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Cervin M, McGuire JF, D'Souza JM, De Nadai AS, Aspvall K, Goodman WK, Andrén P, Schneider SC, Geller DA, Mataix-Cols D, Storch EA. Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis. J Child Psychol Psychiatry 2024; 65:594-609. [PMID: 38171647 DOI: 10.1111/jcpp.13934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2023] [Indexed: 01/05/2024]
Abstract
BACKGROUND Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT). METHODS PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis). RESULTS Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low. CONCLUSIONS In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.
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Affiliation(s)
| | | | | | | | - Kristina Aspvall
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | - Per Andrén
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
| | | | | | - David Mataix-Cols
- Lund University, Lund, Sweden
- Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden
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Smárason O, Højgaard DRMA, Jensen S, Storch EA, Arnkelsson GB, Wolters LH, Torp NC, Melin K, Weidle B, Nissen JB, Hybel KA, Thomsen PH, Ivarsson T, Skarphedinsson G. Long-term functional impairment in pediatric OCD after and during treatment: An analysis of distinct trajectories. Psychiatry Res 2023; 324:115223. [PMID: 37119789 DOI: 10.1016/j.psychres.2023.115223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 04/20/2023] [Accepted: 04/23/2023] [Indexed: 05/01/2023]
Abstract
The present study aimed to: (a) identify latent class trajectories of OCD-related functional impairment, before, during and over three years after stepped-care treatment in children and adolescents with OCD; (b) describe these classes according to pretreatment characteristics; (c) identify predictors of trajectory class membership and (d) examine the relationship of functional impairment trajectory classes with OCD symptom severity trajectory classes. The sample consisted of 266 children and adolescents (aged 7-17 years) with OCD, participating in the Nordic long-term OCD treatment study. Latent class growth analysis was conducted using Child Obsessive-Compulsive Impact Scale-Revised (COIS-R) data from children and parents on seven assessment points over a three-year period. A 3-class solution was identified. The largest class (70.7%) initiated treatment with lower functional impairment and obtained moderate reduction which was maintained over time. The second class (24.4%) initiated with higher functional impairment which rapidly diminished over time. The third and smallest class (4.9%), initiated with moderate functional impairment which remained stable over time. The classes differed on measures of OCD severity and comorbid symptoms. Most participants improved with treatment and maintained low levels of impairment. However, a subgroup distinguished by higher levels of ADHD symptoms, remained at pretreatment levels of impairment throughout.
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Affiliation(s)
- Orri Smárason
- University of Iceland, Faculty of Psychology, Reykjavik, Iceland.
| | - Davíð R M A Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Sanne Jensen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Eric A Storch
- Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, USA
| | | | - Lidewij H Wolters
- Accare Child Study Center, Groningen, the Netherlands; Department of Clinical Psychology and Experimental Psychopathology, University of Groningen, Groningen, the Netherlands
| | - Nor Christian Torp
- Akershus University Hospital, Oslo, Norway; Department of Child and Adolescent Psychiatry, Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway
| | - Karin Melin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Region Västra Götaland, Sahlgrenska University Hospital, Department of Child and Adolescent Psychiatry, Gothenburg, Sweden
| | - Bernhard Weidle
- Regional Center for Child Mental Health and Child Welfare, Norwegian University of Science and Technology and St. Olavs University Hospital, Trondheim, Norway
| | - Judith Becker Nissen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Katja Anna Hybel
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
| | - Per Hove Thomsen
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Denmark
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Trajectory of Change in Parental Accommodation and Its Relation to Symptom Severity and Impairment in Pediatric OCD. Child Psychiatry Hum Dev 2023; 54:232-240. [PMID: 34519945 DOI: 10.1007/s10578-021-01240-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2021] [Indexed: 01/25/2023]
Abstract
Family accommodation (FA) has been shown to relate to poorer treatment outcomes in pediatric obsessive compulsive disorder (OCD), yet few studies have examined the trajectory of change in FA throughout treatment and its relation to treatment outcomes. This study examined change in FA in relation to change in symptom severity and impairment in 63 youth receiving a family-based intervention for early-onset OCD. FA, symptom severity and functional impairment were assessed at baseline, week 5, week 9, and post-treatment (week 14). Results suggested that changes in FA in the beginning stages of treatment preceded global symptom improvement (but not OCD specific improvement) whereas changes in functional impairment preceded changes in FA. In the latter half of treatment, changes in FA preceded improvement in global and OCD specific symptom severity as well as functional impairment. These findings highlight the importance of reducing FA, especially in the later stages of treatment, in order to optimize treatment outcomes in early-onset OCD.
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Metcalfe RE, Pental P, Duke DC. Engaging Preschool and Early Elementary School-Aged Children in Exposure and Response Prevention (ERP). JOURNAL OF HEALTH SERVICE PSYCHOLOGY 2022; 48:117-125. [PMID: 35891963 PMCID: PMC9302218 DOI: 10.1007/s42843-022-00068-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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5
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Farhat LC, Vattimo EFQ, Ramakrishnan D, Levine JLS, Johnson JA, Artukoglu BB, Landeros-Weisenberger A, Asbahr FR, Cepeda SL, Comer JS, Fatori D, Franklin ME, Freeman JB, Geller DA, Grant PJ, Goodman WK, Heyman I, Ivarsson T, Lenhard F, Lewin AB, Li F, Merlo LJ, Mohsenabadi H, Peris TS, Piacentini J, Rosa-Alcázar AI, Rosa-Alcázar À, Rozenman M, Sapyta JJ, Serlachius E, Shabani MJ, Shavitt RG, Small BJ, Skarphedinsson G, Swedo SE, Thomsen PH, Turner C, Weidle B, Miguel EC, Storch EA, Mataix-Cols D, Bloch MH. Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry 2022; 61:495-507. [PMID: 34597773 DOI: 10.1016/j.jaac.2021.05.027] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 05/05/2021] [Accepted: 09/21/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. METHOD A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of ≤2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. RESULTS The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a ≥35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of ≤12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8). CONCLUSION Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.
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Affiliation(s)
- Luis C Farhat
- Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | | | - Divya Ramakrishnan
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Jessica L S Levine
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | - Jessica A Johnson
- Columbia University New York, New York; Columbia School of Nursing, New York
| | | | | | | | | | - Jonathan S Comer
- Center for Children and Families, Florida International University, Miami, Florida
| | - Daniel Fatori
- Faculdade de Medicina FMUSP, Universidade de São Paulo, Brazil
| | - Martin E Franklin
- University of Pennsylvania, Philadelphia; Rogers Memorial Hospital, Oconomowoc, Wisconsin
| | - Jennifer B Freeman
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | - Daniel A Geller
- Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | - Isobel Heyman
- Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom
| | - Tord Ivarsson
- Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Fabian Lenhard
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Adam B Lewin
- University of South Florida, Hillsborough County
| | - Fenghua Li
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut
| | | | - Hamid Mohsenabadi
- Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, IR
| | - Tara S Peris
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | - John Piacentini
- Semel Institute for Neuroscience and Human Behavior, University of California at Los Angeles
| | | | | | | | | | - Eva Serlachius
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Mohammad J Shabani
- Tehran Institute of Psychiatry, Iran University of Medical Sciences, Tehran, IR
| | | | - Brent J Small
- School of Aging Studies, University of South Florida, Hillsborough County
| | | | | | - Per Hove Thomsen
- Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; Aarhus University Hospital, Skejby, Denmark
| | - Cynthia Turner
- Primary Care Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Bernhard Weidle
- Regional Center for Child and Youth Mental Health and Child Welfare, Faculty of Medicine and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway; St. Olav's University Hospital, Trondheim, Norway
| | | | | | - David Mataix-Cols
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Sweden
| | - Michael H Bloch
- Yale Child Study Center, Yale School of Medicine, New Haven, Connecticut.
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Sharma E, Sharma LP, Balachander S, Lin B, Manohar H, Khanna P, Lu C, Garg K, Thomas TL, Au ACL, Selles RR, Højgaard DRMA, Skarphedinsson G, Stewart SE. Comorbidities in Obsessive-Compulsive Disorder Across the Lifespan: A Systematic Review and Meta-Analysis. Front Psychiatry 2021; 12:703701. [PMID: 34858219 PMCID: PMC8631971 DOI: 10.3389/fpsyt.2021.703701] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 10/20/2021] [Indexed: 11/14/2022] Open
Abstract
Comorbidities are seen with obsessive-compulsive disorder (OCD) across the lifespan. Neurodevelopmental comorbidities are common in young children, followed by mood, anxiety, and obsessive-compulsive related disorders (OCRDs) in children, adolescents and adults, and neurological and degenerative disorders in the elderly. Understanding comorbidity prevalence and patterns has clinical and research implications. We conducted a systematic review and meta-analysis on comorbidities in OCD across the lifespan, with the objective to, first, estimate age-wise pattern and prevalence of comorbidities with OCD and, second, to examine associations of demographic (age at assessment, gender distribution) and clinical characteristics (age of onset, illness severity) with comorbidities. Four electronic databases (PubMed, EMBASE, SCOPUS, and PsycINFO) were searched using predefined search terms for articles published between 1979 and 2020. Eligible studies, across age, reported original findings on comorbidities and had an OCD sample size of ≥100. We excluded studies that did not use standardised diagnostic assessments, or that excluded patients on the basis of comorbidity. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The review protocol has been registered on the International Prospective Register of Systematic Reviews. A comorbidity rate of 69% was found in a pooled sample of more than 15,000 individuals. Mood disorders (major depressive disorder), anxiety disorders (generalised anxiety disorder), neurodevelopmental disorders (NDDs) and OCRDs were the commonest comorbidities. Anxiety disorders prevailed in children, mood disorders in adults, whereas NDDs were similarly prevalent. Higher comorbidity with any psychiatric illness, NDDs, and severe mental disorders was seen in males, vs. females. Illness severity was inversely associated with rates for panic disorder, tic disorders, OCRDs, obsessive compulsive personality disorder, and anorexia nervosa. This systematic review and meta-analysis provides base rates for comorbidities in OCD across the lifespan. This has implications for comprehensive clinical evaluation and management planning. The high variability in comorbidity rates suggests the need for quality, multi-centric, large studies, using prospective designs. Systematic Review Registration: Unique Identifier: CRD42020215904.
