Prevalence of Attention Deficit Hyperactivity Disorder among Distinct Symptom Dimensions in Adult Patients with Obsessive-Compulsive Disorder

Objective: Obsessive-compulsive disorder (OCD) is known to frequently coexist with attention deficit hyperactivity disorder (ADHD). However, the two disorders are characterized by a variety of opposite clinical and biological features. We investigated whether different symptom dimensions of OCD might account for this intriguing comorbidity given the different phenomenological and neurobiological characteristics exhibited by patients with OCD. Methods: The sample of this study comprised one hundred and ninety-six patients with OCD who were classified according to their principal obsession or compulsion: (1) contamination and washing; (2) taboo thoughts (sexual, aggressive, or religious obsessions); and 3) symmetry, counting, repeating, or ordering (SCRO). Our study examined whether or not ADHD accompanies any of the abovementioned symptom dimensions. The prevalence of ADHD was assessed by using the DSM-IV criteria. The prevalence of tic disorders, smoking, and alcohol or substance use disorder (SUD) was also examined. The Yale-Brown Obsessive Compulsive Scale (Y-BOCS), 17-Item Hamilton Depression Rating Scale (HDRS-17), Beck Anxiety Inventory (BAI), and Barratt Impulsiveness Scale Version 11 (BIS-11) were administered. Results: The prevalence of ADHD in the following symptom dimensions was 11.6% (n=8) for washing, 20.4% (n=22) for taboo thoughts, and 26.3% (n=5) for SCRO. These differences, however, were not found to be significant. Additionally, neither the total BIS-11 scores nor its subscale scores concerning cognitive impulsiveness, motor impulsiveness, and non-planning differed significantly among the three symptom dimensions. Further, the scores of HDRS-17 and BAI and the prevalence of tic disorder, alcohol abuse, and SUDs were not significantly different among the symptom dimensions. On the other hand, the Y-BOCS scores including the scores of its subscales of obsession and compulsion were significantly higher in the washing symptoms group than the other two groups (p

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1. Bloch MH, Landeros-Weisenberger A, Rosario MC, Pittenger C, Leckman JF. Meta-analysis of the symptom structure of obsessivecompulsive disorder. Am J Psychiatry. 2008;165:1532-42.
2. Kichuk SA, Torres AR, Fontenelle LF, Rosário MC, Shavitt RG, Miguel EC, et al. Symptom dimensions are associated with age of onset and clinical course of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2013;44:233-9.
3. Hasler G, LaSalle-Ricci VH, Ronquillo JG, Crawley SA, Cochran LW, Kazuba D, et al. Obsessive-compulsive disorder symptom dimensions show specific relationships to psychiatric comorbidity. Psychiatry Res. 2005;135:121-32.
4. Prabhu L, Cherian AV, Viswanath B, Kandavel T, Math SB, Reddy YCJ. Symptom dimensions in OCD and their association with clinical characteristics and comorbid disorders. J Obsessive Compuls Relat Disord. 2013;2:14-21.
5. Harrison BJ, Pujol J, Cardoner N, Deus J, Alonso P, López-Solà M, et al. Brain corticostriatal systems and the major clinical symptom dimensions of obsessive-compulsive disorder. Biol Psychiatry.2013;73:321-8.
6. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM, 5th ed., Arlington, VA: American Psychiatric Publishing, 2013.
7. Abramovitch A, Dar R, Mittelman A, Wilhelm S. Comorbidity between attention deficit/hyperactivity disorder and obsessivecompulsive disorder across the lifespan: a systematic and critical review. Harv Rev Psychiatry. 2015;23:245-62.
8. Capusan AJ, Bendtsen P, Marteinsdottir I, Larsson H. Comorbidity of adult ADHD and its subtypes with substance use disorder in a large population-based epidemiological study. J Atten Disord. 2016; Epub ahead of print.
9. American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM- IV. 4th ed., Washington, DC: 1994.
10. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCIDCV), Washington, DC: American Psychiatric Press Inc., 1997.
11. Goodman WK, Price LH, Rasmussen SA, Mazure C, Fleischman RL, Hill CL, et al. The Yale-Brown Obsessive Compulsive Scale, I. Development, use, and reliablity. Arch Gen Psychiatry. 1989;46:1006-11.
