Validation of the Spanish version of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DYBOCS) in children and adolescents.

BACKGROUND: Obsessive-compulsive disorder (OCD) is best understood as a complex overlap of obsessive-compulsive (OC) symptom dimensions with specific clinical and etiological characteristics. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DYBOCS) was developed to assess the presence and severity of each of these OC symptom dimensions. Despite showing excellent psychometric properties in adults, the psychometric properties of the DYBOCS have not been widely investigated in children and adolescents. METHODS: We examined the psychometric properties of the DYBOCS Spanish version in a sample of 97 OCD children and adolescents. RESULTS: The results of the psychometric analyses were excellent overall. The internal consistency for each OC symptom dimension was high, although somewhat lower than in previous studies with adult samples. The DYBOCS showed overall good convergent and divergent validity. Factors obtained from a principal component analysis corresponded with the five DYBOCS dimensions (aggressive; sexual/religious; contamination; symmetry; and hoarding) and each one accounted for approximately 20% of the variance. CONCLUSIONS: The DYBOCS is a valid instrument for assessing the frequency and severity of OC symptom dimensions in children and adolescents with OCD. The principal component analysis supported the division of OC symptoms into five dimensions. OCD is a heterogeneous disorder, and a dimensional approach can help to understand its clinical, etiological and treatment response characteristics.

Fluorescence excitation photography of epidermal cellular proliferation.

BACKGROUND: Fluorescence excitation provides the ability to interrogate innate molecules whose radiation emission correlates with specific functional states of tissue. OBJECTIVES: The present study demonstrates the effectiveness of a novel ultraviolet (UV) fluorescence excitation photography system in its ability to image rapidly proliferating epidermal skin lesions by capturing endogenous fluorescence emissions attributed to tryptophan. METHODS: A clinical prototype UV fluorescence excitation photography system was used to acquire images of endogenous fluorescence ascribed to tryptophan. RESULTS: Twelve human subjects and 11 ex vivo samples with various skin lesions consistently exhibited increased endogenous fluorescence at 340-nm wavelength upon excitation at 295 nm in rapid epidermal proliferations, including psoriasis, actinic keratoses and basal cell carcinoma, compared with surrounding normal skin. In contrast, nonproliferating lesions showed decreased fluorescence. CONCLUSIONS: This simple but robust point-and-shoot imaging system may offer a clinically useful, noncontact, noninvasive device for the diagnosis and detection of skin disease. As opposed to structural imaging modalities, fluorescence excitation imaging at 295/340-nm wavelengths offers high-sensitivity, wide-field functional imaging of cellular proliferation without the need for externally applied dyes or lengthy image processing. Furthermore, the image is instantly available and does not require interpretation or reconstruction.

Clinical significance of psychiatric comorbidity in children and adolescents with obsessive-compulsive disorder: subtyping a complex disorder.

A promising approach in relation to reducing phenotypic heterogeneity involves the identification of homogeneous subtypes of OCD based on age of onset, gender, clinical course and comorbidity. This study aims to assess the sociodemographic characteristics and clinical features of OCD patients in relation to gender and the presence or absence of another comorbid disorder. The sample comprised 112 children and adolescents of both sexes and aged 8-18 years, all of whom had a diagnosis of OCD. Overall, 67 % of OCD patients had one comorbid diagnosis, 20.5 % had two such diagnoses and 2.6 % had three comorbid diagnoses. The group of OCD patients with a comorbid neurodevelopmental disorder had significantly more family history of OCD in parents (p = .049), as compared with the no comorbidity group and the group with a comorbid internalizing disorder, and they also showed a greater predominance of males (p = .013) than did the group with a comorbid internalizing disorder. The group of OCD patients with internalizing comorbidity had a later age of onset of OCD (p = .001) compared with both the other groups. Although the initial severity was similar in all three groups, the need for pharmacological treatment and for hospitalization due to OCD symptomatology was greater in the groups with a comorbid neurodevelopmental disorder (p = .038 and p = .009, respectively) and a comorbid internalizing disorder (p = .008 and p = .004, respectively) than in the group without comorbidity. Our findings suggest that two subtypes of OCD can be defined on the basis of the comorbid pathology presented. The identification of different subtypes according to comorbidity is potentially useful in terms of understanding clinical variations, as well as in relation to treatment management and the use of therapeutic resources.