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Affiliation(s)
- Eesha Sharma
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Lavanya P. Sharma
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Srinivas Balachander
- Obsessive-Compulsive Disorders (OCD) Clinic, Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS), Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Boyee Lin
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Harshini Manohar
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Puneet Khanna
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Cynthia Lu
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Kabir Garg
- Oxleas National Health Service (NHS) Foundation Trust, London, United Kingdom
| | - Tony Lazar Thomas
- Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, India
| | - Anthony Chun Lam Au
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Robert R. Selles
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
| | - Davíð R. M. A. Højgaard
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Skejby, Denmark
| | | | - S. Evelyn Stewart
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada
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Van Noppen B, Sassano-Higgins S, Appasani R, Sapp F. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:430-443. [PMID: 35747293 PMCID: PMC9063577 DOI: 10.1176/appi.focus.20210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.
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Affiliation(s)
- Barbara Van Noppen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Sean Sassano-Higgins
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Raghu Appasani
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Felicity Sapp
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
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8
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Jacoby RJ, Smilansky H, Shin J, Wu MS, Small BJ, Wilhelm S, Storch EA, Geller DA. Longitudinal trajectory and predictors of change in family accommodation during exposure therapy for pediatric OCD. J Anxiety Disord 2021; 83:102463. [PMID: 34428688 PMCID: PMC8925412 DOI: 10.1016/j.janxdis.2021.102463] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 06/11/2021] [Accepted: 08/03/2021] [Indexed: 11/29/2022]
Abstract
Family accommodation (FA) is key in the maintenance of OCD. However, most studies are cross-sectional, and have not identified long-term trajectories and correlates of FA changes over treatment. This study investigated changes in clinician-rated FA over 10 sessions of cognitive behavioral therapy (CBT) for 142 children with OCD, as well as several key predictors/correlates: (a) clinician-rated OCD symptom severity, (b) child- and parent-rated functional impairment, (c) parent-rated treatment expectancies, and (d) child- and parent-rated therapeutic alliance. Multi-level models indicated that FA changed significantly during treatment, with gains maintained over 6-months. Baseline clinician-rated OCD severity did not predict changes in FA. Significant interactions indicated that children with higher child- and parent-rated impairment exhibited greater FA improvements over treatment (versus children with lower impairment). Child- and parent-rated therapeutic alliance and parent-rated expectancies did not predict FA changes. Finally, FA mediated the relationship between OCD severity and parent- (but not child-) rated impairment. Reverse mediation models were also significant. Findings indicate that CBT can successfully reduce FA (a) even if children experience high OCD severity and interference in school, relationships, and family life, and (b) regardless of non-specific factors like treatment expectancies and alliance. FA reductions are an important mechanism mediating treatment response.
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Affiliation(s)
- Ryan J. Jacoby
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Hannah Smilansky
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Jin Shin
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Monica S. Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, Los Angeles, CA 90095, USA
| | - Brent J. Small
- University of South Florida, 13301 Bruce B. Downs Blvd, MHC 1346 Tampa, Florida 33612, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Eric A. Storch
- Baylor College of Medicine, 1977 Butler Blvd, Suite 4-400 Houston, TX 77030, USA
| | - Daniel A. Geller
- Massachusetts General Hospital/Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
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Sharma E, Jacob P, Dharmendra A, Reddy YCJ, Seshadri SP, Girimaji SC, Vijaysagar KJ. Preschool-onset OCD: A review of literature and clinical experience. Bull Menninger Clin 2021; 85:298-315. [PMID: 34468213 DOI: 10.1521/bumc.2021.85.3.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2-3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those treated adequately.
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Affiliation(s)
- Eesha Sharma
- Assistant professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Preeti Jacob
- Associate professor, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Apoorva Dharmendra
- PhD Scholar in Clinical Neurosciences in the Department of Clinical Neurosciences, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Y C Janardhan Reddy
- Professor in the Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Shekhar P Seshadri
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - Sathish C Girimaji
- Senior professors, National Institute of Mental Health and Neuro Sciences, Bangalore, India
| | - K John Vijaysagar
- Professor and head in the Department of Child and Adolescent Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, India
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10
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Harris O, Lloyd S, Ward J. Integrating elements of teddy bear therapy into cognitive behavioral therapy for a child with obsessive-compulsive disorder: A case study. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2021; 34:243-252. [PMID: 34057270 DOI: 10.1111/jcap.12328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/29/2021] [Accepted: 05/08/2021] [Indexed: 11/28/2022]
Abstract
PROBLEM Childhood obsessive-compulsive disorder (OCD) can chronically affect functioning across a multitude of areas. Cognitive behavioral therapy (CBT) is well-evidenced as an effective treatment option, however, there is less research on how CBT for OCD can best be adapted to meet the specific needs of younger children. Integrating CBT with forms of therapy that incorporate play and externalization may be particularly appropriate for this age group. However, more research is needed detailing how this could be carried out in clinical settings. METHODS This study meets this need by describing the treatment of an 8-year-old boy with OCD. An evidence-based CBT approach was used integrated with teddy-bear therapy (TBT). This study employs a single-case A-B design to explore the acceptability and benefits of using an integrated CBT/TBT treatment approach. FINDINGS AND CONCLUSIONS A reduction in ritualistic behavior and anxiety was seen following treatment, with qualitative feedback from the client and his family showing the inclusion of TBT to be experienced as acceptable and useful. All therapy goals were met by the end of treatment, though the parental scores on the Revised Child Anxiety and Depression Scale indicated ongoing clinically significant OCD symptoms. Implications for clinical practice and future research are discussed.
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Affiliation(s)
- Olivia Harris
- Department of Psychology, University of Bath, Bath, UK
| | - Susannah Lloyd
- Melksham Child and Adolescent Mental Health Service, Melksham Hospital, Bath, UK
| | - Jayne Ward
- Highly Specialist Family & Systemic Psychotherapist, Basingstoke Child and Adolescent Mental Health Service, Basingstoke, UK
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Piacentini J, Wu M, Rozenman M, Bennett S, McGuire J, Nadeau J, Lewin A, Sookman D, Lindsey Bergman R, Storch E, Peris T. Knowledge and competency standards for specialized cognitive behavior therapy for pediatric obsessive-compulsive disorder. Psychiatry Res 2021; 299:113854. [PMID: 33765492 DOI: 10.1016/j.psychres.2021.113854] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Although exposure-based cognitive behavior therapy (CBT) and pharmacotherapy have demonstrated efficacy for obsessive-compulsive disorder (OCD), the lack of clinicians effectively trained in these treatments significantly limit effective intervention options for affected youth. This is very unfortunate since child onset is reported by 50% of adults with OCD. To ameliorate this serious global issue the 14 nation International Obsessive-Compulsive Disorders Accreditation Task Force (ATF) of The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) has developed knowledge and competency standards recommended for specialized treatments for OCD through the lifespan. Currently available guidelines are considered by experts to be essential but insufficient because there are not enough clinicians with requisite knowledge and competencies to effectively treat OCD. This manuscript presents knowledge and competency standards recommended for specialized cognitive behavior therapy (CBT) for pediatric OCD, derived from comprehensive literature review and expert synthesis. In addition to standards covering the elements of individual CBT-based assessment and treatment, family and school interventions are addressed given the critical role these domains play in the psychosocial development of youths. The ATF standards presented in these phase two papers will be foundational to the upcoming development of certification (individuals) and accreditation (sites) for specialized treatments in OCD through the lifespan.
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Affiliation(s)
- John Piacentini
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | - Monica Wu
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA.
| | | | - Shannon Bennett
- Department of Psychiatry, Weill Cornell Medical College, NY, NY USA
| | - Joseph McGuire
- Department of Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Josh Nadeau
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, and Rogers Memorial Hospital, Oconomowoc, WI, USA
| | - Adam Lewin
- Departments of Psychiatry and Behavioral Neurosciences and Pediatrics, University of South Florida, St. Petersburg, FL, USA
| | - Debbie Sookman
- Department of Psychology, McGill University Health Center, and Department of Psychiatry, McGill University, Montreal, Quebec, CANADA
| | | | - Eric Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX USA
| | - Tara Peris
- Department of Psychiatry and Biobehavioral Sciences, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA USA
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12
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Reid JE, Laws KR, Drummond L, Vismara M, Grancini B, Mpavaenda D, Fineberg NA. Cognitive behavioural therapy with exposure and response prevention in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of randomised controlled trials. Compr Psychiatry 2021; 106:152223. [PMID: 33618297 DOI: 10.1016/j.comppsych.2021.152223] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 01/05/2021] [Accepted: 01/17/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Cognitive behavioural therapy (CBT), incorporating exposure and response prevention (ERP) is widely recognised as the psychological treatment of choice for obsessive-compulsive disorder (OCD). Uncertainty remains however about the magnitude of the effect of CBT with ERP and the impact of moderating factors in patients with OCD. METHOD This systematic review and meta-analysis assessed randomised-controlled trials of CBT with ERP in patients of all ages with OCD. The study was preregistered in PROSPERO (CRD42019122311). The primary outcome was end-of-trial OCD symptom scores. The moderating effects of patient-related and study-related factors including type of control intervention and risk of bias were examined. Additional exploratory analyses assessed the effects of treatment fidelity and impact of researcher allegiance. RESULTS Thirty-six studies were included, involving 2020 patients (537 children/adolescents and 1483 adults) with 1005 assigned to CBT with ERP and 1015 to control conditions. When compared against all control conditions, a large pooled effect size (ES) emerged in favour of CBT with ERP (g = 0.74: 95% CI = 0.51 to 0.97 k = 36), which appeared to diminish with increasing age. While CBT with ERP was more effective than psychological placebo (g = 1.13 95% CI 0.71 to 1.55, k = 10), it was no more effective than other active forms of psychological therapy (g = -0.05: 95% CI -0.27 to 0.16, k = 8). Similarly, whereas CBT with ERP was significantly superior when compared to all forms of pharmacological treatment (g = 0.36: 95% CI 0.7 to 0.64, k = 7), the effect became marginal when compared with adequate dosages of pharmacotherapy for OCD (g = 0.32: 95% CI -0.00 to 0.64, k = 6).A minority of studies (k = 8) were deemed to be at low risk of bias. Moreover, three quarters of studies (k = 28) demonstrated suspected researcher allegiance and these studies reported a large ES (g = 0.95: 95% CI 0.69 to 1.2), while those without suspected researcher allegiance (k = 8) indicated that CBT with ERP was not efficacious (g = 0.02: 95% CI -0.29 to 0.33). CONCLUSIONS A large effect size was found for CBT with ERP in reducing the symptoms of OCD, but depends upon the choice of comparator control. This meta-analysis also highlights concerns about the methodological rigor and reporting of published studies of CBT with ERP in OCD. In particular, efficacy was strongly linked to researcher allegiance and this requires further future investigation.
