Obsessive-compulsive disorder as a risk factor for schizophrenia: a nationwide study
Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians,...
Uložené v:
| Vydané v: | JAMA psychiatry (Chicago, Ill.) Ročník 71; číslo 11; s. 1215 |
|---|---|
| Hlavní autori: | , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
| Vydavateľské údaje: |
United States
01.11.2014
|
| Predmet: | |
| ISSN: | 2168-6238, 2168-6238 |
| On-line prístup: | Zistit podrobnosti o prístupe |
| Tagy: |
Pridať tag
Žiadne tagy, Buďte prvý, kto otaguje tento záznam!
|
| Abstract | Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians, researchers, and those with the disorders.
To assess whether patients with OCD experience an enhanced risk of developing schizophrenia and schizophrenia spectrum disorders and to determine whether a family history of OCD constitutes a risk factor for schizophrenia and schizophrenia spectrum disorders.
Using individual data from longitudinal nationwide Danish registers, we conducted a prospective cohort study with 45 million person-years of follow-up. All survival analyses were adjusted for sex, age, calendar year, parental age, and place of residence at the time of birth. A total of 3 million people born between January 1, 1955, and November 30, 2006, were followed up from January 1, 1995, through December 31, 2012. During this period, 30 556 people developed schizophrenia or schizophrenia spectrum disorders.
The presence of a prior diagnosis of OCD and the risk of a first lifetime diagnosis of schizophrenia and a schizophrenia spectrum disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals are used as measures of relative risk.
The presence of prior diagnosis of OCD was associated with an increased risk of developing schizophrenia (IRR = 6.90; 95% CI, 6.25-7.60) and schizophrenia spectrum disorders (IRR = 5.77; 95% CI, 5.33-6.22) later in life. Similarly, offspring of parents diagnosed as having OCD had an increased risk of schizophrenia (IRR = 4.31; 95% CI, 2.72-6.43) and schizophrenia spectrum disorders (IRR = 3.10; 95% CI, 2.17-4.27). The results remained significant after adjusting for family history of psychiatric disorders and the patient's psychiatric history.
A diagnosis of OCD was associated with higher rates of schizophrenia and schizophrenia spectrum disorders. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway. |
|---|---|
| AbstractList | Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians, researchers, and those with the disorders.
To assess whether patients with OCD experience an enhanced risk of developing schizophrenia and schizophrenia spectrum disorders and to determine whether a family history of OCD constitutes a risk factor for schizophrenia and schizophrenia spectrum disorders.
Using individual data from longitudinal nationwide Danish registers, we conducted a prospective cohort study with 45 million person-years of follow-up. All survival analyses were adjusted for sex, age, calendar year, parental age, and place of residence at the time of birth. A total of 3 million people born between January 1, 1955, and November 30, 2006, were followed up from January 1, 1995, through December 31, 2012. During this period, 30 556 people developed schizophrenia or schizophrenia spectrum disorders.
The presence of a prior diagnosis of OCD and the risk of a first lifetime diagnosis of schizophrenia and a schizophrenia spectrum disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals are used as measures of relative risk.
The presence of prior diagnosis of OCD was associated with an increased risk of developing schizophrenia (IRR = 6.90; 95% CI, 6.25-7.60) and schizophrenia spectrum disorders (IRR = 5.77; 95% CI, 5.33-6.22) later in life. Similarly, offspring of parents diagnosed as having OCD had an increased risk of schizophrenia (IRR = 4.31; 95% CI, 2.72-6.43) and schizophrenia spectrum disorders (IRR = 3.10; 95% CI, 2.17-4.27). The results remained significant after adjusting for family history of psychiatric disorders and the patient's psychiatric history.
