Anxiety Disorders: Heyman I

Conlan L, Heyman I. · National and Specialist OCD Service for Young People, The Maudsley Hospital, London. · Practitioner. · Pubmed #18087987 No free full text.

This publication has no abstract.

Heyman I, Mataix-Cols D, Fineberg NA. · National and Specialist OCD Service for Young People, Children's Department, Maudsley Hospital, London. · BMJ. · Pubmed #16931840 No free full text.

This publication has no abstract.

Mataix-Cols D, Nakatani E, Micali N, Heyman I. · King's College London, Institute of Psychiatry, Department of Psychological Medicine, P.O. Box 69, De Crespigny Park, UK. · J Am Acad Child Adolesc Psychiatry. · Pubmed #18344900 No free full text.

Abstract: OBJECTIVE: It is unclear whether the structure of obsessive-compulsive disorder (OCD) symptoms seen in adults is preserved in pediatric samples. METHOD: A total of 238 children and adolescents referred to a specialty pediatric OCD clinic were administered the Children's Yale-Brown Obsessive Compulsive Scale Symptom Checklist, and its 13 major symptom categories were subjected to exploratory principal components analysis. The resulting factors were correlated with relevant clinical variables. RESULTS: Principal components analysis identified four symptom dimensions explaining 55% of the total variance and broadly corresponding to those seen in adult samples. Boys were more likely to have sexual obsessions (34% vs. 18%, p = .01), whereas girls were more likely to endorse hoarding compulsions (53% vs. 36%, p=.009). High scores on the hoarding dimension were associated with increased levels of pervasive slowness, responsibility, indecisiveness, pathological doubt, depression and a variety of emotional difficulties, both self-rated and parent-rated. CONCLUSIONS: The structure of OCD symptoms is similar across the lifespan. Hoarding symptoms are prevalent in pediatric OCD, especially among girls, and are associated with greater levels of disability.

Woolley J, Heyman I, Brammer M, Frampton I, McGuire PK, Rubia K. · Child and Adolescent Psychiatry (PO 46), Institute of Psychiatry, Denmark Hill, London SE5 8AF, UK. · Br J Psychiatry. · Pubmed #18174505 links to  free full text

Abstract: BACKGROUND: Obsessive-compulsive disorder (OCD) may be related to a dysfunction in frontostriatal pathways mediating inhibitory control. However, no functional magnetic resonance imaging (fMRI) study has tested this in children. AIMS: To test whether adolescents with OCD in partial remission would show abnormal frontostriatal brain activation during tasks of inhibition. METHOD: Event-related fMRI was used to compare brain activation in 10 adolescent boys with OCD with that of 9 matched controls during three different tasks of inhibitory control. RESULTS: During a 'stop' task, participants with OCD showed reduced activation in right orbitofrontal cortex, thalamus and basal ganglia; inhibition failure elicited mesial frontal underactivation. Task switching and interference inhibition were associated with attenuated activation in frontal, temporoparietal and cerebellar regions. CONCLUSIONS: These preliminary findings support the hypothesis that paediatric OCD is characterised by a dysregulation of frontostriatothalamic brain regions necessary for motor inhibition, and also demonstrate dysfunction of temporoparietal and frontocerebellar attention networks during more cognitive forms of inhibition.

Uher R, Heyman I, Turner CM, Shafran R. · King's College London, Institute of Psychiatry, London, UK. · J Anxiety Disord. · Pubmed #18023139 No free full text.

Abstract: Self-report measures of obsessive-compulsive disorder (OCD) in children and adolescents are needed for practical evaluation of severity and treatment response. We compared the self- and parent-report Obsessional Compulsive Inventory Revised (CHOCI-R) to the interview-based Child Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in a clinical sample of 285 children and adolescents with OCD. Classical test theory and item-response theory were applied to compare the instruments. The self- and parent-report CHOCI-R had good internal consistency and were strongly related to each other. The self- and parent-report CHOCI-R severity scores correlated with the CY-BOCS (Pearson's r 0.55 and 0.45 respectively). The CY-BOCS discriminated better at the severe end of the spectrum. The CHOCI-R provided better discrimination in the mild to moderate range. The time-efficient self- and parent-report alternatives will enable routine measurement of OCD severity in clinical practice. Estimates of equivalent summed scores are provided to facilitate comparison.