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Affiliation(s)
- Jemma E Reid
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK.
| | - Keith R Laws
- University of Hertfordshire, Hatfield, Hertfordshire, UK
| | | | - Matteo Vismara
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Benedetta Grancini
- University of Milan, Department of Biomedical and Clinical Sciences Luigi Sacco, Milano, Italy
| | - Davis Mpavaenda
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK
| | - Naomi A Fineberg
- University of Hertfordshire, Hatfield, Hertfordshire, UK; Hertfordshire Partnership University NHS Foundation Trust, Hertfordshire, UK; University of Cambridge School of Clinical Medicine, Cambridge, UK
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13
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Kemp J, Barker D, Benito K, Herren J, Freeman J. Moderators of Psychosocial Treatment for Pediatric Obsessive-Compulsive Disorder: Summary and Recommendations for Future Directions. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2020; 50:478-485. [DOI: 10.1080/15374416.2020.1790378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Joshua Kemp
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - David Barker
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Kristen Benito
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Jennifer Herren
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
| | - Jennifer Freeman
- Pediatric Anxiety Research Center, Alpert Medical School of Brown University
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14
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Brezinka V, Mailänder V, Walitza S. Obsessive compulsive disorder in very young children - a case series from a specialized outpatient clinic. BMC Psychiatry 2020; 20:366. [PMID: 32653035 PMCID: PMC7353707 DOI: 10.1186/s12888-020-02780-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 07/05/2020] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Paediatric obsessive-compulsive disorder (OCD) is a chronic condition often associated with severe disruptions of family functioning, impairment of peer relationships and academic performance. Mean age of onset of juvenile OCD is 10.3 years; however, reports on young children with OCD show that the disorder can manifest itself at an earlier age. Both an earlier age of onset and a longer duration of illness have been associated with increased persistence of OCD. There seems to be difficulty for health professionals to recognize and diagnose OCD in young children appropriately, which in turn may prolong the interval between help seeking and receiving an adequate diagnosis and treatment. The objective of this study is to enhance knowledge about the clinical presentation, diagnosis and possible treatment of OCD in very young children. CASE PRESENTATION We describe a prospective 6 month follow-up of five cases of OCD in very young children (between 4 and 5 years old). At the moment of first presentation, all children were so severely impaired that attendance of compulsory Kindergarten was uncertain. Parents were deeply involved in accommodating their child's rituals. Because of the children's young age, medication was not indicated. Therefore, a minimal CBT intervention for parents was offered, mainly focusing on reducing family accommodation. Parents were asked to bring video tapes of critical situations that were watched together. They were coached to reduce family accommodation for OCD, while enhancing praise and reward for adequate behaviors of the child. CY-BOCS scores at the beginning and after 3 months show an impressive decline in OCD severity that remained stable after 6 months. At 3 months follow-up, all children were able to attend Kindergarten daily, and at 6 months follow-up, every child was admitted to the next level / class. CONCLUSIONS Disseminating knowledge about the clinical presentation, diagnosis and treatment of early OCD may shorten the long delay between first OCD symptoms and disease-specific treatment that is reported as main predictor for persistent OCD.
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Affiliation(s)
- Veronika Brezinka
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland.
| | - Veronika Mailänder
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland
| | - Susanne Walitza
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital of Psychiatry Zurich, University of Zurich, Neumünsterallee 3, 8032, Zurich, Switzerland
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15
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Belschner L, Lin SY, Yamin DF, Best JR, Edalati K, McDermid J, Stewart SE. Mindfulness-based skills training group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention. Complement Ther Clin Pract 2020; 39:101098. [PMID: 32379640 DOI: 10.1016/j.ctcp.2020.101098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects. MATERIALS AND METHODS Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected. RESULTS In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction. CONCLUSION Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress. CLINICAL TRIAL REGISTRATION NUMBER NCT03212703.
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Affiliation(s)
- Laura Belschner
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Sarah Yao Lin
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Diana Franco Yamin
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - John R Best
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Kourosh Edalati
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Joanna McDermid
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Children's Hospital Centre for Mindfulness, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - S Evelyn Stewart
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Children's Hospital Centre for Mindfulness, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
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16
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Johnco C, McGuire JF, Roper T, Storch EA. A meta-analysis of dropout rates from exposure with response prevention and pharmacological treatment for youth with obsessive compulsive disorder. Depress Anxiety 2020; 37:407-417. [PMID: 31778595 DOI: 10.1002/da.22978] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/15/2019] [Accepted: 11/03/2019] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Beliefs that exposure with response prevention (ERP) is excessively distressing and will result in client dropout from treatment are commonly-cited reasons for clinicians not providing evidence-based treatment. This meta-analysis examined treatment attrition for ERP for youth with obsessive compulsive disorder (OCD) compared with other treatment modalities. METHOD A systematic literature search identified 11 randomized controlled trials (RCTs) comparing ERP to active or waitlist control conditions, 9 comparing pharmacotherapy to control, and 3 comparing ERP to pharmacotherapy for youth with OCD. RESULTS Attrition rates were low for ERP (10.24%) compared to pharmacotherapy (17.29%), active control (e.g., relaxation, metacognitive therapy; 20.63%), and pill placebo (23.49%). ERP had lower risk of attrition compared to active control conditions (RR = 0.60; p = .02), and was not significantly different to waitlist (RR = 0.80; p = .59). In head-to-head trials, there was no difference between the risk of attrition from ERP and pharmacotherapy (RR = 1.26; p = .74). Of the pharmacotherapy trials, risk of attrition from serotonin reuptake inhibitors treatment was not significantly different compared to placebo (RR = 0.94; p = .76), with no difference between antidepressants and clomipramine (p = .19). Attrition from ERP was primarily for logistical reasons, compared to lack of efficacy for relaxation and/or adverse reactions from pharmacotherapy. CONCLUSIONS Attrition from ERP is low, and is generally lower than non-ERP interventions. Given favorable attrition and efficacy data, there is little justification for appropriately-trained clinicians not to offer ERP as a first-line treatment for youth with OCD.
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Affiliation(s)
- Carly Johnco
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Joseph F McGuire
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Tegan Roper
- Department of Psychology, Centre for Emotional Health, Macquarie University, Sydney, Australia
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas
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17
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Storch EA, Schneider SC, De Nadai AS, Selles RR, McBride NM, Grebe SC, Bergez KC, Ramirez A, Viana AG, Lewin AB. A Pilot Study of Family-Based Exposure-Focused Treatment for Youth with Autism Spectrum Disorder and Anxiety. Child Psychiatry Hum Dev 2020; 51:209-219. [PMID: 31493105 DOI: 10.1007/s10578-019-00923-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Anxiety is a common and impairing condition in youth with autism spectrum disorders (ASD). Evidence supports the use of cognitive behavioral therapy for treating anxiety in this population; however, available treatment protocols may be difficult to implement outside of research settings. The present study examined the efficacy of family-based exposure-focused treatment (FET) compared to a treatment as usual (TAU) control in 32 youth aged 6-17 years with ASD and co-occurring anxiety. Fourteen youth were randomized to FET, which included 12 face-to-face weekly therapy sessions lasing 45-55 min, while 18 youth completed the TAU control where engagement in psychotherapy or pharmacotherapy was at the discretion of the families. Results strongly supported FET with a 79% (versus 0% in TAU) response rate, 86% (versus 0% in TAU) remission in primary anxiety diagnosis, and large between-group effects on clinician-rated anxiety severity and most parent-rated domains of anxiety-related impairment. Among treatment responders, 2-month follow-up supported maintenance of gains. Overall, the study supported FET as a relatively brief intervention for the treatment of anxiety in youth with ASD, although further research is needed to replicate these findings and compare FET outcomes to more comprehensive interventions.
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Affiliation(s)
- Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA.
| | - Sophie C Schneider
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | | | - Robert R Selles
- University of British Columbia and BC Children's Hospital, Vancouver, BC, Canada
| | - Nicole M McBride
- Department of Family and Preventive Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Stacey C Grebe
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Katherine C Bergez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Ana Ramirez
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza MS:350, Houston, TX, 77030, USA
| | - Andres G Viana
- Department of Psychology, University of Houston, Houston, TX, USA.,Texas Institute of Measurement, Evaluation, and Statistics, University of Houston, Houston, TX, USA
| | - Adam B Lewin
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, Saint Petersburg, FL, USA
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18
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Cost-Effectiveness of Treatment Alternatives for Treatment-Refractory Pediatric Obsessive-Compulsive Disorder. J Anxiety Disord 2020; 69:102151. [PMID: 31864218 DOI: 10.1016/j.janxdis.2019.102151] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 08/16/2019] [Accepted: 10/09/2019] [Indexed: 11/23/2022]
Abstract
PURPOSE Current guidelines for first-line treatment of childhood OCD are cognitive-behavioral therapy (CBT) utilizing exposure and response prevention (ERP), and/or antidepressant (ADM) pharmacotherapy, specifically serotonin reuptake inhibitors (SRI). Given that first-line are relatively similar in terms of clinical effectiveness, the role of costs to provide such services may help influence treatment decisions. In the case of treatment refractory pediatric OCD, this cost-effectiveness analysis (CEA) aims to further evaluate two additional, higher intensity combination therapies, namely OCD-specific Intensive Outpatient (IOP) and Partial Hospitalization Programs (PHP), to determine the additional benefits, in terms of effectiveness, that may result, and the corresponding increase in costs for these higher-intensity courses of therapy. RESULTS IOP was the most cost-effective strategy in terms of change in CY-BOCS, pre/post treatment, equal to 16.42 units, followed by PHP and CBT monotherapy augmented with ADM CBT-monotherapy augmented with additional CBT and ADM-only augmented with CBT followed closely with 15.56 and 14.75 unit improvements in CY-BOCS. IOP accomplished its superior cost-effectiveness with an Incremental Cost-Effectiveness Ratio (ICER), of $48,834, lower than either of the established willingness to Pay thresholds. CONCLUSIONS Lack of access to high fidelity, high dose CBT paired with pharmacotherapy is an issue for OCD patients and families. Among youth who were treatment non-responsive, these results indicate the superiority of a high dosage CBT strategy, indicating the need to increase access to these treatments.
