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Concept, Diagnostic Criteria and a Future Prospective of Obsessive-Compulsive Disorder  

Roh, Dae-Young (Department of Psychiatry, Yonsei University College of Medicine)
Kim, Ji-Min (Department of Psychiatry, Yonsei University College of Medicine)
Kim, Chan-Hyung (Department of Psychiatry, Yonsei University College of Medicine)
Publication Information
Anxiety and mood / v.6, no.2, 2010 , pp. 93-101 More about this Journal
Abstract
Research on obsessive-compulsive disorder (OCD) has advanced substantially since the DSM-IV was published in 1994. It is time to reexamine the nosology of this disorder, reviewing conflicting views regarding the classification as well as subtypes and specifiers of OCD. Although there is ongoing debate, OCD experts have suggested that OCD be retained in the section related to anxiety disorders and also that along with OCD, this section include obsessive-compulsive spectrum disorders (OCSD), a group of disorders closely related to OCD. A combined 'anxiety and obsessive-compulsive spectrum chapter' has also been proposed to include OCSDs. A growing body of scientific data has provided empirical support for the inclusion of a 'tic-related' subtype of OCD in the DSM-V. However, it remains controversial as to whether to introduce OCD symptom dimensions as specifiers as well as items in the diagnostic criteria. With regard to compulsive hoarding, there has been sufficient evidence to recommend that it be classified in the DSM-V as a separate disorder. Much work remains in order to ensure that the DSM-V is as evidence based as possible. It is necessary to strive toward integrating the biological and psychological data related to OCD and OCSD based on their endophenotypic features.
Keywords
Obsessive-compulsive disorder; Obsessive-compulsive spectrum disorder; DSM-V; Symptom dimensions; Hoarding;
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1 Shulman ST. Pediatric autoimmune neuropsychiatric disorders associated with streptococci (PANDAS): Update. Curr Opin Pediatr 2009; 21:127.   DOI   ScienceOn
2 ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization;1992.
3 Nestadt G, Samuels J, Riddle M, Bienvenu III OJ, Liang KY, LaBuda M, et al. A family study of obsessive-compulsive disorder. Arch Gen Psychiatry 2000;57:358.   DOI   ScienceOn
4 Storch EA, Lack C, Merlo LJ, Marien WE, Geffken GR, Grabill K, et al. Associations between miscellaneous symptoms and symptom dimensions: an examination of pediatric obsessive-compulsive disorder. Behav Res Ther 2007;45:2593-2603.   DOI   ScienceOn
5 Wendland JR, Moya PR, Timpano KR, Anavitarte AP, Kruse MR, Wheaton MG, et al. A haplotype containing quantitative trait loci for SLC1A1 gene expression and its association with obsessive-compulsive disorder. Arch Gen Psychiatry 2009;66:408.   DOI   ScienceOn
6 McKay D, Neziroglu F. Methodological issues in the obsessive-compulsive spectrum. Psychiatry Res 2009;170:61-65.   DOI   ScienceOn
7 Lucey JV, Costa DC, Blanes T, Busatto GF, Pilowsky LS, Takei N, et al. Regional cerebral blood flow in obsessive-compulsive disordered patients at rest. Differential correlates with obsessive-compulsive and anxious-avoidant dimensions. Br J Psychiatry 1995;167:629.   DOI   ScienceOn
8 Leckman JF, Kim Y. A primary candidate gene for obsessive-compulsive disorder. Arch Gen Psychiatry 2006;63:717-720.   DOI   ScienceOn
9 Chamberlain SR, Fineberg NA, Blackwell AD, Robbins TW, Sahakian BJ. Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. Am J Psychiatry 2006;163:1282-1284.   DOI   ScienceOn
10 Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry 2000;48:287-293.   DOI   ScienceOn
11 Rosario-Campos MC, Miguel EC, Quatrano S, Chacon P, Ferrao Y, Findley D, et al. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS): an instrument for assessing obsessive-compulsive symptom dimensions. Mol Psychiatry 2006;11:495-504.   DOI   ScienceOn
12 Grados MA, Riddle MA, Samuels JF, Liang KY, Hoehn-Saric R, Bienvenu OJ, et al. The familial phenotype of obsessive-compulsive disorder in relation to tic disorders: the Hopkins OCD family study. Biol Psychiatry 2001;50:559-565.   DOI   ScienceOn
13 Kim SJ, Choi NK, Hong HJ, Hwang YS, Kim YK, Lee HS, et al. Dimensional Analyses of the Yale-Brown Obsessive-Compulsive Scale and Yale-Brown Obsessive-Compulsive Scale Checklist. Korean J Psycho-pharmacol 2004;15:339-345.