A diagnosis of OCD was associated with higher rates of schizophrenia and schizophrenia spectrum disorders. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway. Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians, researchers, and those with the disorders.IMPORTANCEDespite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of these 2 disorders. Exploring the degree to which these disorders share etiological factors might provide useful implications for clinicians, researchers, and those with the disorders.To assess whether patients with OCD experience an enhanced risk of developing schizophrenia and schizophrenia spectrum disorders and to determine whether a family history of OCD constitutes a risk factor for schizophrenia and schizophrenia spectrum disorders.OBJECTIVESTo assess whether patients with OCD experience an enhanced risk of developing schizophrenia and schizophrenia spectrum disorders and to determine whether a family history of OCD constitutes a risk factor for schizophrenia and schizophrenia spectrum disorders.Using individual data from longitudinal nationwide Danish registers, we conducted a prospective cohort study with 45 million person-years of follow-up. All survival analyses were adjusted for sex, age, calendar year, parental age, and place of residence at the time of birth. A total of 3 million people born between January 1, 1955, and November 30, 2006, were followed up from January 1, 1995, through December 31, 2012. During this period, 30 556 people developed schizophrenia or schizophrenia spectrum disorders.DESIGN, SETTING, AND PARTICIPANTSUsing individual data from longitudinal nationwide Danish registers, we conducted a prospective cohort study with 45 million person-years of follow-up. All survival analyses were adjusted for sex, age, calendar year, parental age, and place of residence at the time of birth. A total of 3 million people born between January 1, 1955, and November 30, 2006, were followed up from January 1, 1995, through December 31, 2012. During this period, 30 556 people developed schizophrenia or schizophrenia spectrum disorders.The presence of a prior diagnosis of OCD and the risk of a first lifetime diagnosis of schizophrenia and a schizophrenia spectrum disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals are used as measures of relative risk.MAIN OUTCOMES AND MEASURESThe presence of a prior diagnosis of OCD and the risk of a first lifetime diagnosis of schizophrenia and a schizophrenia spectrum disorder assigned by a psychiatrist in a hospital, outpatient clinic, or emergency department setting. Incidence rate ratios (IRRs) and accompanying 95% confidence intervals are used as measures of relative risk.The presence of prior diagnosis of OCD was associated with an increased risk of developing schizophrenia (IRR = 6.90; 95% CI, 6.25-7.60) and schizophrenia spectrum disorders (IRR = 5.77; 95% CI, 5.33-6.22) later in life. Similarly, offspring of parents diagnosed as having OCD had an increased risk of schizophrenia (IRR = 4.31; 95% CI, 2.72-6.43) and schizophrenia spectrum disorders (IRR = 3.10; 95% CI, 2.17-4.27). The results remained significant after adjusting for family history of psychiatric disorders and the patient's psychiatric history.RESULTSThe presence of prior diagnosis of OCD was associated with an increased risk of developing schizophrenia (IRR = 6.90; 95% CI, 6.25-7.60) and schizophrenia spectrum disorders (IRR = 5.77; 95% CI, 5.33-6.22) later in life. Similarly, offspring of parents diagnosed as having OCD had an increased risk of schizophrenia (IRR = 4.31; 95% CI, 2.72-6.43) and schizophrenia spectrum disorders (IRR = 3.10; 95% CI, 2.17-4.27). The results remained significant after adjusting for family history of psychiatric disorders and the patient's psychiatric history.A diagnosis of OCD was associated with higher rates of schizophrenia and schizophrenia spectrum disorders. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway.CONCLUSIONS AND RELEVANCEA diagnosis of OCD was associated with higher rates of schizophrenia and schizophrenia spectrum disorders. The observed increase in risk suggests that OCD, schizophrenia, and schizophrenia spectrum disorders probably lay on a common etiological pathway. |