12. Karamustafalıoğlu KO, Üçışık AM, Ulusoy M, Erkmen H. YaleBrown Obsesyon Kompülsiyon Derecelendirme Ölçeği'nin geçerlik ve güvenilirlik çalışması. XXIX. 29. Ulusal Psikiyatri Kongresi Program ve Bildiri Özetleri Kitabı, 1993, Bursa:Savaş Ofset, 1993:86.
13. Williams JB. A structured interview guide for the Hamilton Depression Rating Scale. Arch Gen Psychiatr. 1988;45:742-7.
14. Akdemir A, Örsel S, Dağ İ, Türkçapar H, İşcan N, Özbay H. Hamilton Depresyon Derecelendirme Ölçeği'nin geçerliği, güvenilirliği ve klinikte kullanımı. Psikiyatri Psikoloji Psikofarmakoloji Dergisi. 1996;4:251-9.
15. Beck AT, Epstein N, Brown G, Steer RA. An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol. 1988;56:893-7.
16. Ulusoy M, Şahin N, Erkmen H. Turkish version of the Beck Anxiety Inventory: psychometric properties. J Cognitive Pschotherapy: Int Quarterly. 1998;12:28-35.
17. Patton JH, Stanford MS, Barratt ES. Factor structure of the Barratt impulsiveness scale. J Clin Psychol. 1995;51:768-74.
18. Güleç H, Tamam L, Güleç MY, Turhan M, Karakuş G, Zengin M, Stanford MS. Psychometric properties of the Turkish version of the barratt impulsiveness scale-11. Klinik Psikofarmakoloji BülteniBulletin of Clinical Psychopharmacology. 2008;18:251-58.
19. Torres AR, Fontenelle LF, Shavitt RG, Ferrão YA, do Rosário MC, Storch EA, et al. Comorbidity variation in patients with obsessivecompulsive disorder according to symptom dimensions: Results from a large multicentre clinical sample. J Affect Disord. 2016;190:508-16.
20. Frank H, Stewart E, Walther M, Benito K, Freeman J, Conelea C, et al. Hoarding behavior among young children with obsessivecompulsive disorder. J Obsessive Compuls Relat Disord. 2014;3:6-11.
21. Abramovitch A, Abramowitz JS, Mittelman A. The neuropsychology of adult obsessive-compulsive disorder: a meta-analysis. Clin Psychol Rev. 2013;33:1163-71.
22. Leopold R, Backenstrass M. Neuropsychological differences between obsessive-compulsive washers and checkers: a systematic review and meta-analysis. J Anxiety Disord. 2015;30:48-58.
23. Woods CM, Vevea JL, Chambless DL, Bayen UJ. Are compulsive checkers impaired in memory? A meta-analytic review. Clinical Psychology: Science and Practice. 2002;9:353-66.
24. Hashimoto N, Nakaaki S, Omori IM, Fujioi J, Noguchi Y, Murata Y, et al. Distinct neuropsychological profiles of three major symptom dimensions in obsessive-compulsive disorder. Psychiatry Res. 2011;187:166-73.
25. McGuire JF, Crawford EA, Park JM, Storch EA, Murphy TK, Larson MJ, et al. Neuropsychological performance across symptom dimensions in pediatric obsessive compulsive disorder. Depress Anxiety. 2014;31:988-96.
26. Milad MR, Rauch SL. Obsessive-compulsive disorder: beyond segregated cortico-striatal pathways. Trends Cogn Sci. 2012;16:43- 51.
27. van den Heuvel OA, Remijnse PL, Mataix-Cols D, Vrenken H, Groenewegen HJ, Uylings HB, et al. The major symptom dimensions of obsessive-compulsive disorder are mediated by partially distinct neural systems. Brain. 2009;132:853-68.
28. Gilbert AR, Mataix-Cols D, Almeida JR, Lawrence N, Nutche J, Diwadkar V, Keshavan MS, Phillips ML. Brain structure and symptom dimension relationships in obsessive-compulsive disorder: a voxel-basedmorphometry study. J Affect Disord. 2008;109:117-26.
