These include: (a) preoccupation or obsession with Internet games, (b) withdrawal symptoms when not playing Internet games, (c) an increasing need over time to spend more and more time playing video games, (d) failed attempts to stop or curb Internet gaming, (e) loss of interest in other activities such as hobbies, (f) continued overuse of Internet games even with knowledge of the impact of overuse on their life, (g) lying about extent of Internet game usage, (h) uses Internet games to relieve anxiety or guilt, and (i) has lost or put at risk an opportunity or relationship because of Internet games (American Psychiatric Association [APA], 2013).
Insight in obsessive-compulsive disorder (OCD) refers to patients' recognition that their obsessions and compulsions are symptoms rather than necessary or natural thoughts and behaviors.<sup>1</sup> It has been estimated that 20% to 45% of youth with OCD exhibit poor or absent insight.<sup>2-4</sup> Identified correlates of poor insight include younger age,<sup>2,3,5,6</sup> increased OCD severity,<sup>2,4,7</sup> impairment,<sup>4,7,8</sup> and family accommodation<sup>2,4</sup>; lower intellectual and adaptive functioning<sup>3</sup>; and greater depressive symptoms.<sup>2,3</sup> Poorer insight has also been associated with reduced response across treatment groups (ie, selective serotonin reuptake inhibitor [SSRI], cognitive behavioral therapy [CBT], combined SSRI plus CBT, or pill placebo).<sup>9</sup>.
Here, we report on a patient with a de novo nonsynonymous TRRAP single-nucleotide variant (EST00000355540.3:c.5957G > A, p.Arg1986Gln) and early onset major depression accompanied by a psychotic episode (before age 10) that occurred in the context of longer standing nonverbal learning disability and a past history of obsessions and compulsions.
Nevertheless, on analyzing OCD subphenotypes, SNP rs34535804 in ESR1 and a five SNPs haplotype, located at the 5' end of intron 1 of ESR1, were associated with the presence of contamination obsessions and cleaning compulsions.
The presence of obsessions and compulsions similar to OCD in autism, the identification of this region in a genome-wide linkage analysis of individuals with autism spectrum disorders (ASDs), and the hypothesized role of glutamate in ASDs make SLC1A1 a candidate gene for ASD as well.
There is evidence that three factors (symmetry/ordering, obsessions/checking, and hoarding) are familial and preliminary evidence that repetitive rituals are associated with a functional polymorphism in the promotor region of the serotonin transporter gene (5-HTTLPR).