| Author | Nielsen, Philip R Meier, Sandra M Pedersen, Marianne G Mors, Ole Arendt, Mikkel C B Mattheisen, Manuel Petersen, Liselotte Mortensen, Preben B |
| Author_xml | – sequence: 1 givenname: Sandra M surname: Meier fullname: Meier, Sandra M organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark2National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark – sequence: 2 givenname: Liselotte surname: Petersen fullname: Petersen, Liselotte organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark2National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark – sequence: 3 givenname: Marianne G surname: Pedersen fullname: Pedersen, Marianne G organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark2National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark – sequence: 4 givenname: Mikkel C B surname: Arendt fullname: Arendt, Mikkel C B organization: Clinic for Anxiety Disorders, Aarhus University Hospital, Risskov, Denmark4Department of Psychology and Behavioral Sciences, Aarhus University, Aarhus, Denmark – sequence: 5 givenname: Philip R surname: Nielsen fullname: Nielsen, Philip R organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark2National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark – sequence: 6 givenname: Manuel surname: Mattheisen fullname: Mattheisen, Manuel organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark5Department of Biomedicine, Aarhus University, Aarhus, Denmark – sequence: 7 givenname: Ole surname: Mors fullname: Mors, Ole organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark6Research Department P, Aarhus University Hospital, Risskov, Denmark – sequence: 8 givenname: Preben B surname: Mortensen fullname: Mortensen, Preben B organization: The Lundbeck Foundation Initiative for Integrative Psychiatric Research, iPSYCH, Aarhus, Denmark2National Centre for Register-Based Research, Aarhus University, Aarhus, Denmark |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/25188738$$D View this record in MEDLINE/PubMed |
| BookMark | eNpNkF1LwzAUhoNM3Jz7C5JLbzrz0aaJdzL8gsFu5nVJm1OW2TY1aZX66404wRcO54X34ZzDuUSzznWAEKZkTQmht0fd6j5M1cHqwU9rRmgaA0rP0IJRIRPBuJz983O0CuFIoiQhKZcXaM4yKmXO5QLtd2WAEOwHJJVr-7H5sdjY4LwBj3XAGnsb3nCtq8F5XMcKcfWX6w8eOqvvItDpwbru0xrAYRjNdIXOa90EWJ36Er0-Puw3z8l29_Syud8mmgs2JJKnOQElGGEZU6WKNwmZciZNFDcSRMkh16omqqKCiBo4ZApMrmPAlGFLdPM7t_fufYQwFK0NFTSN7sCNoaCCMSIoVVlEr0_oWLZgit7bVvup-PsE-wYSh2cb |
| CitedBy_id | crossref_primary_10_1007_s10802_023_01089_2 crossref_primary_10_1016_j_schres_2023_03_024 crossref_primary_10_1177_13591045241257019 crossref_primary_10_1007_s00406_023_01642_6 crossref_primary_10_3390_brainsci14020116 crossref_primary_10_1007_s00406_018_0899_x crossref_primary_10_1002_da_22733 crossref_primary_10_1007_s00406_022_01543_0 crossref_primary_10_1002_aur_2232 crossref_primary_10_1007_s40263_015_0282_7 crossref_primary_10_1016_j_psychres_2015_07_089 crossref_primary_10_1155_2020_8824204 crossref_primary_10_1016_j_jpsychires_2024_09_006 crossref_primary_10_36290_psy_2020_013 crossref_primary_10_1016_j_neubiorev_2025_106320 crossref_primary_10_1007_s00787_025_02757_y crossref_primary_10_1016_j_jad_2024_07_123 crossref_primary_10_3389_fpsyt_2022_853428 crossref_primary_10_1007_s11920_019_1002_7 crossref_primary_10_1007_s00115_022_01332_z crossref_primary_10_1016_j_schres_2019_05_024 crossref_primary_10_3389_fpsyt_2023_1120974 crossref_primary_10_1007_s40501_016_0085_6 crossref_primary_10_1002_bsl_2486 crossref_primary_10_1016_j_psychres_2019_112583 crossref_primary_10_3389_fpsyt_2021_681701 crossref_primary_10_1016_j_schres_2022_12_013 crossref_primary_10_1891_JCP_2021_0008 