14 Pinto A, Greenberg BD, Grados MA, Bienvenu III OJ, Samuels JF, Murphy DL, et al. Further development of YBOCS dimensions in the OCD Collaborative Genetics study: symptoms vs. categories. Psychiatry Res 2008;160:83-93.   DOI   ScienceOn
15 Storch EA, McNamara J, Jordan C, Marien WE, Jacob ML, Murphy TK, et al. Associations between miscellaneous symptoms and symptom dimensions in adults with obsessive-compulsive disorder. Anxiety Stress Coping 2008;21:199-212.   DOI   ScienceOn
16 Mataix-Cols D, do Rosario-Campos MC, Leckman JF. A multidimensional model of obsessive-compulsive disorder. Am J Psychiatry 2005; 162:228.   DOI   ScienceOn
17 Richter MA, Summerfeldt LJ, Antony MM, Swinson RP. Obsessivecompulsive spectrum conditions in obsessive compulsive disorder and other anxiety disorders. Depress Anxiety 2003;18:118-127.   DOI   ScienceOn
18 Hemmings SM, Kinnear CJ, Lochner C, Seedat S, Corfield VA, Moolman- Smook JC, et al. Genetic correlates in trichotillomania--A casecontrol association study in the South African Caucasian population. Isr J Psychiatry Relat Sci 2006;43:93.
19 Keuthen NJ, Makris N, Schlerf JE, Martis B, Savage CR, McMullin K, et al. Evidence for reduced cerebellar volumes in trichotillomania. Biol Psychiatry 2007;61:374-381.   DOI   ScienceOn
20 O'Sullivan RL, Rauch SL, Breiter HC, Grachev ID, Baer L, Kennedy DN, et al. Reduced basal ganglia volumes in trichotillomania measured via morphometric magnetic resonance imaging. Biol Psychiatry 1997;42:39-45.   DOI   ScienceOn
21 http://www.psych.org/MainMenu/Research/DSMIV/DSMV/DSMRevisionActivities/ ConferenceSummaries/ObsessiveCompulsiveSpectrumDisorders Conference.aspx.
22 Taylor S, Mckay D, Abramowitz JS, Woody EZ, Szechtman H. Comment on: Is obsessive-compulsive disorder a disturbance of security motivation? By Szechtman et al. Psychol Rev 2005;112:650-661.   DOI
23 Hollander E, Kim SJ, Braun A, Simeon D, Zohar J. Cross-cutting issues and future directions for the OCD spectrum. Psychiatry Res 2009; 170:3-6.   DOI   ScienceOn
24 Leckman JF, Bloch MH, King RA. Symptom dimensions and subtypes of obsessive-compulsive disorder: a developmental perspective. Dialogues Clin Neurosci 2009;11:21-33.
25 do Rosario-Campos MC, Leckman JF, Curi M, Quatrano S, Katsovitch L, Miguel EC, et al. A family study of early-onset obsessivecompulsive disorder. Am J Med Genet B Neuropsychiatr Genet 2005; 136:92-97.
26 Holzer JC, Goodman WK, McDougle CJ, Baer L, Boyarsky BK, Leckman JF, et al. Obsessive-compulsive disorder with and without a chronic tic disorder. A comparison of symptoms in 70 patients. Br J Psychiatry 1994;164:469-473.   DOI   ScienceOn
27 Phillips KA, Stein DJ, Rauch SL, Hollander E, Fallon BA, Barsky A, et al. Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depress Anxiety 2010;27:528-555.   DOI   ScienceOn
28 Phillips KA, Hollander E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image 2008;5:13-27.   DOI   ScienceOn
29 Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Syst Rev 2009:CD-005332.