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19
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Law C, Boisseau CL. Exposure and Response Prevention in the Treatment of Obsessive-Compulsive Disorder: Current Perspectives. Psychol Res Behav Manag 2019; 12:1167-1174. [PMID: 31920413 PMCID: PMC6935308 DOI: 10.2147/prbm.s211117] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 12/17/2019] [Indexed: 11/23/2022] Open
Abstract
Numerous clinical trials support the efficacy of exposure and response prevention (ERP) for the treatment of obsessive-compulsive disorder (OCD). Accordingly, ERP has been formally recognized as a first-line, evidence-based treatment for OCD. This review discusses the theoretical underpinnings of the treatment from a behavioral and neurobiological perspective and summarizes the evidence supporting the efficacy of ERP across child and adult populations. Next, we discuss predictors of ERP treatment outcome and discuss implementation strategies designed to improve feasibility and adoption. Finally, strategies to improve treatment dissemination are discussed.
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Affiliation(s)
- Clara Law
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Christina L Boisseau
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Nomani H, Mohammadpour AH, Moallem SMH, YazdanAbad MJ, Barreto GE, Sahebkar A. Anti-Androgen Drugs in the Treatment of Obsessive-Compulsive Disorder: A Systematic Review. Curr Med Chem 2019; 27:6825-6836. [PMID: 31814547 DOI: 10.2174/0929867326666191209142209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 10/24/2019] [Accepted: 10/27/2019] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study aimed to systematically investigate whether anti-androgens could significantly reduce Obsessive-Compulsive Disorder (OCD) symptoms compared to placebo or usual care in OCD patients. METHODS PubMed, EMBASE, CENTRAL and International Clinical Trials Registry Platform (ICTRP) databases were searched up to October 2018 using relevant keywords. All randomized and if not available non-randomized studies conducted on a population including OCD patients who were administered with anti-androgen, which reported changes in their symptoms, were included. The studies on compulsive hypersexuality were excluded. Required data were extracted from full-text of the included articles by two independent authors. One randomized and four non-randomized trials were found. RESULTS The only randomized trial showed that flutamide, an anti-androgen agent, was effective in reducing compulsion scores in male OCD patients with comorbid Tourette syndrome, compared to placebo. Three out of four non-randomized trials showed that different anti-androgens including finasteride, cyproterone acetate and triptorelin were effective in reducing OCD symptoms. The only study, which failed to show the efficacy of an anti-androgen agent, administered OCD patients with flutamide. Despite the positive results, available studies provide the evidence with low quality based on the Grades of Recommendation, Assessment, Development and Evaluation Working Group (GRADE) approach. CONCLUSION Available studies are not sufficient for a precise answer to our study question. There is still a need for further large randomized blinded clinical trials to evaluate the effectiveness of antiandrogens in OCD patients. It is recommended that gender, comorbidities and subscales of Yale- Brown Obsessive-Compulsive Score (Y-BOCS) should be considered in designing the studies and interpreting their results.
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Affiliation(s)
- Homa Nomani
- School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Hooshang Mohammadpour
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran,Pharmaceutical Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Mahdi Jannati YazdanAbad
- Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
| | - George E Barreto
- Department of Biological Sciences, University of Limerick, Limerick, Ireland
| | - Amirhossein Sahebkar
- Halal Research Center of IRI, FDA, Tehran, Iran,Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences,
Mashhad, Iran,Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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21
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Riise EN, Kvale G, Öst LG, Skjold SH, Hansen B. Does Family Accommodation Predict Outcome of Concentrated Exposure and Response Prevention for Adolescents? Child Psychiatry Hum Dev 2019; 50:975-986. [PMID: 31134420 DOI: 10.1007/s10578-019-00898-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Findings suggest that increased levels of family accommodation are associated with a poorer treatment outcome in obsessive-compulsive disorder (OCD). A concentrated treatment format, the Bergen 4-day treatment (B4DT), has previously demonstrated promising results in the treatment of adolescents with OCD. The present paper examined changes in family accommodation and investigated whether family accommodation predicted outcome, in a sample of 63 adolescents (age range 11-18) participating in the B4DT. There were significant reductions on CY-BOCS and FAS from pre- to post-treatment and from pre-treatment to follow-up (p < 0.001), with large within-group effect sizes on both measures. Pre-treatment levels of symptom severity or family accommodation was not found to predict outcome at post-treatment or at follow-up. Less OCD-related functional impairment at pre-treatment predicted a better outcome at both post-treatment and follow-up. The findings suggest that the B4DT significantly reduces OCD-symptoms regardless of pre-treatment levels of family accommodation or OCD severity.
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Affiliation(s)
- Eili N Riise
- Department of Clinical Psychology, University of Bergen, Bergen, Norway. .,OCD-Team, Haukeland University Hospital, Bergen, Norway.
| | - Gerd Kvale
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,OCD-Team, Haukeland University Hospital, Bergen, Norway
| | - Lars-Göran Öst
- Department of Clinical Neuroscience, The Karolinska Institute, Stockholm, Sweden.,Department of Psychology, Stockholm University, Stockholm, Sweden
| | - Solvei Harila Skjold
- OCD-Team, Haukeland University Hospital, Bergen, Norway.,Øyane Outpatient Clinic for Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Bjarne Hansen
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.,OCD-Team, Haukeland University Hospital, Bergen, Norway
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22
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Family involvement and treatment for young children with Obsessive-Compulsive Disorder: Randomized control study. Int J Clin Health Psychol 2019; 19:218-227. [PMID: 31516500 PMCID: PMC6732770 DOI: 10.1016/j.ijchp.2019.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 06/06/2019] [Indexed: 11/25/2022] Open
Abstract
Background/Objective The aim of this paper was to evaluate the diferential efficacy of cognitive behavioral family treatment in children under 8 years of age with Obsessive-Compulsive Disorder (OCD) in the reduction of obsessive-compulsive responses and secondary outcomes in three treatment conditions: (a) Treatment of parents and child, (b) Treatment of mother and child, and (c) Treatment of mother. Method Forty-four children with obsessive-compulsive disorder, aged 5.2-7.9 years old and their parents, were randomized to one of three groups in a 1:1:1 ratio. Seventy-five percent was male and 100% Caucasian (White-European). Treatment involved 12 individual sessions of is Cognitive-Behavioral Family-Based Treatment delivered. Results The three conditions produced clinical improvements in post-test and follow-up in the primary (symptom severity OCD) and secondary outcomes. The results showed no intergroup differences in variables related to OCD symptom severity, although statistically significant differences were found in groups in Internalizing and Externalizing problem, mother and fathers accomodation. Conclusions The most efficient condition was that including a greater number of family members even when there was high family accommodation. The direct involvement of the child in the psychological treatment was important in achieving better results.
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Family-Based Psychological Treatment for Obsessive Compulsive Disorder in Children and Adolescents: A Meta-analysis and Systematic Review. Clin Child Fam Psychol Rev 2019; 22:478-501. [DOI: 10.1007/s10567-019-00296-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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24
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Comer JS, Hong N, Poznanski B, Silva K, Wilson M. Evidence Base Update on the Treatment of Early Childhood Anxiety and Related Problems. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2019; 48:1-15. [PMID: 30640522 DOI: 10.1080/15374416.2018.1534208] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The controlled evaluation of treatments for early childhood anxiety and related problems has been a relatively recent area of investigation, and accordingly, trials examining early childhood anxiety treatment have not been well represented in existing systematic reviews of youth anxiety treatments. This Evidence Base Update provides the first systematic review of evidence supporting interventions specifically for the treatment of early childhood anxiety and related problems. Thirty articles testing 38 treatments in samples with mean age < 7.9 years (N = 2,228 children) met inclusion criteria. We applied Southam-Gerow and Prinstein's (2014) review criteria, which classifies families of treatments according to one of five levels of empirical support-Well-Established, Probably Efficacious, Possibly Efficacious, Experimental, and of Questionable Efficacy. We found family-based cognitive-behavioral therapy (CBT) to be a Well-Established treatment, and Group Parent CBT and Group Parent CBT + Group Child CBT to both be Probably Efficacious treatments. In contrast, play therapy and attachment-based therapy are still only Experimental treatments for early childhood anxiety, relaxation training has Questionable Efficacy, and there is no evidence to date to speak to the efficacy of individual child CBT and/or medication in younger anxious children. All 3 currently supported interventions for early childhood anxiety entail exposure-based CBT with significant parental involvement. This conclusion meaningfully differs from conclusions for treating anxiety in older childhood that highlight the well-established efficacy of individual child CBT and/or medication and that question whether parental involvement in treatment enhances outcomes.