crossref_primary_10_1097_NMD_0000000000001337 crossref_primary_10_1017_S1092852916000390 crossref_primary_10_1159_000526708 crossref_primary_10_1016_j_pnpbp_2023_110906 crossref_primary_10_1093_schbul_sbu169 crossref_primary_10_5093_clysa2020a13 crossref_primary_10_1016_j_schres_2021_11_038 crossref_primary_10_1007_s15005_015_1337_5 crossref_primary_10_7202_1088187ar crossref_primary_10_1001_jamanetworkopen_2023_45793 crossref_primary_10_4103_psychiatry_IndianJPsychiatry_527_18 crossref_primary_10_1177_1039856215588207 crossref_primary_10_3389_fpsyt_2022_785547 crossref_primary_10_1017_neu_2018_27 crossref_primary_10_1016_j_psychres_2017_08_070 crossref_primary_10_1097_YCO_0000000000000853 crossref_primary_10_4103_aip_aip_190_22 crossref_primary_10_1007_s00787_024_02480_0 crossref_primary_10_1002_pcn5_70103 crossref_primary_10_1016_j_heliyon_2023_e14330 crossref_primary_10_1097_WNF_0000000000000248 crossref_primary_10_1007_s00406_018_0898_y crossref_primary_10_1017_S0954579425000124 crossref_primary_10_2478_cpp_2022_0004 crossref_primary_10_1007_s11571_022_09858_3 crossref_primary_10_1017_S1092852921000560 crossref_primary_10_1016_j_schres_2019_12_032 crossref_primary_10_1007_s11920_019_1051_y crossref_primary_10_1111_acps_13665 crossref_primary_10_1002_jclp_23129 crossref_primary_10_21307_sjcapp_2016_007 crossref_primary_10_1155_2015_136835 crossref_primary_10_1016_j_schres_2019_08_014 crossref_primary_10_1016_j_eurpsy_2016_01_2425 crossref_primary_10_1016_j_jpsychires_2022_10_001 crossref_primary_10_1017_S0033291721001744 crossref_primary_10_1038_tp_2016_34 crossref_primary_10_3389_fpsyt_2019_00853 crossref_primary_10_1017_S2045796023000021 crossref_primary_10_1186_s12888_021_03554_y crossref_primary_10_3390_healthcare10101910 crossref_primary_10_3390_biom13081220 crossref_primary_10_1016_j_jocrd_2020_100539 crossref_primary_10_3389_fnins_2019_00096 crossref_primary_10_1016_j_jad_2020_06_009 crossref_primary_10_1016_j_ajp_2020_102096 crossref_primary_10_1016_j_schres_2016_01_002 crossref_primary_10_1007_s00406_021_01361_w crossref_primary_10_1007_s11682_016_9657_8 crossref_primary_10_1016_j_bpsc_2019_05_008 crossref_primary_10_1016_j_psychres_2016_09_031 crossref_primary_10_1007_s00406_019_01022_z crossref_primary_10_1007_s00451_024_00563_x crossref_primary_10_1007_s00406_018_0884_4 crossref_primary_10_1016_j_schres_2022_02_014 crossref_primary_10_1111_eip_12986 crossref_primary_10_1136_bmjopen_2017_017172 crossref_primary_10_7759_cureus_89776 crossref_primary_10_1016_j_schres_2022_06_034 crossref_primary_10_1111_eip_13594 crossref_primary_10_1093_schbul_sbw082 |
| ContentType | Journal Article |
| DBID | CGR CUY CVF ECM EIF NPM 7X8 |
| DOI | 10.1001/jamapsychiatry.2014.1011 |
| DatabaseName | Medline MEDLINE MEDLINE (Ovid) MEDLINE MEDLINE PubMed MEDLINE - Academic |
| DatabaseTitle | MEDLINE Medline Complete MEDLINE with Full Text PubMed MEDLINE (Ovid) MEDLINE - Academic |
| DatabaseTitleList | MEDLINE MEDLINE - Academic |
| Database_xml | – sequence: 1 dbid: NPM name: PubMed url: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed sourceTypes: Index Database – sequence: 2 dbid: 7X8 name: MEDLINE - Academic url: https://search.proquest.com/medline sourceTypes: Aggregation Database |
| DeliveryMethod | no_fulltext_linktorsrc |
| Discipline | Medicine |
| EISSN | 2168-6238 |
| ExternalDocumentID | 25188738 |
| Genre | Research Support, Non-U.S. Gov't Journal Article |
| GeographicLocations | Denmark |
| GeographicLocations_xml | – name: Denmark |
| GroupedDBID | -DZ 0R~ 4.4 53G 5RS 9M8 AAGZG AAYJJ ABIVO ABJNI ABPMR ACDNT ACGFS ACHQT ACNCT ADBBV ADHGD ADXHL AENEX AFCHL AHMBA ALMA_UNASSIGNED_HOLDINGS AMJDE ANMPU BRYMA C45 CGR CUY CVF EBD EBS ECM EIF EJD EMOBN EX3 HF~ KOO M5~ NPM OB2 OBH OCB OFXIZ OGEVE OHH OMH OVD PQQKQ RAJ SV3 TEORI WH7 WOW XJT ~H1 7X8 |
| ID | FETCH-LOGICAL-a362t-83470e96202529b9188684328dddd3d8e6b3e7a9f09c1606fe3e59ed7a6b329d2 |
| IEDL.DBID | 7X8 |
| ISICitedReferencesCount | 92 |