29. Valente AA Jr, Miguel EC, Castro CC, Amaro E Jr, Duran FL, Buchpiguel CA, Chitnis X, McGuire PK, Busatto GF. Regional gray matter abnormalities in obsessive-compulsive disorder: a voxelbased morphometry study. Biol Psychiatry. 2005;58:479-87.
30. Pujol J, Soriano-Mas C, Alonso P, Cardoner N, Menchón JM, Deus J, Vallejo J. Mapping structural brain alterations in obsessivecompulsive disorder. Arch Gen Psychiatry. 2004;61:720-30.
31. Cottraux J, Gérard D, Cinotti L, Froment JC, Deiber MP, Le Bars D, Galy G, Millet P, Labbé C, Lavenne F, Bouvard M, Mauguière F. A controlled positron emission tomography study of obsessive and neutral auditory stimulation in obsessive-compulsive disorder with checking rituals. Psychiatry Res. 1996;60:101-12.
32. Mataix-Cols D, Wooderson S, Lawrence N, Brammer MJ, Speckens A, Phillips ML. Distinct neural correlates of washing, checking, and hoarding symptom dimensions in obsessive-compulsive disorder. Arch Gen Psychiatry. 2004;61:564-76.
33. Phillips ML, Marks IM, Senior C, Lythgoe D, O'Dwyer AM, Meehan O, Williams SC, Brammer MJ, Bullmore ET, McGuire PK. A differential neural response in obsessive-compulsive disorder patients with washing compared with checking symptoms to disgust. Psychol Med. 2000;30:1037-50.
34. Shapira NA, Liu Y, He AG, Bradley MM, Lessig MC, James GA, Stein DJ, Lang PJ, Goodman WK. Brain activation by disgust-inducing pictures in obsessive-compulsive disorder. Biol Psychiatry. 2003;54:751-6.
35. Murayama K, Nakao T, Sanematsu H, Okada K, Yoshiura T, Tomita M, Masuda Y, Isomura K, Nakagawa A, Kanba S. Differential neural network of checking versus washing symptoms in obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry. 2013;40:160-6.
36. Via E, Cardoner N, Pujol J, Alonso P, López-Solà M, Real E, Contreras-Rodríguez O, Deus J, Segalàs C, Menchón JM, SorianoMas C, Harrison BJ. Amygdala activation and symptom dimensions in obsessive-compulsive disorder. Br J Psychiatry. 2014;204:61-8.
37. Tan O, Taş C. Symptom Dimensions, Smoking and Impulsiveness in Obsessive-Compulsive Disorder. Psychiatr Danub. 2015;27:397- 405.
38. Boisseau CL, Thompson-Brenner H, Caldwell-Harris C, Pratt E, Farchione T, Barlow DH. Behavioral and cognitive impulsivity in obsessive-compulsive disorder and eating disorders. Psychiatry Res. 2012;200:1062-6.
39. Ettelt S, Ruhrmann S, Barnow S, Buthz F, Hochrein A, Meyer K, Kraft S, Reck C, Pukrop R, Klosterkötter J, Falkai P, Maier W, Wagner M, Freyberger HJ, Grabe HJ. Impulsiveness in obsessivecompulsive disorder: results from a family study. Acta Psychiatr Scand. 2007;115:41-7.
40. Roh D, Kim SJ, Kim C-H. The relationship between clinical characteristics and impulsiveness in obsessive-compulsive disorder. J Korean Neuropsychiatr Assoc 2009;48:336-43.
41. Sohn SY, Kang JI, Namkoong K, Kim SJ: Multidimensional measures of impulsivity in obsessive-compulsive disorder: cannot wait and stop. PLoS One. 2014;9:e111739.
42. Lei H, Zhu X, Fan J, Dong J, Zhou C, Zhang X, Zhong M. Is impaired response inhibition independent of symptom dimensions in obsessive-compulsive disorder? Evidence from ERPs. Sci Rep. 2015;5:10413.
43. Lee SS, Humphreys KL, Flory K, Liu R, Glass K. Prospective association of childhood attention-deficit/hyperactivity disorder (ADHD) and substance use and abuse/dependence: a metaanalytic review. Clin Psychol Rev. 2011;31:328-41.
44. McClernon FJ, Kollins SH. ADHD and smoking: from genes to brain to behavior. Ann N Y Acad Sci. 2008;1141:131-47.