Uher R, Heyman I, Mortimore C, Frampton I, Goodman R. · South London and Maudsley NHS Trust, Institute of Psychiatry, King's College London, UK. · Br J Psychiatry. · Pubmed #17906247 links to  free full text

Abstract: Obsessive-compulsive disorder (OCD) in young people is underrecognized and undertreated. Simple screening tools suitable for general practice and community services are needed. We created a seven-item self-report Short OCD Screener (SOCS) and administered itto young people aged 11-15 years, including 116 patients with OCD, 181 healthy community controls and 33 young people with other psychiatric diagnoses. The SOCS has excellent sensitivity of 0.97 (95% CI 0.91-0.98) to detect OCD cases. Its specificity is good in children without psychiatric diagnoses, but low in a psychiatric sample. The SOCS is a screening tool suitable for community but not specialist settings.

Volz C, Heyman I. · Service for Young People with Obsessive-Compulsive Disorder, Children's Department, Maudsley Hospital, London, UK. · J Am Acad Child Adolesc Psychiatry. · Pubmed #17513989 No free full text.

Abstract: This article presents a previously unreported symptom of obsessive-compulsive disorder. The young people reported describe a fear of turning into someone or something else or taking on unwanted characteristics. We have called this transformation obsession. The bizarre nature of this obsession had led to misdiagnosis and inappropriate treatments in a number of these patients. Recognition of this symptom as an ordinary obsession (unwanted, intrusive, repetitive, and associated with an anxiety-reducing compulsion or avoidance) facilitates treatment with cognitive-behavioral therapy for obsessive-compulsive disorder. Consideration is given to screening for this obsession and whether its presence indicates a subtype of obsessive-compulsive disorder.

Dale RC, Heyman I, Giovannoni G, Church AW. · Department of Child and Adolescent Psychiatry, PO Box 085, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Br J Psychiatry. · Pubmed #16199788 links to  free full text

Abstract: BACKGROUND: Obsessions and compulsions may occur in the post-streptococcal disorders Sydenham's chorea and paediatric autoimmune neuropsychiatric disorders associated with streptococcus (PANDAS). The proposed mediators are anti-basal ganglia antibodies (ABGA). AIMS: We tested the hypothesis that post-streptococcal autoimmunity may have a role in'idiopathic'obsessive-compulsive disorder (OCD). METHOD: We examined 50 children with OCD for ABGA using enzyme-linked immunosorbent assay (ELISA) and western immunoblotting. The findings were compared with paediatric autoimmune (n=50), neurological (n=100) and streptococcal (n=40) controls. RESULTS: The mean ABGA binding on ABGA binding on ELISA was elevated in the patient cohort compared with all control groups (P<0.005 in all comparisons). Western immunoblotting revealed positive antibody binding (as seen in Sydenham's chorea) in 42% of the patient cohort compared with 2-10% of control groups (P<0.001 in all comparisons). CONCLUSIONS: Our findings support the hypothesis that central nervous system autoimmunity may have a role in a significant subgroup of cases of OCD. Further study is required to examine whether the antibodies concerned are pathogenic.

Dale RC, Heyman I, Surtees RA, Church AJ, Giovannoni G, Goodman R, Neville BG. · Neurosciences Unit, Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, London, UK. · Arch Dis Child. · Pubmed #15210487 links to  free full text

