Increased risk of suicide in patients with obsessive-compulsive disorder

title Fernández de la Cruz et al

In a recent study published in Molecular Psychiatry, members of our group and colleagues at Karolinska Institutet have looked at suicide in obsessive-compulsive disorder (OCD). The study compared rates of suicide among 36 788 patients with OCD and matched controls without an OCD diagnosis.

The risk of dying by suicide was found to be about 10 times higher in patients with OCD (OR = 9.83 (95% CI, 8.72-11.08). Patients with OCD were also about 5 times more likely to attempt suicide (OR = 5.45 (05% CI, 5.24-5.67). The risk was marginally attenuated in women compared to men.

Lorena Fernández de la Cruz and her co-authors also note that the increased risk of death by suicide

“… remained substantial after adjusting for different groups of psychiatric comorbidities that are already known to be associated with suicide. In fact, 43% of the individuals from the OCD cohort who died by suicide did not have any other recorded psychiatric comorbidity.” (p. 4)

They argue that OCD is associated with an increased risk of death by suicide in its own right. The main predictor for dying by suicide was a previous suicide attempt.

The message for clinicians is clear:

“OCD should be added to the list of psychiatric disorders that are known to increase the risk of suicide in their own right. Suicide risk needs to be carefully monitored in these patients, particularly in those who have previously attempted suicide.” (p. 6)

The paper is freely available here.



New study: Chronic tic disorders highly heritable

The risk for tic disorders, including Tourette syndrome and chronic tic disorders, increased with the degree of genetic relatedness in a study of families in Sweden, according to an article published online today by JAMA Psychiatry.

While tic disorders are thought to be strongly familial and heritable, precise estimates of familial risk and heritability are lacking.

David Mataix-Cols, lead author, of the Karolinska Institutet, Stockholm, and coauthors including Johan Larsson and Christian Rück from our group tried to overcome some of those limitations by estimating family clustering and heritability of tic disorders using data from two Swedish population-based registers. We identified 4,826 individuals diagnosed as having Tourette syndrome or chronic tic disorders from 1969 through 2009.

The authors found first-degree relatives of individuals with tic disorders had higher risk of having Tourette syndrome or chronic tic disorders than second- and third-degree relatives. In turn, the odds were higher for second-degree relatives than third-degree relatives.

Full siblings, parents and children of individuals with Tourette syndrome or chronic tic disorder (all with 50 percent genetic similarity but with siblings assumed to have more shared environment because they grew up together) had comparable risks. The results also indicate that risks for full siblings (50 percent genetic similarity) were higher than those for maternal half siblings (25 percent genetic similarity) despite similar shared environmental exposures. First cousins (12.5 percent) genetic similarity had a three-fold higher risk of having Tourette syndrome or chronic tic disorders compared with control patients.

“The heritability of tic disorders was estimated to be approximately 77 percent, with the remaining variance being attributable to nonshared environmental influences and measurement error. … Our heritability estimates place tic disorders among the most heritable neuropsychiatric conditions,” the study concludes.

Mataix-Cols D, Isomura K, Pérez-Vigil A, Chang Z, Rück C,  Larsson KJ, ; Leckman JF, Serlachius E, Larsson H, Lichtenstein P. Familial Risks of Tourette Syndrome and Chronic Tic Disorders: A Population-Based Cohort Study. JAMA Psychiatry. Published online June 17, 2015. doi:10.1001/jamapsychiatry.2015.0627

Jim Crowley affiliated to our group

Assistant Professor James J. Crowley is now affilated to Karolinska Institutet and our group. Jim is currently at the Department of Genetics at the University of North Carolina at Chapel Hill. Check out some his recent publications here. We are very proud to have him at KI.

New study: How is OCD related to schizophrenia and bipolar disorder?

In a new publication in Schizophrenia Bulletin Swedish registers were used in the so far largest study set out to understand the relationship between OCD and psychosis and bipolar disorders.  Clinically it is clear that psychotic delusions can sometimes  be hard to tell apart from obsessions, especially when there is low insight.

In this population-based longitudinal and multigenerational family study, we examined the patterns of comorbidity, longitudinal risks, and shared familial risks between these disorders. Participants were individuals with a diagnosis of OCD (n = 19814), schizophrenia (n = 58336), bipolar disorder (n = 48180), and schizoaffective disorder (n = 14904) included in the Swedish Patient Register; their first-, second-, and third-degree relatives; and population-matched unaffected controls and their relatives. Individuals with OCD had a 12-fold increased risk of having a comorbid diagnosis of schizophrenia and a 13-fold increased risk of bipolar disorder and schizoaffective disorder. This still means that those disorders disorders will not affect most OCD patients. Longitudinal analyses showed that individuals first diagnosed with OCD had an increased risk for later diagnosis of all other disorders, and vice versa. OCD-unaffected first-, second-, and third-degree relatives of probands with OCD had a significantly increased risk for all 3 disorders; the magnitude of this risk decreased as the genetic distance increased. We conclude that OCD is etiologically related to both schizophrenia spectrum and bipolar disorders.

Cederlöf M, Lichtenstein P, Larsson H, Boman M, Rück C, Landén M, Mataix-Cols D. Obsessive-Compulsive Disorder, Psychosis, and Bipolarity: A Longitudinal Cohort and Multigenerational Family Study. Schizophr Bull (2014) doi: 10.1093/schbul/sbu169

On track: Volen Ivanov passed his half-time seminar

Volen with the examination board: Bo Melin, Jerker Hetta and Karin Wirdefeldt
Zooming in on Volen.

Volen passed his half-way checkpoint to his PhD today. We wish to thank the examination board and the co-supervisors Eva Serlachius, David Mataix-Cols and Paul Lichtenstein.

Next up in our group for his half-time seminar is Jesper Enander: January 16th, 13h00 at Askö, M57, Huddinge. Welcome.

Half-time seminar for Volen Ivanov

Welcome to Volen Ivanov’s half-time seminar for his PhD plan “Never let go! The etiology, clinical presentation and treatment of Hoarding Disorder”.

When: December 8, 13H00.

Where: Askö, M57, Karolinska University Hospital Huddinge.

Volen Ivanov

Erik Andersson nails his thesis

Boom. He nailed it.
Boom. He nailed it.

Erik Andersson nailed his thesis “Enhancing cognitive behavior therapy in the treatment of obsessive-compulsive disorder” to the KI library as the traditional publication. He will defend his work on September 19. 

The thesis defense is open to the public. Details here: