Obsessive Compulsive Disorders Evident in Duchenne Patients and in Need of Treatment, Study Says

Obsessive compulsive disorder (OCD), a type of “internalizing disorder,” are evident in children with Duchenne muscular dystrophy, and particularly associated with anxiety and places considerable stress on the patient’s family, a small retrospective study reported.

Researchers call attention to the importance of care providers being alert to signs of OCD and anxiety in patients, and treating their mental as well as physical health.

Their study “Descriptive Phenotype of Obsessive Compulsive Symptoms in Males With Duchenne Muscular Dystrophy” was published in the Journal of Child Neurology.

Previous work has shown a higher-than-average prevalence of behavioral or emotional disorders like OCD — known as internalizing disorders — in boys with Duchenne muscular dystrophy (DMD). But these studies do not detail the clinical symptoms that mark this patient population.

A team of researchers at University of Iowa sought to characterize the clinical signs, impact on patients and families, and response to treatment of internalizing disorders in DMD patients.

They retrospectively reviewed medical charts of boys and men, ages 5 to 34, being treated at the University of Iowa Hospital and Clinics between 2012 and 2017.

In total, data on 107 patients were reviewed; the study focused on a final group of 39 Duchenne patients. Of these, 15 exhibited OCD spectrum symptoms (14.0%), anxiety was evident in 27 patients (25.2%), and 14 had signs of depression (13.1%), the study reported. Often, symptoms of more than one disorder were reported in patients.

The mean age at OCD onset was 12.1 years, but the study reported evidence of symptoms having started earlier — as young as age 5 — although not problematic until the patients were older. At the time of the study, these 15 people ranged in age from 5 to 23.

Anxiety was also more likely to affect Duchenne boys with evidence of OCD (73.3%) than is common; anxiety at notable levels is usually seen in about 50% of other young patients with OCD.

Patients’ daily life and that of their families were often unsettled by these internalized disorders. Three cases were emphasized in the study, detailing patients who began experiencing OCD symptoms at very early ages, ranging from 4 to 6.

Irritability and distress in these children significantly disturbed family routines and quality of life. Symptoms also worsened as patients grew older, but treatment with selective serotonin reuptake inhibitors (SSRIs), a common type of antidepressant, resulted in consistent improvements over time. 

Records showed that psychotherapy was recommended to all 15 OCD patients in the study — whether evaluated by psychiatrists (nine patients) or doctors in their healthcare team — but only five were getting routine treatment by a psychiatrist or a therapist.

Most, 14 of the 15, were using SSRIs prescribed to them, a finding the researchers attributed to limited access to psychotherapy or financial burden.  According to the study, SRRIs given these patients included fluoxetine, sertraline, citalopram, escitalopram, paroxetine, and clonazepam.

These medicines did not completely resolve OCD symptoms, but patients and families reported their use helpful in easing anxiety and greatly improving quality of life.

“Our data affirm that internalizing disorders are prevalent in the Duchenne muscular dystrophy population, warranting clinical attention and screening, as generally early diagnosis and treatment are associated with greater symptom improvement,” the researchers concluded.