Childhood-onset obsessive-compulsive disorder (OCD) affects 1%–2% of children and adolescents. It is characterized by recurrent obsessions and compulsions that create distress and interfere with daily life. The symptoms reported by children are similar to those seen among individuals who develop OCD in adulthood, and the two groups of patients are treated with similar symptom-relieving behavior therapies and medications. However, there are differences in sex ratios, patterns of comorbidity, and the results of neuroimaging studies that might be important. Here we review the diagnosis and treatment of childhood-onset OCD in light of pediatric and adult studies. We also discuss current knowledge of the pathophysiology of the disorder. Despite advances in this area, further research is needed to understand better the etiopathogenesis of the disorder and to develop new, more effective therapeutic options.
Simran K. Kalra, Susan E. Swedo
The cortico-striato-thalamo-cortical circuit in a healthy individual.
In the normally functioning cortico-striato-thalamo-cortical circuit, glutamatergic signals from the frontal cortex lead to excitation in the striatum, which increases inhibitory GABA signals to the GPi and the SNr. This then decreases the inhibitory output via GABA from the GPi and SNr to the thalamus, resulting in thalamic excitatory glutamatergic output to the frontal cortex. This is a positive feedback loop. An indirect external loop composed of the GPe and subthalamic nucleus (STN) is postulated to contribute to a steady state of excitation/inhibition. The striatum inhibits the GPe, which decreases its inhibition on the STN. The STN is then free to excite the GPi/SNr and therefore inhibit the thalamus (adapted from ref.