30 Neziroglu F, Khemlani-Patel S. A review of cognitive and behavioral treatment for body dysmorphic disorder. CNS Spectr 2002;7:464-471.   DOI
31 Saxena S, Feusner JD. Toward a neurobiology of body dysmorphic disorder. Prim psychiatry 2006;13:41.
32 Rotge J, Guehl D, Dilharreguy B, Cuny E, Tignol J, Bioulac B, et al. Provocation of obsessive-compulsive symptoms: a quantitative voxelbased meta-analysis of functional neuroimaging studies. J Psychiatry Neurosci 2008;33:405-412.
33 Deckersbach T, Savage CR, Phillips KA, Wilhelm S, Buhlmann U, Rauch SL, et al. Characteristics of memory dysfunction in body dysmorphic disorder. J Int Neuropsychol Soc 2000;6:673-681.   DOI   ScienceOn
34 Sherman BJ, Savage CR, Eddy KT, Blais MA, Deckersbach T, Jackson SC, et al. Strategic memory in adults with anorexia nervosa: are there similarities to obsessive compulsive spectrum disorders? Int J Eat Disord 2006;39:468-476.   DOI   ScienceOn
35 Jaisoorya TS, Janardhan R. The relationship of obsessive-compulsive disorder to putative spectrum disorders: results from an Indian study. Compr Psychiatry 2003;44:317-323.   DOI   ScienceOn
36 Miguel EC, Ferro YA, Rosario MC, de Mathis MA, Torres AR, Fontenelle LF, et al. The Brazilian Research Consortium on Obsessive- Compulsive Spectrum Disorders: recruitment, assessment instruments, methods for the development of multicenter collaborative studies and preliminary results. Rev BrasPsiquiatr Braz J Psychiatry 2008;30:185-196.
37 Fineberg NA, Gale TM. Evidence-based pharmacotherapy of obsessive- compulsive disorder. Int J Neuropsychopharmacol 2005;8:107-129.   DOI   ScienceOn
38 Stein DJ, Denys D, Gloster AT, Hollander E, Leckman JF, Rauch SL, et al. Obsessive-compulsive disorder: diagnostic and treatment issues. Psychiatr Clin North Am 2009;32:665-685.   DOI   ScienceOn
39 Arch J, Craske MG. First-line treatment: a critical appraisal of cognitive behavioral therapy developments and alternatives. Psychiatr Clin North Am 2009;32:525-547.   DOI   ScienceOn
40 Geffken GR, Storch EA, Gelfand KM, Adkins JW, Goodman WK. Cognitive-behavioral therapy for obsessive-compulsive disorder: review of treatment techniques. J Psychosoc Nurs Ment Health Serv 2004;42:44-51.
41 Mataix-Cols D, Pertusa A, Leckman JF. Issues for DSM-V: how should obsessive-compulsive and related disorders be classified? Am J Psychiatry 2007;164:1313-1314.   DOI   ScienceOn
42 McKay D, Abramowitz JS, Calamari JE, Kyrios M, Radomsky A, Sookman D, et al. A critical evaluation of obsessive-compulsive disorder subtypes: Symptoms versus mechanisms* 1. Clin Psychol Rev 2004;24:283-313.   DOI   ScienceOn
43 Stein DJ, Lochner C. Obsessive-compulsive spectrum disorders: a multidimensional approach. Psychiatr Clin North Am 2006;29:343-351.   DOI   ScienceOn
44 Joel D, Stein DJ, Schreiber R. Animal models of obsessive-compulsive disorder: from bench to bedside via endophenotypes and biomarkers. In: McArthur RA, Borsini F, editors. Animal and Translational Models for CNS Drug Discovery, Volume 1: Psychiatric Disorders. Amsterdam: Elsevier;2008.