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Affiliation(s)
- Jonathan S Comer
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Natalie Hong
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Bridget Poznanski
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Karina Silva
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
| | - Maria Wilson
- a Mental Health Interventions and Technology (MINT) Program, Center for Children and Families , Florida International University
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Kobayashi Y, Kanie A, Nakagawa A, Takebayashi Y, Shinmei I, Nakayama N, Yamaguchi K, Nakayama C, Hirabayashi N, Mimura M, Horikoshi M. An Evaluation of Family-Based Treatment for OCD in Japan: A Pilot Randomized Controlled Trial. Front Psychiatry 2019; 10:932. [PMID: 31998153 PMCID: PMC6962241 DOI: 10.3389/fpsyt.2019.00932] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 11/25/2019] [Indexed: 02/05/2023] Open
Abstract
Objective: Although family involvement in the treatment of obsessive-compulsive disorder (OCD) produces a reduction in OCD symptoms and has significant effects on global functioning, few studies have focused on family intervention as part of OCD treatment in Japan. This study aims to examine the feasibility and efficacy of the family-based exposure and response prevention (FERP) program for adult patients with OCD and their family members. Design: Randomized controlled pilot study. Methods: A total of 18 outpatients aged 18-65 years with a primary diagnosis of OCD and one family member of each patient were randomized to an intervention group or a control group (1:1). The intervention group received the FERP program, which consisted of 16 weekly face-to-face cognitive behavioral therapy (CBT) sessions, including eight joint sessions with family members, in addition to treatment-as-usual (TAU). The control group received TAU alone. The primary outcome was the alleviation of OCD symptoms, as measured by changes in the total Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score from baseline to posttreatment. Analyses were provided on an intention-to-treat basis, and linear mixed models were used to test for significant group differences. Results: After 16 weeks, patients allocated to the FERP program showed improvement in OCD symptom severity, as measured by the total change score of the Y-BOCS (Hedges' g = -1.58), as compared to the control group. Two patients (22.2%) in the FERP group reached remission, and five patients (55.6%) in the FERP group achieved treatment response. Clinical global improvement measured by the FAS-SR scores, K6 scores, and CGI-S scores was also observed (Hedges' g = -1.35, -1.25, and -1.26, respectively) in the FERP group as compared to the control group. The dropout rate from the study was low (n = 2, 11.8%), and no adverse events were reported in the FERP group. Conclusion: Our results suggest that FERP may be an effective program for reducing patients' OCD symptoms. Clinical Trial Registration: www.umin.ac.jp/ctr/, identifier UMIN000021763.
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Affiliation(s)
- Yuki Kobayashi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Ayako Kanie
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Atsuo Nakagawa
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan.,Clinical and Translational Research Center, Keio University Hospital, Tokyo, Japan
| | - Yoshitake Takebayashi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,Department of Health Risk Communication, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Issei Shinmei
- TCBT Counseling Office, Tokyo, Japan.,Department of Neurology, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Noriko Nakayama
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Keiko Yamaguchi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Chiaki Nakayama
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Naotsugu Hirabayashi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan.,National Center Hospital, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Masaru Mimura
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Masaru Horikoshi
- National Center for Cognitive Behavioral Therapy and Research, National Center of Neurology and Psychiatry, Tokyo, Japan
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26
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Wilhelm S, Berman N, Small BJ, Porth R, Storch EA, Geller D. D-Cycloserine augmentation of cognitive behavior therapy for pediatric OCD: Predictors and moderators of outcome. J Affect Disord 2018; 241:454-460. [PMID: 30149332 PMCID: PMC6129428 DOI: 10.1016/j.jad.2018.07.042] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 04/19/2018] [Accepted: 07/14/2018] [Indexed: 01/03/2023]
Abstract
BACKGROUND Over half of children receiving cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) do not fully remit. To improve response rates and enhance extinction learning, d-cycloserine (DCS) has been examined as an augmenting agent of CBT. To direct children with OCD towards treatments with the highest likelihood of success, the current study evaluated the conditions under which DCS augmentation works best (i.e., moderators) and the baseline characteristics associated with outcome, irrespective of treatment type (i.e., predictors). METHODS Data came from a two-site randomized controlled trial (N = 142) in which children received either DCS + CBT (n = 70) or placebo + CBT. RESULTS No baseline variables moderated the effects of DCS augmentation on CBT outcome. However, several predictor variables were associated with a decreased likelihood of achieving remission status, including higher family accommodation scores, higher impairment scores, higher depression scores, and higher externalizing scores. Furthermore, better insight at pre-treatment was associated with more improvement longitudinally on a clinician-rated summary measure of illness severity. LIMITATIONS The current study did not examine all variables that had previously been shown to moderate or predict treatment outcome (e.g., family history of OCD or cognitive profile). CONCLUSIONS The absence of significant moderators suggests that baseline factors cannot yet be used to determine who benefits most from DCS. To maximize treatment benefits for children presenting with identified predictors of worse treatment outcome, clinicians might need to adapt existing CBT protocols and administer additional interventions that address patients' specific problem areas.
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Affiliation(s)
- Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States.
| | - Noah Berman
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States
| | - Brent J Small
- School of Aging Studies, University of South Florida, Tampa, FL, United States
| | - Rachel Porth
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States
| | - Eric A Storch
- School of Aging Studies, University of South Florida, Tampa, FL, United States; Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, United States
| | - Daniel Geller
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States
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27
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Cancilliere MK, Freeman J, Garcia A, Benito K, Sapyta J, Franklin M. Assessing Acute Secondary Treatment Outcomes in Early-Onset Obsessive-Compulsive Disorder. Child Psychiatry Hum Dev 2018; 49:718-729. [PMID: 29435695 DOI: 10.1007/s10578-018-0786-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Obsessive-compulsive disorder (OCD) in children under 8 years of age, referred to as early-onset OCD, has similar features to OCD in older children, including moderate to severe symptoms, impairment, and significant comorbidity. Family-based cognitive behavioral therapy (FB-CBT) has been found efficacious in reducing OCD symptoms and functional impairment in children ages 5-8 years with OCD; however, its effectiveness on reducing comorbid psychiatric symptoms in this same population has yet to be demonstrated. This study examined the acute effects of FB-CBT vs. family-based relaxation treatment over 14 weeks on measures of secondary treatment outcomes (non-OCD) in children with early-onset OCD. Children in the FB-CBT condition showed significant improvements from pre- to post-treatment on secondary outcomes, with a decrease in overall behavioral and emotional problems, internalizing symptoms, as well as overall anxiety symptom severity. Neither condition yielded significant change in externalizing symptoms. Clinical implications of these findings are considered.
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Affiliation(s)
- Mary Kathryn Cancilliere
- Department of Psychology, University of Rhode Island, 10 Chafee Road, Suite 8, Kingston, RI, 02881, USA.
| | - Jennifer Freeman
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA.,Bradley-Hasbro Children's Research Center, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Abbe Garcia
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA.,Bradley-Hasbro Children's Research Center, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Kristen Benito
- Department of Psychiatry and Human Behavior, Brown University Medical School, Providence, RI, USA.,Bradley-Hasbro Children's Research Center, Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Jeffrey Sapyta
- Duke Child and Family Study Center, Duke University School of Medicine, Durham, NC, USA
| | - Martin Franklin
- Child and Adolescent OCD, Tic, Trich, and Anxiety Group, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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28
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Wu MS, Rozenman M, Peris TS, O'Neill J, Bergman RL, Chang S, Piacentini J. Comparing OCD-affected youth with and without religious symptoms: Clinical profiles and treatment response. Compr Psychiatry 2018; 86:47-53. [PMID: 30077806 PMCID: PMC6245548 DOI: 10.1016/j.comppsych.2018.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 07/14/2018] [Accepted: 07/21/2018] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND Childhood obsessive-compulsive disorder (OCD) is a heterogeneous psychiatric condition, with varied symptom presentations that have been differentially associated with clinical characteristics and treatment response. One OCD symptom cluster of particular interest is religious symptoms, including fears of offending religious figures/objects; patients affected by these symptoms have been characterized as having greater overall OCD severity and poorer treatment response. However, the extant literature primarily examines this symptom subtype within adults, leaving a gap in our understanding of this subtype in youth. METHOD Consequently, this study examined whether presence of religious symptoms in OCD-affected children and adolescents (N = 215) was associated with greater clinical impairments across OCD symptoms and severity, insight, other psychiatric comorbidity, family variables, or worse treatment response. RESULTS Results found that youth with religious OCD symptoms presented with higher OCD symptom severity and exhibited more symptoms in the aggressive, sexual, somatic, and checking symptom cluster, as well as the symmetry, ordering, counting, and repeating cluster. Religious OCD symptoms were also significantly associated with poorer insight and higher family expressiveness. No differences in treatment response were observed in youths with versus without religious OCD symptoms. CONCLUSION Ultimately, youths with religious OCD symptoms only differed from their OCD-affected counterparts without religious symptoms on a minority of clinical variables; this suggests they may be more comparable to youths without religious OCD symptoms than would be expected based on the adult OCD literature and highlights the importance of examining these symptoms within a pediatric OCD sample.
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Affiliation(s)
- Monica S Wu
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA.
| | - Michelle Rozenman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Tara S Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Joseph O'Neill
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - R Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
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29
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Freeman J, Benito K, Herren J, Kemp J, Sung J, Georgiadis C, Arora A, Walther M, Garcia A. Evidence Base Update of Psychosocial Treatments for Pediatric Obsessive-Compulsive Disorder: Evaluating, Improving, and Transporting What Works. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2018; 47:669-698. [DOI: 10.1080/15374416.2018.1496443] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Affiliation(s)
- Jennifer Freeman
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Kristen Benito
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Jennifer Herren
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Joshua Kemp
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Jenna Sung
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Christopher Georgiadis
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Aishvarya Arora
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Michael Walther
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
| | - Abbe Garcia
- Alpert Medical School of Brown University, Pediatric Anxiety Research Center, Bradley Hospital
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30
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Aspvall K, Andrén P, Lenhard F, Andersson E, Mataix-Cols D, Serlachius E. Internet-delivered cognitive behavioural therapy for young children with obsessive-compulsive disorder: development and initial evaluation of the BIP OCD Junior programme. BJPsych Open 2018; 4:106-112. [PMID: 29971153 PMCID: PMC6020306 DOI: 10.1192/bjo.2018.10] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Accepted: 01/15/2018] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Internet-delivered cognitive behavioural therapy (ICBT) is a promising approach for increasing access to evidence-based treatments. AIMS To develop and evaluate the feasibility and preliminary efficacy of an ICBT programme for young children with obsessive-compulsive disorder (OCD), named BIP OCD Junior. METHOD Eleven children aged 7-11 years were enrolled in a 12-week open trial of parent- and therapist-guided ICBT for OCD. The primary outcome measure was the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). RESULTS There was a significant improvement in OCD symptoms post-treatment, with a large within-group effect size on the CY-BOCS (Cohen's d = 1.86, 95% CI 0.83 to 2.86). Results were maintained at 3-month follow-up. Both children and parents rated the treatment as credible and were highly satisfied with the intervention. CONCLUSIONS BIP OCD Junior is a feasible and credible treatment option for young children with OCD. Randomised controlled trials are needed to further establish its efficacy and cost-effectiveness relative to gold standard face-to-face CBT. DECLARATION OF INTEREST None.
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Affiliation(s)
- Kristina Aspvall
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Fabian Lenhard
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Erik Andersson
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, and Stockholm Health Care Services, Stockholm County Council, Sweden
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31
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Zavrou S, Rudy B, Johnco C, Storch EA, Lewin AB. Preliminary study of family accommodation in 4–7 year-olds with anxiety: frequency, clinical correlates, and treatment response. J Ment Health 2018; 28:365-371. [DOI: 10.1080/09638237.2018.1466034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Sophia Zavrou
- Department of Health, University of South Florida, Tampa, FL, USA,
| | | | - Carly Johnco
- Department of Human Sciences, Macquarie University, Sydney, Australia,
| | - Eric A. Storch
- Department of Health, University of South Florida, Tampa, FL, USA,
- Rogers Behavioral Health-Tampa Bay, Tampa, FL, USA, and
- All Children’s Hospital-Johns Hopkins Medicine, St. Petersburg, FL, USA
| | - Adam B. Lewin
- Department of Health, University of South Florida, Tampa, FL, USA,
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32
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Play-Modified One-Session Treatment for Young Children with a Specific Phobia of Dogs: A Multiple Baseline Case Series. Child Psychiatry Hum Dev 2018; 49:317-329. [PMID: 28766176 DOI: 10.1007/s10578-017-0752-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The one-session treatment (OST) approach for SPs is deemed well-established, and has been found to be highly effective for older children and adults; however, has not yet been trialled with very young children. The present study examines the preliminary effectiveness of play-modified OST for young children with a SP of dogs, using a multiple baseline controlled case series design. Treatment involved play modified one-session of intensive cognitive-behavioural therapy (OST plus Play) which was followed by brief telephone delivered maintenance calls over the 3 weeks immediately following treatment. Four young children (4 years of age) participated and symptoms were assessed at pre-treatment, across a 1-3 week baseline phase, immediately following the OST plus Play, and at 1 and 3 months follow-up. Visual inspection provided evidence for stability of symptoms across the baseline phase, followed by reductions in symptoms over the course of treatment and follow-up. Non-parametric analyses offered further support, with significant improvements in following the intensive OST plus Play intervention.
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33
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Selles RR, Belschner L, Negreiros J, Lin S, Schuberth D, McKenney K, Gregorowski N, Simpson A, Bliss A, Stewart SE. Group family-based cognitive behavioral therapy for pediatric obsessive compulsive disorder: Global outcomes and predictors of improvement. Psychiatry Res 2018; 260:116-122. [PMID: 29179016 DOI: 10.1016/j.psychres.2017.11.041] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/15/2017] [Accepted: 11/14/2017] [Indexed: 11/17/2022]
Abstract
This open, uncontrolled study examined the efficacy of a group family-based cognitive behavioral therapy (GF-CBT) protocol in treating pediatric obsessive-compulsive disorder (OCD) and explored predictors of symptom improvement. Eighty-five OCD-affected youth aged 8-18 years (M = 13.9 years, SD = 2.49; 46% male) and their parent(s) participated in a weekly, 12-session GF-CBT program. Data from multiple perspectives were gathered at the beginning and end of treatment, as well as at one-month follow-up. A broad range of assessment measures were utilized to capture clinically-relevant domains and a number of potential predictor variables were explored. Paired t-tests indicated that treatment was associated with significant reductions in clinician- and parent-rated OCD severity (d = 1.47, 1.32), youth and parent-rated functional impairment (d = 0.87, 0.67), coercive/disruptive behaviors (d = 0.75), and family accommodation (d = 1.02), as well as improvements in youth-, mother-, and father-rated family functioning (d = 1.05, 0.50, 0.88). Paired t-tests also indicated that youth remained improved at one-month follow-up. Step-wise regression identified greater homework success as a significant predictor of symptom improvement. This study provides evidence that GF-CBT significantly improves a wide range of domains for youth/families that extends beyond OCD symptom severity and supports homework as a core treatment component.
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Affiliation(s)
- Robert R Selles
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada.
| | - Laura Belschner
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Juliana Negreiros
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Sarah Lin
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - David Schuberth
- BC Children's Hospital, Vancouver, BC, Canada; Simon Fraser University, Burnaby, BC, Canada
| | - Katherine McKenney
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Noel Gregorowski
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Annie Simpson
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
| | - Andrea Bliss
- Alberta Children's Hospital, Calgary, AB, Canada
| | - S Evelyn Stewart
- BC Children's Hospital, Vancouver, BC, Canada; University of British Columbia, Vancouver, BC, Canada
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34
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Miyawaki D, Goto A, Iwakura Y, Hirai K, Miki Y, Asada N, Terakawa H, Inoue K. Preschool-onset obsessive-compulsive disorder with complete remission. Neuropsychiatr Dis Treat 2018; 14:1747-1753. [PMID: 30013347 PMCID: PMC6039057 DOI: 10.2147/ndt.s169797] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Early-onset obsessive-compulsive disorder (OCD) is more severe than later-onset OCD. There are no reports of any early-onset OCD patients being cured, especially with respect to preschoolers. In this case report, we describe the successful treatment and cure of a 6-year-old preschool girl with severe OCD since the age of 3. At the age of 3, the patient began to fear contamination and danger to herself and her family, leading to excessive hand-washing, and several months later, ritualized checking. The OCD symptoms waxed and waned for about 3 years and thereafter worsened gradually over a few weeks, culminating in a refusal to eat and dress. At the age of 6, after a week of inpatient pediatric treatment with no improvement, the patient was transferred to Osaka City University Hospital to seek psychiatric treatment. The patient fully recovered from OCD following family-based cognitive-behavioral therapy (CBT) and short-term use of low-dose fluvoxamine in an inpatient setting. After treatment, the OCD symptoms disappeared with complete remission for over 3 years. Now, aged 9, the patient has good global functioning and is well adjusted in her daily life with no need for any treatment. To the best of our knowledge, this is the first report of preschool-onset OCD with long-term complete remission with inpatient treatment in a preschooler with severe OCD. Some preschoolers with very early-onset OCD may have good prognosis without continuous pharmacotherapy, although the symptoms with the onset are severe enough to require hospitalization. Preschool-onset OCD is likely to be misdiagnosed as separation anxiety disorder. Our findings suggest that family-based CBT, which is the treatment of choice for preschool-onset OCD, can be applicable to inpatient treatment. Early detection and intensive intervention of OCD in preschoolers may improve the chance of remission.
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Affiliation(s)
- Dai Miyawaki
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Ayako Goto
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Yoshihiro Iwakura
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan, .,Department of Child and Adolescent Psychiatry, Osaka City General Hospital, Osaka, Japan
| | - Kaoru Hirai
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Yusuke Miki
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Naomi Asada
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan, .,Department of Child and Adolescent Psychiatry, Osaka City General Hospital, Osaka, Japan
| | - Hiroki Terakawa
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
| | - Koki Inoue
- Department of Neuropsychiatry, Osaka City University Graduate School of Medicine, Osaka, Japan,
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Baruah U, Pandian RD, Narayanaswamy JC, Bada Math S, Kandavel T, Reddy YCJ. A randomized controlled study of brief family-based intervention in obsessive compulsive disorder. J Affect Disord 2018; 225:137-146. [PMID: 28829958 DOI: 10.1016/j.jad.2017.08.014] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Revised: 05/10/2017] [Accepted: 08/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Cognitive behaviour therapy (CBT) for Obsessive Compulsive Disorder (OCD) is therapist-intensive and prolonged making it less accessible to patients, particularly in resource-constrained situations. We examined the efficacy of a brief psychotherapeutic intervention as an adjunct to serotonin reuptake inhibitors (SRIs) in OCD. METHOD We randomized 64 adult OCD patients stabilized on SRIs to either the 6-session brief family-based intervention (BFBI; n = 30) that included psychoeducation, exposure and response prevention and family intervention or to a control arm of relaxation exercises (RE). Assessments were conducted at baseline and at 1- and 3- months post-intervention. Primary outcome measure was response to treatment defined as ≥ 35% reduction in the Yale-Brown Obsessive Compulsive Scale total score relative to baseline score plus a Clinical Global Impression- Improvement rating of very much improved or much improved. Family accommodation and expressed emotions were also assessed. RESULTS At 3- month follow-up, the BFBI group responded better than the RE group (53% vs. 12%, p < 0.001). Illness severity, family accommodation and expressed emotion declined significantly over time in the BFBI group compared to the RE group. The BFBI (OR = 13.17, p < 0.001) and baseline illness severity (OR = 0.746, p < 0.011) predicted treatment response. LIMITATIONS Sample size was small and follow-up duration was short. Control group had less time with the therapist although number of sessions was identical in both the groups. CONCLUSION Briefer intervention is effective in treating OCD. Briefer and inclusive format of intervention has important implications for clinical practice in resource-constrained circumstances.
