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Younger DS. Pediatric neuropsychiatric disorders with motor and nonmotor phenomena. HANDBOOK OF CLINICAL NEUROLOGY 2023; 196:367-387. [PMID: 37620079 DOI: 10.1016/b978-0-323-98817-9.00028-4] [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: 08/26/2023]
Abstract
The concept of pediatric autoimmune neuropsychiatric disorders associated with group A beta-hemolytic streptococcus (PANDAS) has become seminal since first introduced more than two decades ago. At the time of this writing, most neurologists, pediatricians, psychiatrists, and general pediatricians will probably have heard of this association or treated an affected child with PANDAS. The concept of an acute-onset, and typically self-limited, postinfectious autoimmune neuropsychiatric disorder resembling PANDAS manifesting vocal and motor tics and obsessive-compulsive disorder has broadened to other putative microbes and related endogenous and exogenous disease triggers. These disorders with common features of hypometabolism in the medial temporal lobe and hippocampus in brain 18fluorodeoxyglucose positron emission tomography fused to magnetic resonance imaging (FDG PET-MRI), form a spectrum: with the neuropsychiatric disorder Tourette syndrome and PANDAS with its well-defined etiopathogenesis at one end, and pediatric abrupt-onset neuropsychiatric syndrome (PANS), alone or associated with specific bacterial and viral pathogens, at the other end. The designation of PANS in the absence of a specific trigger, as an exclusionary diagnosis, reflects the current problem in nosology.
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Affiliation(s)
- David S Younger
- Department of Clinical Medicine and Neuroscience, CUNY School of Medicine, New York, NY, United States; Department of Medicine, Section of Internal Medicine and Neurology, White Plains Hospital, White Plains, NY, United States.
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2
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Tan V, Dockstader C, Moxon-Emre I, Mendlowitz S, Schacter R, Colasanto M, Voineskos AN, Akingbade A, Nishat E, Mabbott DJ, Arnold PD, Ameis SH. Preliminary Observations of Resting-State Magnetoencephalography in Nonmedicated Children with Obsessive-Compulsive Disorder. J Child Adolesc Psychopharmacol 2022; 32:522-532. [PMID: 36548364 PMCID: PMC9917323 DOI: 10.1089/cap.2022.0036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background: Cortico-striato-thalamo-cortical (CSTC) network alterations are hypothesized to contribute to symptoms of obsessive-compulsive disorder (OCD). To date, very few studies have examined whether CSTC network alterations are present in children with OCD, who are medication naive. Medication-naive pediatric imaging samples may be optimal to study neural correlates of illness and identify brain-based markers, given the proximity to illness onset. Methods: Magnetoencephalography (MEG) data were analyzed at rest, in 18 medication-naive children with OCD (M = 12.1 years ±2.0 standard deviation [SD]; 10 M/8 F) and 13 typically developing children (M = 12.3 years ±2.2 SD; 6 M/7 F). Whole-brain MEG-derived resting-state functional connectivity (rs-fc), for alpha- and gamma-band frequencies were compared between OCD and typically developing (control) groups. Results: Increased MEG-derived rs-fc across alpha- and gamma-band frequencies was found in the OCD group compared to the control group. Increased MEG-derived rs-fc at alpha-band frequencies was evident across a number of regions within the CSTC circuitry and beyond, including the cerebellum and limbic regions. Increased MEG-derived rs-fc at gamma-band frequencies was restricted to the frontal and temporal cortices. Conclusions: This MEG study provides preliminary evidence of altered alpha and gamma networks, at rest, in medication-naive children with OCD. These results support prior findings pointing to the relevance of CSTC circuitry in pediatric OCD and further support accumulating evidence of altered connectivity between regions that extend beyond this network, including the cerebellum and limbic regions. Given the substantial portion of children and youth whose OCD symptoms do not respond to conventional treatments, our findings have implications for future treatment innovation research aiming to target and track whether brain patterns associated with having OCD may change with treatment and/or predict treatment response.