45 Hollander E. Obsessive-compulsive related disorders: Amer Psychiatric Pub Inc;1993.
46 Phillips KA, McElroy SL, Keck PE, Pope HG, Hudson JI. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry 1993; 150:302-308.   DOI
47 Stein DJ, Fineberg NA, Bienvenu OJ, Denys D, Lochner C, Nestadt G, et al. Should OCD be classified as an anxiety disorder in DSM-V? Depress Anxiety 2010;27:495-506.   DOI   ScienceOn
48 Rauch SL, Drevets WC. Neuroimaging and neuroanatomy of stressinduced and fear circuitry disorders. In: Andrews G, Charney DS, P.J. S, Regier DA, editors. Stress-Induced and Fear Circuitry Disorders: Refining the Research Agenda for DSM-V. Arlington, VA: American Psychiatric Association;2009.
49 Rauch SL, Wedig M, Wright CI, Martis B, McMullin KG, Shin LM, et al. Functional magnetic resonance imaging study of regional brain activation during implicit sequence learning in obsessive-compulsive disorder. Biol Psychiatry 2007;61:330-336.   DOI   ScienceOn
50 Fitzgerald KD, Welsh RC, Gehring WJ, Abelson JL, Himle JA, Liberzon I, et al. Error-related hyperactivity of the anterior cingulate cortex in obsessive-compulsive disorder. Biol Psychiatry 2005;57:287-294.   DOI   ScienceOn
51 Greenberg BD, Rauch SL, Haber SN. Invasive circuitry-based neurotherapeutics: stereotactic ablation and deep brain stimulation for OCD. Neuropsychopharmacology 2009;35:317-336.
52 Cannistraro PA, Wright CI, Wedig M, Martis B, Shin LM, Wilhelm S, et al. Amygdala responses to human faces in obsessive-compulsive disorder. Biol Psychiatry 2004;56:916-920.   DOI   ScienceOn
53 Menzies L, Achard S, Chamberlain SR, Fineberg N, Chen C, del Campo N, et al. Neurocognitive endophenotypes of obsessive-compulsive disorder. Brain 2007;130:3223-3236.   DOI   ScienceOn
54 Baldwin DS, Anderson IM, Nutt DJ, Bandelow B, Bond A, Davidson JR, et al. Evidence-based guidelines for the pharmacological treatment of anxiety disorders: recommendations from the British Association for Psychopharmacology. J Psychopharmacol 2005;19:567-596.   DOI   ScienceOn
55 Stein DJ, Ipser JC, Baldwin DS, Bandelow B. Treatment of obsessivecompulsive disorder. CNS Spectr 2007;12:28-35.   DOI
56 Baxter Jr LR, Schwartz JM, Bergman KS, Szuba MP, Guze BH, Mazziotta JC, et al. Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Arch Gen Psychiatry 1992;49:681.   DOI   ScienceOn
57 Hu XZ, Lipsky RH, Zhu G, Akhtar LA, Taubman J, Greenberg BD, et al. Serotonin transporter promoter gain-of-function genotypes are linked to obsessive-compulsive disorder. Am J Hum Genet 2006;78:815-826.   DOI   ScienceOn
58 Kang DH, Kwon JS, Kim JJ, Youn T, Park HJ, Kim MS, et al. Brain glucose metabolic changes associated with neuropsychological improvements after 4 months of treatment in patients with obsessivecompulsive disorder. Acta Psychiatr Scand 2003;107:291-297.   DOI   ScienceOn
59 Alexander GE, Crutcher MD, DeLong MR. Basal ganglia-thalamocortical circuits: Parallel substrates for motor, oculomotor. Prog Brain Res 1991;85:119-146.   DOI
60 Cavallini MC, Di Bella D, Siliprandi F, Malchiodi F, Bellodi L. Exploratory factor analysis of obsessive-compulsive patients and association with 5-HTTLPR polymorphism. Am J Med Genet B Neuropsychiatr Genet 2002;114:347-353.   DOI   ScienceOn
61 Arnold PD, Rosenberg DR, Mundo E, Tharmalingam S, Kennedy JL, Richter MA. Association of a glutamate (NMDA) subunit receptor gene (GRIN2B) with obsessive-compulsive disorder: a preliminary study. Psychopharmacologia 2004;174:530-538.
62 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision ed. Washington, DC: American Psychiatric Press;2000.