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Affiliation(s)
- Upasana Baruah
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore 560029, Karnataka, India.
| | - R Dhanasekara Pandian
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bangalore 560029, Karnataka, India
| | - Janardhanan C Narayanaswamy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Suresh Bada Math
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Thennarasu Kandavel
- Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
| | - Y C Janardhan Reddy
- Obsessive-Compulsive Disorder Clinic, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bangalore, Karnataka, India
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Aripiprazole Monotherapy Was Effective in Treating Obsessive-Compulsive Disorder in a Preschool Boy. J Clin Psychopharmacol 2017; 37:636-637. [PMID: 28786825 DOI: 10.1097/jcp.0000000000000748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Iniesta-Sepúlveda M, Rosa-Alcázar AI, Sánchez-Meca J, Parada-Navas JL, Rosa-Alcázar Á. Cognitive-behavioral high parental involvement treatments for pediatric obsessive-compulsive disorder: A meta-analysis. J Anxiety Disord 2017; 49:53-64. [PMID: 28431305 DOI: 10.1016/j.janxdis.2017.03.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/16/2017] [Accepted: 03/30/2017] [Indexed: 01/04/2023]
Abstract
A meta-analysis on the efficacy of cognitive-behavior-family treatment (CBFT) on children and adolescents with obsessive-compulsive disorder (OCD) was accomplished. The purposes of the study were: (a) to estimate the effect magnitude of CBFT in ameliorating obsessive-compulsive symptoms and reducing family accommodation on pediatric OCD and (b) to identify potential moderator variables of the effect sizes. A literature search enabled us to identify 27 studies that fulfilled our selection criteria. The effect size index was the standardized pretest-postest mean change index. For obsessive-compulsive symptoms, the adjusted mean effect size for CBFT was clinically relevant and statistically significant in the posttest (dadj=1.464). For family accommodation the adjusted mean effect size was also positive and statistically significant, but in a lesser extent than for obsessive-compulsive symptoms (dadj=0.511). Publication bias was discarded as a threat against the validity of the meta-analytic results. Large heterogeneity among effect sizes was found. Better results were found when CBFT was individually applied than in group (d+=2.429 and 1.409, respectively). CBFT is effective to reduce obsessive-compulsive symptoms, but offers a limited effect for family accommodation. Additional modules must be included in CBFT to improve its effectiveness on family accommodation.
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Affiliation(s)
| | - Ana I Rosa-Alcázar
- Dept. Personality, Assessment & Psychological Treatment, University of Murcia, Spain.
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Halldorsson B, Salkovskis PM. Why Do People with OCD and Health Anxiety Seek Reassurance Excessively? An Investigation of Differences and Similarities in Function. COGNITIVE THERAPY AND RESEARCH 2017; 41:619-631. [PMID: 28751797 PMCID: PMC5504131 DOI: 10.1007/s10608-016-9826-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Excessive reassurance seeking (ERS) is commonly reported in patients who have OCD or health anxiety. Despite its prevalence and associated risk of ongoing difficulties, little is known about the function of ERS. It has been conceptualised as a type of compulsive checking behaviour, but could also be seen as being a supportive maneuver. This study offers a new approach towards defining ERS and support seeking (SS), and similarities between these two constructs in a sample of OCD and health anxious patients. A semi-structured interview was employed. Participants reflected on the nature and goals of their reassurance and support seeking-its impact on themselves and other people. Twenty interviews were conducted, transcribed and analysed in accordance to framework thematic analysis. Six overarching themes were identified in terms of ERS and five for SS. Results revealed limited diagnosis specificity of ERS. Strikingly, participants with health anxiety did not report seeking support.
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Affiliation(s)
- Brynjar Halldorsson
- Department of Psychology, University of Bath, Bath, UK
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, UK
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A preliminary study of cognitive-behavioral family-based treatment versus parent training for young children with obsessive-compulsive disorder. J Affect Disord 2017; 208:265-271. [PMID: 27792972 DOI: 10.1016/j.jad.2016.09.060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 09/07/2016] [Accepted: 09/27/2016] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cognitive-Behavioral Family-Based Treatment (CBFT) is the standard of care in young children with OCD. Developmental considerations, parent desires, and cost-effective advantages motivate research to explore the relative efficacy of parent-only interventions. The main goal in this study was to test the effectiveness and feasibility of a parent only intervention for OCD in young children, comparing, in a preliminary fashion the relative efficacy of reducing obsessive-compulsive symptoms through two treatment conditions: 1) an individual CBFT for early OCD involving both parents and children, and 2) the family component of the intervention involving only individual Parent Training (PT). METHODS Twenty treatment-seeking families from two private outpatient clinics in Spain were alternately assigned to one of the two treatment conditions. Participants had a primary diagnosis of OCD and a mean age of 6.62 years (65% males). Interventions were conducted by the same therapist and the assessments were administered by independent clinicians who were blind to the experimental conditions of the participants. Assessment time-points were pretreatment, posttreatment, and 3-month follow-up (including diagnosis, symptom severity, global functioning, family accommodation, externalizing and internalizing symptoms, and satisfaction measures). RESULTS The two ways of implementation, involving child and parents (CBFT) or involving only parents (PT), produced clinical improvements and were well-accepted by parents and children. The CBFT condition was superior to the PT condition in reducing externalizing problems. LIMITATIONS reduced sample size and absence of randomization were the main limitations of this study. CONCLUSIONS these results suggest, in a preliminary manner, that the need to have the child present at session with the clinician could be decreased for some children, as well as the overall feasibility of working only with parents for the implementation of CBT for OCD in very young children.
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Vloet TD, Herpertz-Dahlmann B, Simons M. [New developments in the psychotherapeutic and pharmacological treatment of pediatric obsessivecompulsive disorder]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2017; 45:9-22. [PMID: 27299378 DOI: 10.1024/1422-4917/a000445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Den Goldstandard in der Behandlung von Zwangsstörungen im Kindes- und Jugendalter stellen die kognitiv-behaviorale Therapie sowie die Medikation mit selektiven Serotonin-Wiederaufnahmehemmern dar. In den letzten Jahren wurden vermehrt auch alternative psychotherapeutische und v. a. psychopharmakologische Behandlungsstrategien untersucht, die möglicherweise bei therapieresistenten Zwangsstörungen erfolgreich sein könnten. Die vorliegende Übersichtsarbeit fasst diese neuen Entwicklungen zusammen, wobei ein Schwerpunkt auf expositionsbezogene psychotherapeutische bzw. pharmakologische Ansätze im glutamatergen System gelegt wurde. Hinsichtlich neuer pharmakologischer Behandlungsoptionen bei Kindern und Jugendlichen unterstreicht die derzeitige Datenlage, v. a. im Hinblick auf den Grad der nachgewiesenen Evidenz sowie mögliche unerwünschte Nebenwirkungen, die Bedeutung einer optimal durchgeführten Kombinationstherapie. Dabei kann diese einer Monotherapie mit kognitiv-behavioraler Therapie im Einzelfall überlegen sein. Eine grundsätzliche Überlegenheit der Kombinationstherapie ist derzeit allerdings nicht nachgewiesen.
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Affiliation(s)
- Timo D Vloet
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
- 2 Lehr- und Forschungsgebiet Klinische Neuropsychologie des Kindes- und Jugendalters an der Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes und Jugendalters, Universitätsklinikum der RWTH Aachen
| | - Beate Herpertz-Dahlmann
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
| | - Michael Simons
- 1 Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Universitätsklinikum der RWTH Aachen
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Storch EA, Johnco C, McGuire JF, Wu MS, McBride NM, Lewin AB, Murphy TK. An initial study of family accommodation in children and adolescents with chronic tic disorders. Eur Child Adolesc Psychiatry 2017; 26:99-109. [PMID: 27277754 DOI: 10.1007/s00787-016-0879-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/01/2016] [Indexed: 12/15/2022]
Abstract
This initial study examined the nature, incidence, and clinical correlates of family accommodation in youth with tic disorders, and validated a brief self-report measure of tic-related family accommodation, the Tic Family Accommodation Scale (TFAS). Seventy-five youth aged 6-18 who were diagnosed with a tic disorder and their parent completed a diagnostic clinical interview, and clinician and parent-report measures of tic severity, depressive symptoms, anxiety symptoms, behavioral problems, family accommodation and impairment. An exploratory factor analysis of the TFAS showed a two-factor structure, with good internal consistency for the Total score, Modification of Child Environment and Modification of Parent Environment subscales (α = 0.88, 0.86, and 0.81, respectively). Family accommodation was not associated with tic severity. Family accommodation was associated with increased anxiety and depressive symptoms, higher externalizing, rule breaking, aggressive behaviors and social problems, and with greater tic-related functional impairment. Anxiety and externalizing problems (but not depressive symptoms) predicted family accommodation when controlling for tic severity. Family accommodation predicted high levels of functional impairment over and above the effect of tic severity, anxiety, depression and externalizing problems. Family accommodation is a common phenomenon for youth with tic disorders, with modifications typically encompassing changes to the child and/or parent environments. Accommodation was not associated with tic severity, but was related to higher levels of anxiety, depressive symptoms, externalizing symptoms, aggression, and rule breaking behaviors. Results suggest that other emotional symptoms are more likely to drive accommodation practices than the tic symptoms per se.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA.
- Department of Health Policy and Management, University of South Florida, Tampa, USA.
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA.
- Department of Psychology, University of South Florida, Tampa, USA.
- Rogers Behavioral Health, Tampa Bay, Tampa, USA.
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA.
| | - Carly Johnco
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Joseph F McGuire
- Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, USA
| | - Monica S Wu
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Nicole M McBride
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
| | - Adam B Lewin
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- Department of Psychology, University of South Florida, Tampa, USA
| | - Tanya K Murphy
- Department of Pediatrics, University of South Florida, Box 7523, 880 6th Street South, St. Petersburg, FL, 33701, USA
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, USA
- All Children's Hospital, Johns Hopkins Medicine, St. Petersburg, USA
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Öst LG, Riise EN, Wergeland GJ, Hansen B, Kvale G. Cognitive behavioral and pharmacological treatments of OCD in children: A systematic review and meta-analysis. J Anxiety Disord 2016; 43:58-69. [PMID: 27632568 DOI: 10.1016/j.janxdis.2016.08.003] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Revised: 08/12/2016] [Accepted: 08/12/2016] [Indexed: 12/15/2022]
Abstract
Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children's Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT+SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings.
