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Psychol Med. 2017 Jun 27:1-15. doi: 10.1017/S0033291717001672. [Epub ahead of print]

Genetic and phenotypic overlap of specific obsessive-compulsive and attention-deficit/hyperactive subtypes with Tourette syndrome.

Author information

1
Department of Psychiatry,University of California,San Francisco, CA,USA.
2
Psychiatric and Neurodevelopmental Genetics Unit,Center for Genomic Medicine,Department of Psychiatry,Massachusetts General Hospital, Harvard Medical School,Boston, MA,USA.
3
Department of Psychiatry and Behavioral Sciences,Johns Hopkins University School of Medicine,Baltimore, MD,USA.
4
Department of Psychiatry,University of Toronto and University Health Network, Youthdale Treatment Centers,Toronto, Ontario,Canada.
5
Department of Psychiatry,University of Montreal,Montreal, Quebec,Canada.
6
Yale Child Study Center, Yale University School of Medicine,New Haven, CT,USA.
7
Department of Psychiatry,North Shore University Hospital, Northwell Health System,Manhasset, NY,USA.
8
Faculty of Social and Behavioural Sciences, Utrecht University and Altrecht Academic Anxiety Center,UtrechtandGGz Drenthe and Department of Psychiatry,University Medical Center Groningen,The Netherlands.
9
Stanley Institute for Cognitive Genomics, Cold Spring Harbor Laboratory,Cold Spring Harbor, NY,USA.
10
Department of Psychology,University of Denver,Denver, CO,USA.
11
Department of Psychiatry,University of Utah,Salt Lake City, UT,USA.
12
Department of Behavioral Health,Tripler Army Medical Center,Honolulu, HI,USA.
13
Department of Psychiatry,University of Florida Genetics Institute, University of Florida,Gainesville, FL,USA.

Abstract

BACKGROUND:

The unique phenotypic and genetic aspects of obsessive-compulsive (OCD) and attention-deficit/hyperactivity disorder (ADHD) among individuals with Tourette syndrome (TS) are not well characterized. Here, we examine symptom patterns and heritability of OCD and ADHD in TS families.

METHOD:

OCD and ADHD symptom patterns were examined in TS patients and their family members (N = 3494) using exploratory factor analyses (EFA) for OCD and ADHD symptoms separately, followed by latent class analyses (LCA) of the resulting OCD and ADHD factor sum scores jointly; heritability and clinical relevance of the resulting factors and classes were assessed.

RESULTS:

EFA yielded a 2-factor model for ADHD and an 8-factor model for OCD. Both ADHD factors (inattentive and hyperactive/impulsive symptoms) were genetically related to TS, ADHD, and OCD. The doubts, contamination, need for sameness, and superstitions factors were genetically related to OCD, but not ADHD or TS; symmetry/exactness and fear-of-harm were associated with TS and OCD while hoarding was associated with ADHD and OCD. In contrast, aggressive urges were genetically associated with TS, OCD, and ADHD. LCA revealed a three-class solution: few OCD/ADHD symptoms (LC1), OCD & ADHD symptoms (LC2), and symmetry/exactness, hoarding, and ADHD symptoms (LC3). LC2 had the highest psychiatric comorbidity rates (⩾50% for all disorders).

CONCLUSIONS:

Symmetry/exactness, aggressive urges, fear-of-harm, and hoarding show complex genetic relationships with TS, OCD, and ADHD, and, rather than being specific subtypes of OCD, transcend traditional diagnostic boundaries, perhaps representing an underlying vulnerability (e.g. failure of top-down cognitive control) common to all three disorders.

KEYWORDS:

Attention-deficit/hyperactivity disorder; Tourette syndrome; factors; heritability; latent classes; obsessive-compulsive disorder

PMID:
28651666
DOI:
10.1017/S0033291717001672
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