title: New onset obsessive-compulsive symptoms in children and adolescents with severe traumatic brain injury.
abstract: Traumatic brain injury (TBI) constitutes a major source of psychiatric morbidity and disability. This study examines new onset of obsessions and compulsions (OCS) within 1 year of severe pediatric TBI. Eighty children and adolescents ages 6-18 years with severe TBI were interviewed by a child psychiatrist using the Diagnostic Interview for Children and Adolescents-Revised to diagnose OCS and comorbidities. A brain magnetic resonance imaging used a 1.5 T scanner 3 months after injury with a T1-weighted spoiled gradient-recalled-echo sequence to provide high spatial resolution and T1- and T2(*)-contrast sensitivity. Race, sex, socioeconomic status, psychosocial adversity, and injury severity were used to predict new onset OCS. Psychiatric comorbidities and brain lesion volumes in orbitofrontal, mesial prefrontal, temporal lobe, basal ganglia, and thalamus were examined in relation to new onset OCS. Twenty-one children (21/72, 29.2%) had OCS after TBI. Most common were worries about disease, cleanliness, and inappropriate actions as well as excessive cleaning, doing things a certain way and ordering. Anxiety disorders, mania, dysthymia, depressive symptoms, and posttraumatic stress disorder were significantly associated with new onset OCS. Injury severity was not associated with new onset OCS. Greater psychosocial adversity (P=0.009), and being female (P=0.005) were associated with OCS while mesial prefrontal and temporal lobe lesions were associated with new onset obsessions (P<0.05). OCS are common after severe pediatric TBI and are associated with greater comorbidities. New onset obsessions are associated with female sex, psychosocial adversity, and mesial prefrontal and temporal lesions.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21287, USA. mjgrados@jhmi.edu
authors.forename: Marco A
authors.initials: MA
authors.lastname: Grados
authors.forename: Roma A
authors.initials: RA
authors.lastname: Vasa
authors.forename: Mark A
authors.initials: MA
authors.lastname: Riddle
authors.forename: Beth S
authors.initials: BS
authors.lastname: Slomine
authors.forename: Cynthia
authors.initials: C
authors.lastname: Salorio
authors.forename: James
authors.initials: J
authors.lastname: Christensen
authors.forename: Joan
authors.initials: J
authors.lastname: Gerring
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000150:complications* / Q000175:diagnosis / Q000523:psychology / Q000534:rehabilitation; D002648:Child; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D015600:Glasgow Coma Scale; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000523:psychology; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis* / Q000523:psychology; D012307:Risk Factors