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Affiliation(s)
- Lars-Göran Öst
- Department of Clinical Neuroscience, The Karolinska Institute, Stockholm, Sweden; Department of Psychology, Stockholm University, Sweden; Department of Clinical Psychology, University of Bergen, Norway.
| | - Eili N Riise
- Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
| | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Bjarne Hansen
- Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
| | - Gerd Kvale
- Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway
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Wu MS, Storch EA. A Case Report of Harm-Related Obsessions in Pediatric Obsessive-Compulsive Disorder. J Clin Psychol 2016; 72:1120-1128. [DOI: 10.1002/jclp.22392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
| | - Eric A. Storch
- University of South Florida
- Rogers Behavioral Health
- All Children's Hospital-Johns Hopkins Medicine
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Wu MS, Storch EA. Personalizing cognitive-behavioral treatment for pediatric obsessive-compulsive disorder. EXPERT REVIEW OF PRECISION MEDICINE AND DRUG DEVELOPMENT 2016. [DOI: 10.1080/23808993.2016.1209972] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Monica S. Wu
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Psychiatry, UCLA Semel Institute for Neuroscience and Human Behavior, Los Angeles, CA, USA
| | - Eric A. Storch
- Department of Pediatrics, University of South Florida, St. Petersburg, FL, USA
- Department of Psychology, University of South Florida, Tampa, FL
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, FL, USA
- Department of Health Management and Policy, University of South Florida, Tampa, FL, USA
- Rogers Behavioral Health – Tampa Bay, Tampa, FL, USA
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Halvaiepour Z, Nosratabadi M, Khanzadeh M. External criticism by parents and obsessive beliefs in adolescents in Iran: the mediating role of emotional self-regulation. Int J Adolesc Med Health 2016; 29:/j/ijamh.ahead-of-print/ijamh-2016-0016/ijamh-2016-0016.xml. [PMID: 27299199 DOI: 10.1515/ijamh-2016-0016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/30/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is considered to be a significant impairment in childhood and adolescence. According to cognitive theories, parents' external criticism and emotional self-regulation are among the variables that can directly or indirectly affect obsessive beliefs. OBJECTIVE The present study aimed to examine the mediating role of emotional self-regulation in the relationship between parents' external criticism and obsessive beliefs in adolescents. METHODS In this study, 547 high school students aged between 15 and 18 years were selected using multi-stage cluster random sampling. An obsessive beliefs questionnaire-child version (OBQ-CV), a self-regulatory orientations scale, and a perceived criticism questionnaire were used to collect data. Pearson's correlation was used to investigate the relationship between the study variables. For analysis of the mediation model, structural equation modeling using the AMOS software was employed. RESULTS The fitness indices for the four-factor structure of the OBQ, two-factor structure of the emotional self-regulation instrument, and single-factor structure of parents' external criticism were reported as favorable [root mean square error of approximation (RMSEA)<0.1]. External criticism was associated only indirectly with obsessive beliefs through emotional self-regulation. The two variables of emotional self-regulation and external criticism explained 47% of the variance in obsessive beliefs. CONCLUSION This study showed that self-regulation can mediate in the relationship between parents' external criticism and obsessive beliefs in adolescents that could have implications for parents' behaviors and positive emotional regulatory processes. In order to identify other potential mechanisms of parents' criticism on obsessive beliefs, further studies are necessary, especially in clinical samples.
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A meta-analysis of family accommodation and OCD symptom severity. Clin Psychol Rev 2016; 45:34-44. [DOI: 10.1016/j.cpr.2016.03.003] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/07/2016] [Accepted: 03/14/2016] [Indexed: 11/23/2022]
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McMurtry CM, Taddio A, Noel M, Antony MM, Chambers CT, Asmundson GJG, Pillai Riddell R, Shah V, MacDonald NE, Rogers J, Bucci LM, Mousmanis P, Lang E, Halperin S, Bowles S, Halpert C, Ipp M, Rieder MJ, Robson K, Uleryk E, Votta Bleeker E, Dubey V, Hanrahan A, Lockett D, Scott J. Exposure-based Interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research. Cogn Behav Ther 2016; 45:217-35. [PMID: 27007463 PMCID: PMC4867871 DOI: 10.1080/16506073.2016.1157204] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 02/09/2016] [Indexed: 12/20/2022]
Abstract
Needle fear typically begins in childhood and represents an important health-related issue across the lifespan. Individuals who are highly fearful of needles frequently avoid health care. Although guidance exists for managing needle pain and fear during procedures, the most highly fearful may refuse or abstain from such procedures. The purpose of a clinical practice guideline (CPG) is to provide actionable instruction on the management of a particular health concern; this guidance emerges from a systematic process. Using evidence from a rigorous systematic review interpreted by an expert panel, this CPG provides recommendations on exposure-based interventions for high levels of needle fear in children and adults. The AGREE-II, GRADE, and Cochrane methodologies were used. Exposure-based interventions were included. The included evidence was very low quality on average. Strong recommendations include the following. In vivo (live/in person) exposure-based therapy is recommended (vs. no treatment) for children seven years and older and adults with high levels of needle fear. Non-in vivo (imaginal, computer-based) exposure (vs. no treatment) is recommended for individuals (over seven years of age) who are unwilling to undergo in vivo exposure. Although there were no included trials which examined children < 7 years, exposure-based interventions are discussed as good clinical practice. Implementation considerations are discussed and clinical tools are provided. Utilization of these recommended practices may lead to improved health outcomes due to better health care compliance. Research on the understanding and treatment of high levels of needle fear is urgently needed; specific recommendations are provided.
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Affiliation(s)
- C. Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph, Canada
- Pediatric Chronic Pain Program, McMaster Children’s Hospital, Hamilton, Canada
- Children’s Health Research Institute, London, Canada
- Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Anna Taddio
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- The Hospital for Sick Children, Toronto, Canada
| | - Melanie Noel
- Department of Psychology, University of Calgary, Calgary, Canada
- Alberta Children’s Hospital Research Institute, Calgary, Canada
| | | | - Christine T. Chambers
- Department of Pediatrics, Department of Psychology and Neuroscience, Dalhousie University, Halifax, Canada
- The Centre for Pediatric Pain Research, IWK Health Centre, Halifax, Canada
| | | | - Rebecca Pillai Riddell
- The Hospital for Sick Children, Toronto, Canada
- Department of Psychology, York University, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Vibhuti Shah
- Mount Sinai Hospital, Toronto, Canada
- Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Noni E. MacDonald
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
| | - Jess Rogers
- Centre for Effective Practice, Toronto, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada
| | - Lucie M. Bucci
- Immunize Canada, Ottawa, Canada
- Canadian Public Health Association, Ottawa, Canada
| | | | - Eddy Lang
- Alberta Health Services and the Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Scott Halperin
- Department of Pediatrics, Dalhousie University, Halifax, Canada
- IWK Health Centre, Halifax, Canada
- Canadian Center for Vaccinology, Halifax, Canada
- Department of Microbiology & Immunology, Dalhousie University, Halifax, Canada
| | - Susan Bowles
- College of Pharmacy, Dalhousie University, Halifax, Canada
| | - Christine Halpert
- Immunization Programs and Vaccine Preventable Diseases Service, BC Centre for Disease Control, Vancouver, Canada
| | - Moshe Ipp
- The Hospital for Sick Children, Toronto, Canada
- Faculty of Medicine, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Michael J. Rieder
- Departments of Paediatrics, Physiology & Pharmacology and Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Kate Robson
- Canadian Family Advisory Network, Toronto, Canada
| | | | | | | | - Anita Hanrahan
- Communicable Disease Control, Alberta Health Services, Edmonton, Canada
| | - Donna Lockett
- Bodhi Seed Center for Healing and Conscious Living, Milton, Canada
| | - Jeffrey Scott
- Department of Emergency Medicine, IWK Health Centre, Halifax, Canada
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Skriner LC, Freeman J, Garcia A, Benito K, Sapyta J, Franklin M. Characteristics of Young Children with Obsessive-Compulsive Disorder: Baseline Features from the POTS Jr. Sample. Child Psychiatry Hum Dev 2016; 47:83-93. [PMID: 25820921 DOI: 10.1007/s10578-015-0546-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pediatric obsessive-compulsive disorder (OCD) is a chronic and impairing condition that can emerge early in childhood and persist into adulthood. The primary aim of this paper is to examine the characteristics of a large sample of young children with OCD (age range from 5 to 8). The sample will be described with regard to: demographics, OCD symptoms/severity, family history and parental psychopathology, comorbidity, and global and family functioning. The sample includes 127 youth with a primary diagnosis of OCD who participated in a multi-site, randomized control clinical trial of family-based exposure with response prevention. Key findings include moderate to severe OCD symptoms, high rates of impairment, and significant comorbidity, despite the participants' young age. Discussion focuses on how the characteristics of young children compare with older youth and with the few other samples of young children with OCD. Considerations regarding generalizability of the sample and limitations of the study are discussed.
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Affiliation(s)
- L C Skriner
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI, USA.
| | - J Freeman
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI, USA
| | - A Garcia
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI, USA
| | - K Benito
- Department of Psychiatry and Human Behavior, Bradley/Hasbro Children's Research Center, Alpert Medical School of Brown University, Providence, RI, USA
| | - J Sapyta
- Duke Child and Family Study Center, Duke University School of Medicine, Durham, NC, USA
| | - M Franklin
- Child & Adolescent OCD, Tic, Trich & Anxiety Group, University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Lebowitz ER, Panza KE, Bloch MH. Family accommodation in obsessive-compulsive and anxiety disorders: a five-year update. Expert Rev Neurother 2015; 16:45-53. [PMID: 26613396 PMCID: PMC4895189 DOI: 10.1586/14737175.2016.1126181] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Family accommodation describes changes that individuals make to their behavior, to help their relative who is dealing with a psychiatric and/or psychological disorder(s), avoid or alleviate distress related to the disorder. Research on family accommodation has advanced rapidly. In this update we aim to provide a synthesis of findings from the past five years. A search of available, peer-reviewed, English language papers was conducted through PubMed and PsycINFO, cross referencing psychiatric disorders with accommodation and other family-related terms. The resulting 121 papers were individually reviewed and evaluated and the main findings were discussed. Family accommodation is common in obsessive-compulsive disorder (OCD) and in anxiety disorders, and manifests similarly across these disorders. Family accommodation is associated with more severe psychopathology and poorer clinical outcomes. Treatments have begun to focus on the reduction of family accommodation as a primary therapeutic goal and finally, neurobiological underpinnings of family accommodation are beginning to be investigated.
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Affiliation(s)
- Eli R. Lebowitz
- Yale Child Study Center, Yale University, New Haven, CT, USA
| | - Kaitlyn E. Panza
- Department of Psychology, Arizona State University, Tempe, AZ, USA
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