| ISICitedReferencesURI | http://www.webofscience.com/api/gateway?GWVersion=2&SrcApp=Summon&SrcAuth=ProQuest&DestLinkType=CitingArticles&DestApp=WOS_CPL&KeyUT=000344989100002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| ISSN | 2168-6238 |
| IngestDate | Thu Oct 02 06:18:08 EDT 2025 Mon Jul 21 05:39:47 EDT 2025 |
| IsPeerReviewed | true |
| IsScholarly | true |
| Issue | 11 |
| Language | English |
| LinkModel | DirectLink |
| MergedId | FETCHMERGED-LOGICAL-a362t-83470e96202529b9188684328dddd3d8e6b3e7a9f09c1606fe3e59ed7a6b329d2 |
| Notes | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
| PMID | 25188738 |
| PQID | 1622061195 |
| PQPubID | 23479 |
| ParticipantIDs | proquest_miscellaneous_1622061195 pubmed_primary_25188738 |
| PublicationCentury | 2000 |
| PublicationDate | 2014-Nov 20141101 |
| PublicationDateYYYYMMDD | 2014-11-01 |
| PublicationDate_xml | – month: 11 year: 2014 text: 2014-Nov |
| PublicationDecade | 2010 |
| PublicationPlace | United States |
| PublicationPlace_xml | – name: United States |
| PublicationTitle | JAMA psychiatry (Chicago, Ill.) |
| PublicationTitleAlternate | JAMA Psychiatry |
| PublicationYear | 2014 |
| SSID | ssj0000800438 |
| Score | 2.4546297 |
| Snippet | Despite a remarkable co-occurrence of obsessive-compulsive disorder (OCD) and schizophrenia, little is known about the clinical and etiological relationship of... |
| SourceID | proquest pubmed |
| SourceType | Aggregation Database Index Database |
| StartPage | 1215 |
| SubjectTerms | Denmark - epidemiology Family Health - statistics & numerical data Female Humans Incidence Male Obsessive-Compulsive Disorder - complications Obsessive-Compulsive Disorder - epidemiology Obsessive-Compulsive Disorder - psychology Prospective Studies Registries Risk Factors Schizophrenia - complications Schizophrenia - epidemiology Schizophrenia - etiology |
| Title | Obsessive-compulsive disorder as a risk factor for schizophrenia: a nationwide study |
| URI | https://www.ncbi.nlm.nih.gov/pubmed/25188738 https://www.proquest.com/docview/1622061195 |
| Volume | 71 |
| WOSCitedRecordID | wos000344989100002&url=https%3A%2F%2Fcvtisr.summon.serialssolutions.com%2F%23%21%2Fsearch%3Fho%3Df%26include.ft.matches%3Dt%26l%3Dnull%26q%3D |
| hasFullText | |
| inHoldings | 1 |
| isFullTextHit | |
| isPrint | |
| link | http://cvtisr.summon.serialssolutions.com/2.0.0/link/0/eLvHCXMwpV3NS8MwFA_qRLz4_TG_iOA12KRZmngREYcHN3eYsFtJmxcYSDftpv--L23nvAiCPZRCWwgvr3m_vPfr7xFyJbl0NnHAvHeKSYT8zOCAmcdonkdSWld3LXlK-n09GplBk3ArG1rlYk2sFmo3yUOO_JorITD2cNO5nb6x0DUqVFebFhqrpBUjlAlenYz0d44loCFZNbMWXGmGkV43ZJ6F8NCSUhxYXjLsZfnvWLOKOd3t_452h2w1aJPe1e6xS1ag2CMbvaaevk-Gz1mo-eKKxwK3fP4aLqlrFDmpLamlgXxO67Y8FBEuLX_S9G7wgTqf-Dl2QCux2gPy0n0Y3j-yps8Csxi-ZkzHMonAKIH4R5jMcK2VlrHQDo_YaVBZDIk1PjI5xw2Phxg6Blxi8YYwThyStWJSwDGhJgIJsclkxwXhGWO909JDrkBp44C3yeXCXin6cShO2AIm8zJdWqxNjmqjp9NacCMVQTUuifXJH94-JZthJuvfBc9Iy-NXDOdkPf-Yjcv3i8pB8Nwf9L4A02HGsw |
| linkProvider | ProQuest |
| openUrl | ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info%3Asid%2Fsummon.serialssolutions.com&rft_val_fmt=info%3Aofi%2Ffmt%3Akev%3Amtx%3Ajournal&rft.genre=article&rft.atitle=Obsessive-compulsive+disorder+as+a+risk+factor+for+schizophrenia%3A+a+nationwide+study&rft.jtitle=JAMA+psychiatry+%28Chicago%2C+Ill.%29&rft.au=Meier%2C+Sandra+M&rft.au=Petersen%2C+Liselotte&rft.au=Pedersen%2C+Marianne+G&rft.au=Arendt%2C+Mikkel+C+B&rft.date=2014-11-01&rft.eissn=2168-6238&rft.volume=71&rft.issue=11&rft.spage=1215&rft_id=info:doi/10.1001%2Fjamapsychiatry.2014.1011&rft_id=info%3Apmid%2F25188738&rft_id=info%3Apmid%2F25188738&rft.externalDocID=25188738 |
| thumbnail_l | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/lc.gif&issn=2168-6238&client=summon |
| thumbnail_m | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/mc.gif&issn=2168-6238&client=summon |
| thumbnail_s | http://covers-cdn.summon.serialssolutions.com/index.aspx?isbn=/sc.gif&issn=2168-6238&client=summon |