Abstract: BACKGROUND: The classical extrapyramidal movement disorder following beta haemolytic streptococcus (BHS) infection is Sydenham's chorea (SC). Recently, other post-streptococcal movement disorders have been described, including motor tics and dystonia. Associated emotional and behavioural alteration is characteristic. AIMS: To describe experience of post-streptococcal dyskinesias and associated co-morbid psychiatric features presenting to a tertiary referral centre 1999-2002. METHODS: In all patients, dyskinetic movement disorders followed BHS pharyngeal infection. BHS infection was defined by pharyngeal culture of the organism, or paired streptococcal serology. Movement disorders were classified according to international criteria, and validated by experienced child neurologists. Psychiatric complications were defined using ICD-10 criteria using a validated psychiatric interview. RESULTS: In the 40 patients, the following dyskinetic movement disorders were present: chorea (n = 20), motor tics (n = 16), dystonia (n = 5), tremor (n = 3), stereotypies (n = 2), opsoclonus (n = 2), and myoclonus (n = 1). Sixty five per cent of the chorea patients were female, whereas 69% of the tic patients were male. ICD-10 psychiatric diagnoses were made in 62.5%. Using the same psychiatric instrument, only 8.9% of UK children would be expected to have an ICD-10 psychiatric diagnosis. Emotional disorders occurred in 47.5%, including obsessive-compulsive disorder (27.5%), generalised anxiety (25%), and depressive episode (17.5%). Additional psychiatric morbidity included conduct disorders (27.5%) and hyperkinetic disorders (15%). Psychiatric, movement, and post-streptococcal autoimmune disorders were commonly observed in family members. At a mean follow up of 2.7 years, 72.5% had continuing movement and psychiatric disorders. CONCLUSION: Post-streptococcal dyskinesias occur with significant and disabling psychiatric co-morbidity and are potential autoimmune models of common "idiopathic" movement and psychiatric disorders in children. Multiple factors may be involved in disease expression including genetic predisposition, developmental status, and the patient's sex.

Heyman I, Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. · Department of Child and Adolescent Psychiatry, Institute of Psychiatry, London, UK. · Int Rev Psychiatry. · Pubmed #12745330 No free full text.

Abstract: Obsessive-compulsive disorder (OCD) is a disorder that appears to be under-diagnosed and under-treated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends. The aim of this study was to establish the prevalence and associates of OCD in young people aged 5-15 years. The method was a nationwide (UK) epidemiological study of rates of psychiatric disorder in 5-15 year olds (1999 British Child Mental Health Survey): 10,438 children were assessed. Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% CI 0.14-0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services. Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.

Shafran R, Frampton I, Heyman I, Reynolds M, Teachman B, Rachman S. · Oxford University Department of Pschiatry, Warnefond Hospital, Oxford OX3 7JX, UK. · J Adolesc. · Pubmed #12550826 No free full text.

Abstract: The aim of this study was to develop a reliable self-report instrument to assess obsessive-compulsive disorder (OCD) in young people. The children's Obsessional Compulsive Inventory (CHOCI) had good internal consistency, criterion validity and was significantly correlated with the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). This preliminary new measure could serve to provide a more efficient and accessible way of assessing OCD in young people.

Heyman I, Fombonne E, Simmons H, Ford T, Meltzer H, Goodman R. · Department of Child and Adolescent Psychiatry, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. · Br J Psychiatry. · Pubmed #11581112 links to  free full text

Abstract: BACKGROUND: Obsessive-compulsive disorder (OCD) is a disorder that appears to be underdiagnosed and undertreated, despite the evidence for effective treatments. There are variable estimates of OCD prevalence in the under-16s and published rates give little indication of age trends. AIMS: To establish the prevalence and associates of OCD in young people aged 5-15 years. METHOD: A nationwide (UK) epidemiological study of rates of psychiatric disorder in 5- to 15-year-olds (1999 British Child Mental Health Survey): 10 438 children were assessed. RESULTS: Twenty-five children with OCD were identified (weighted overall prevalence 0.25%; 95% CI 0.14-0.35), with prevalence rising exponentially with increasing age. Compared with normal controls, children with OCD were more likely to be from lower socio-economic class and of lower intelligence. Only three of these children had been seen by specialist children's services. CONCLUSIONS: Although OCD is rare in young children, the rate increases towards the adult rates at puberty. Children with OCD have additional psychosocial disadvantage. The majority of the childhood cases identified in this survey appear to have been undetected and untreated.

Nicholson T, Heyman I, Church A, Giovannoni G. · No affiliation provided · Cogn Behav Neurol. · Pubmed #18091077 No free full text.

This publication has no abstract.

Micali N, Heyman I. · No affiliation provided · Am J Psychiatry. · Pubmed #16449493 links to  free full text

This publication has no abstract.

Woolley JB, Heyman I. · No affiliation provided · Am J Psychiatry. · Pubmed #12505824 links to  free full text

This publication has no abstract.