63 ICD-10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research. Geneva: World Health Organization;1992.
64 Storch EA, Abramowitz J, Goodman WK. Where does obsessive-compulsive disorder belong in DSM-V? Depress Anxiety 2008;25:336-347.   DOI   ScienceOn
65 Hollander E, Braun A, Simeon D. Should OCD leave the anxiety disorders in DSM-V? The case for obsessive compulsive-related disorders. Depress Anxiety 2008;25:317-329.   DOI   ScienceOn
66 Hollander E, DeCaria CM, Nitescu A, Gully R, Suckow RF, Cooper TB, et al. Serotonergic function in obsessive-compulsive disorder: behavioral and neuroendocrine responses to oral m-chlorophenylpiperazine and fenfluramine in patients and healthy volunteers. Arch Gen Psychiatry 1992;49:21.   DOI   ScienceOn
67 Milanfranchi A, Ravagli S, Lensi P, Marazziti D, Cassano GB. A double- blind study of fluvoxamine and clomipramine in the treatment of obsessive-compulsive disorder. Int Clin Psychopharmacol 1997;12: 131.   DOI   ScienceOn
68 Zohar J, Chopra M, Sasson Y, Amiaz R, Amital D. Obsessive compulsive disorder: serotonin and beyond. World J Biol Psychiatry 2000;1: 92-100.   DOI   ScienceOn
69 Yehuda R, Voetb S, Zohara J. Serotonergic dissection of obsessive compulsive symptoms: a challenge study with m-chlorophenylpiperazine and sumatriptan. Neuropsychobiology 2004;50:200-205.   DOI   ScienceOn
70 Thoren P, Asberg M, Cronholm B, Jornestedt L, Traskman L. Clomipramine treatment of obsessive-compulsive disorder: I. A controlled clinical trial. Arch Gen Psychiatry 1980;37:1281.   DOI   ScienceOn
71 Clinical practice guidelines. Management of anxiety disorders. Can J Psychiatry 2006;51:9S-91S.   DOI
72 Kim SJ, Kim W, Yang JC, Ha TH, Koo MS, Kwon JS, et al. Korean Treatment Algorithm for Obsessive-Compulsive Disorder 2007 (II): Initial Treatment and Treatment Resistant OCD. Korean J Psychopharmacol 2007;18:347-357.
73 Koran LM, Hanna GL, Hollander E, Nestadt G, Simpson HB. Practice guideline for the treatment of patients with obsessive-compulsive disorder. Am J Psychiatry 2007;164:5-53.
74 Baxter Jr LR, Phelps ME, Mazziotta JC, Guze BH, Schwartz JM, Selin CE. Local cerebral glucose metabolic rates in obsessive-compulsive disorder: a comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry 1987;44:211.   DOI   ScienceOn
75 American Psychiatric Association, DSM-5 Development http://www.dsm5.org.
76 Shin YW, Kwon JS, Kim JJ, Kang DH, Youn T, Kang KW, et al. Altered neural circuit for working memory before and after symptom provocation in patients with obsessive-compulsive disorder. Acta Psychiatr Scand 2006;113:420-429.   DOI   ScienceOn
77 Fontenelle LF, Mendlowicz MV, Versiani M. The descriptive epidemiology of obsessive-compulsive disorder. Prog Neuropsychopharmacol Biol Psychiatry 2006;30:327-337.   DOI   ScienceOn
78 Ruscio AM, Stein DJ, Chiu WT, Kessler RC. The epidemiology of obsessive- compulsive disorder in the National Comorbidity Survey Replication. Mol Psychiatry 2008;15:53-63.