1H-MRS of the anterior cingulate cortex in childhood and adolescent obsessive-compulsive disorder: a case-control study.

Abnormal glutamate concentrations in the anterior cingulate cortex (ACC) have been identified in children and adults with obsessive-compulsive disorder (OCD). The purpose of the present study was to measure in vivo (1)H-MRS neurometabolite concentrations in the ACC of children and adolescents with OCD, in order to identify metabolite abnormalities compared to healthy controls and to assess their relationship with clinical variables. 3T proton-magnetic resonance spectroscopy was used to probe ACC biochemistry in 47 paediatric and adolescent OCD patients (11-18 years old) compared to 31 healthy subjects of similar age, sex and estimated intellectual quotient. There were no significant differences in the concentration of glutamate plus glutamine (Glx) adjusted for CSF between OCD patients and healthy controls [F1,74=0.00; P=0.943], but there were significant differences in the concentration of Glx adjusted for CSF in paediatric and adolescent OCD patients according to duration of illness (less than or more than 24 months) [F2,73=3.95; P=0.024]. In addition, we found significantly lower levels of myo-inositol adjusted for CSF in the ACC [F1,74=5.686; P=0.02] in patients compared with controls. The present findings do not confirm the hypothesis of differences in Glx concentrations in the ACC between children and adolescents with OCD and healthy controls; however, the observation of differences in the Glx concentration in children and adolescent OCD patients depending on the duration of illness is of interest.

White matter structural alterations in pediatric obsessive-compulsive disorder: relation to symptom dimensions.

UNLABELLED: The aims of this study were to identify gray matter (GM) and white matter (WM) volume abnormalities in pediatric obsessive-compulsive patients, to examine their relationship between these abnormalities and the severity of disorder, and to explore whether they could be explained by the different symptom dimensions. METHODS: 62 child and adolescent OCD patients (11-18years old) and 46 healthy subjects of the same gender and similar age and estimated intellectual quotient were assessed by means of psychopathological scales and magnetic resonance imaging (MRI). Axial three-dimensional T1-weighted images were obtained in a 3T scanner and analyzed using optimized voxel-based morphometry (VBM). RESULTS: Compared with healthy controls, OCD patients showed lower white matter (WM) volume in the left dorsolateral and cingulate regions involving the superior and middle frontal gyri and anterior cingulate gyrus (t=4.35, p=0.049 FWE (family wise error)-corrected). There was no significant correlation between WM and the severity of obsessive-compulsive symptomatology. There were no regions with lower gray matter (GM) volume in OCD patients than in controls. Compared with healthy controls, only the "harm/checking" OCD dimension showed a cluster with a near significant decrease in WM volume in the right superior temporal gyrus extending into the insula (t=5.61, p=.056 FWE-corrected). CONCLUSION: The evidence suggests that abnormalities in the dorsolateral prefrontal cortex, anterior cingulate cortex, temporal and limbic regions play a central role in the pathophysiology of OCD. Moreover, regional brain volumes in OCD may vary depending on specific OCD symptom dimensions, indicating the clinical heterogeneity of the condition.

Comparison of peak expiratory flow and FEV1 admission criteria for acute bronchial asthma.

One hundred nine episodes of acute bronchial asthma were studied utilizing PEFR and FEV1 measurements to determine objective patient disposition criteria. Of patients with both a pre-treatment PEFR less than 100 L/min, and a post-treatment value less than 300 L/min, 92% required admission or had an unsuccessful OPD course. Of patients with a pre-treatment PEFR less than 100 L/min and an improvement less than 60 L/min after initial terbutaline, 85% were admitted or had problems after discharge. PEFR correlated well with FEV1 at all stages of treatment.