with and without familial loading was performed using Pearson's chi(2) test, Fisher's exact test, or Student's t test when appropriate. The rate of OCD was 3.5% in directly interviewed first-degree relatives. Eleven percent of the probands had at least one family member with OCD. There were no differences between the two types of OCD (familial vs. non-familial) except for life events prior to the onset of OCD, which were more common and more severe in non-familial OCD subtypes. In conclusion, our results (1) confirm that there is a familial component in the expression of some forms of OCD and (2) indicate that familial OCD patients are not characterized by peculiar clinical features, but appear to have a lower threshold for precipitating events., (Copyright 2002 S. Karger AG, Basel)

Nonresponse to treatment in obsessive-compulsive disorder is common, associated with substantial impairment, and understudied. Little practical advice is available to clinicians on next-step treatment strategies for patients who have not responded well to 2 trials of selective serotonin reuptake inhibitors (SSRIs). Available options include continuation of SSRI treatment, switching to another SSRI or selective serotonin-norepinephrine reuptake inhibitor, augmenting with atypical neuroleptics or cognitive-behavioral therapy, or utilizing novel treatment approaches. The authors synthesize state-of-the-art treatment and give practical advice for clinicians.

Several lines of evidence support the concept of obsessive-compulsive disorder (OCD) as a heterogeneous illness. Using a range of factors such as demographic, psychosocial, and clinical variables, we compared OCD patients with chronic (n = 55) versus episodic (n = 46) courses of illness. Patients were evaluated monthly for 1 year while receiving no treatment. Significant differences in sex ratio, age at onset of the disorder, illness duration, type of symptoms, and familial history were found between the two groups. These findings are consistent with the concept of OCD as a heterogeneous disorder. Patients with an episodic course of the disorder may be a distinct subgroup within the whole group of obsessive-compulsive patients. [ABSTRACT FROM AUTHOR]