79 Burgy M. Psychopathology of obsessive-compulsive disorder: a phenomenological approach. Psychopathology 2005;38:291-300.   DOI   ScienceOn
80 Lowenfeld L. Die psychischen Zwangserscheinungen; auf klinischer Grundlage dargestellt: Bergmann;1904.
81 Insel TR. Phenomenology of obsessive compulsive disorder. J Clin Psychiatry 1990;51 Suppl:4-8; discussion 9.
82 Friedmann M. Zur Auffassung und zur Kenntnis der Zwangsideen und der isolierten uberwertigen Ideen. Zeitschrift fur die gesamte Neurologie und Psychiatrie 1914;21:333-450.   DOI
83 Friedmann M. Uber die Natur der Zwangsvorstellungen und ihre Beziehungen zum Willensproblem;1920.
84 Bleuler E, Aschaffenburg G. Dementia praecox: oder Gruppe der Schizophrenien: F. Deuticke;1911.
85 Marks IM. Review of behavioral psychotherapy, I: Obsessive-compulsive disorders. Am J Psychiatry 1981;138:584.   DOI
86 Mahony PJ. Freud's cases: are they valuable today? Int J Psychoanal 1993;74:1027-1035.
87 Frost RO, Steketee G, Tolin D, Glossner K. Diagnostic comorbidity in hoarding and OCD. World Congress of Behavioral and Cognitive Therapies. Boston;2010. p.2-5.
88 Khanna S, Channabasavanna SM. Towards a classification of compulsions in obsessive compulsive neurosis. Psychopathology 1987;20:23-28.   DOI   ScienceOn
89 Zohar J, Zohar-Kadouch RC, Kindler S. Current concepts in the pharmacological treatment of obsessive-compulsive disorder. Drugs 1992; 43:210.   DOI   ScienceOn
90 Leckman JF, Denys D, Simpson HB, Mataix-Cols D, Hollander E, Saxena S, et al. Obsessive-compulsive disorder: a review of the diagnostic criteria and possible subtypes and dimensional specifiers for DSM-V. Depress Anxiety 2010;27:507-527.   DOI   ScienceOn
91 Saxena S. Neurobiology and treatment of compulsive hoarding. CNS Spectr 2008;13:29.   DOI
92 Saxena S, Brody AL, Maidment KM, Smith EC, Zohrabi N, Katz E, et al. Cerebral glucose metabolism in obsessive-compulsive hoarding. Am J Psychiatry 2004;161:1038.   DOI   ScienceOn
93 An S, Mataix-Cols D, Lawrence NS, Wooderson S, Giampietro V, Speckens A, et al. To discard or not to discard: the neural basis of hoarding symptoms in obsessive-compulsive disorder. Mol Psychiatry 2008;14:318-331.
94 Pallanti S, Hollander E. Obsessive-compulsive disorder spectrum as a scientific "metaphor". CNS Spectr 2008;13:6-15.
95 Tolin DF, Kiehl KA, Worhunsky P, Book GA, Maltby N. An exploratory study of the neural mechanisms of decision making in compulsive hoarding. Psychol Med 2008;39:325-336.
96 Samuels J, Shugart YY, Grados MA, Willour VL, Bienvenu OJ, Greenberg BD, et al. Significant linkage to compulsive hoarding on chromosome 14 in families with obsessive-compulsive disorder: results from the OCD Collaborative Genetics Study. Am J Psychiatry 2007; 164:493.   DOI   ScienceOn
97 Mataix-Cols D, Frost RO, Pertusa A, Clark LA, Saxena S, Leckman JF, et al. Hoarding disorder: a new diagnosis for DSM-V? Depress Anxiety; 2010.
98 Cath DC, Spinhoven P, Hoogduin C, Landman A, van Woerkom T, van de Wetering B, et al. Repetitive behaviors in Tourette's syndrome and OCD with and without tics: what are the differences? Psychiatry Res 2001;101:171-185.   DOI   ScienceOn
99 Peterson BS, Pine DS, Cohen P, Brook JS. Prospective, longitudinal study of tic, obsessive-compulsive, and attention-deficit/hyperactivity disorders in an epidemiological sample. J Am Acad Child Adolesc Psychiatry 2001;40:685-695.   DOI   ScienceOn
100 Leckman JF, Cohen DJ. Tourette's syndrome: tics, obsessions, compulsions: developmental psychopathology and clinical care: John Wiley & Sons Inc;2001.
101 Gilbert DL, Kurlan R. PANDAS: Horse or zebra? Neurology 2009; 73:1252.   DOI   ScienceOn