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Affiliation(s)
- Vinh Tan
- Human Biology Program, Faculty of Arts and Science, University of Toronto, Toronto, Canada
- Kimel Family Translational Imaging Genetics Research Laboratory, Centre for Addiction and Mental Health, Toronto, Canada
| | - Colleen Dockstader
- Human Biology Program, Faculty of Arts and Science, University of Toronto, Toronto, Canada
| | - Iska Moxon-Emre
- Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
| | - Sandra Mendlowitz
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Reva Schacter
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Marlena Colasanto
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, University of Toronto, Toronto, Canada
| | - Aristotle N. Voineskos
- Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aquila Akingbade
- Human Biology Program, Faculty of Arts and Science, University of Toronto, Toronto, Canada
| | - Eman Nishat
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Canada
- Department of Physiology, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Donald J. Mabbott
- Department of Physiology, Temetry Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Department of Psychology, University of Toronto, Toronto, Canada
| | - Paul D. Arnold
- Department of Psychiatry, Cumming School of Medicine, The Mathison Centre for Mental Health Research & Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Stephanie H. Ameis
- Cundill Centre for Child and Youth Depression, Margaret and Wallace McCain Centre for Child, Youth and Family Mental Health, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Neuroscience and Mental Health, The Hospital for Sick Children, Toronto, Canada
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3
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Maneeton N, Maneeton B, Karawekpanyawong N, Woottiluk P, Putthisri S, Srisurapanon M. Fluoxetine in acute treatment of children and adolescents with obsessive-compulsive disorder: a systematic review and meta-analysis. Nord J Psychiatry 2020; 74:461-469. [PMID: 32242450 DOI: 10.1080/08039488.2020.1744037] [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: 12/22/2022]
Abstract
Background: Obsessive-compulsive disorder (OCD) is a common psychiatric illness in children and adolescents. Previous evidence suggests that fluoxetine is effective in the treatment of OCD in children and adolescents. However, those studies had small sample sizes. As a result, a systematic review, which is a more powerful method to calculate the true effect size, can be applied to examine the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.Objectives: The aims of this study were to review the efficacy, acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents.Study appraisal and synthesis methods: The titles and abstracts collected from electronic databases were evaluated. Then, the full-text versions of relevant studies were thoroughly assessed and extracted.Results: A total of 188 randomized patients in three RCTs of fluoxetine versus placebo and one RCT of fluoxetine versus citalopram were included in this review. Considering efficacious outcomes, the pooled mean change score of the CY-BOCS in the fluoxetine-treated group was significantly greater than that in the placebo-treated group. Additionally, the CGI-S in the fluoxetine-treated group and the pooled mean change score of the NIMH-OC were also significantly different from those in the placebo-treated group.Limitation: This review included studies with small sample sizes.Conclusions and implications of key findings: Fluoxetine is associated with a significantly greater reduction in OCD severity, as measured by the CY-BOCS, NIMH-OC and CGI-S, in children and adolescents. Additionally, it is well tolerated in children and adolescents. The acceptability is comparable to that of the placebo-treated group. Nonetheless, further large prospective trials should be conducted to confirm these outcomes.
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Affiliation(s)
- Narong Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Benchalak Maneeton
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Pakapan Woottiluk
- Psychiatric Nursing Division, Faculty of Nursing, Chiang Mai University, Chiang Mai, Thailand
| | - Suwannee Putthisri
- Department of Psychiatry, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Manit Srisurapanon
- Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Nazeer A, Latif F, Mondal A, Azeem MW, Greydanus DE. Obsessive-compulsive disorder in children and adolescents: epidemiology, diagnosis and management. Transl Pediatr 2020; 9:S76-S93. [PMID: 32206586 PMCID: PMC7082239 DOI: 10.21037/tp.2019.10.02] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Obsessive-compulsive disorder (OCD) can be found in about 4% of the general population and is characterized by various compulsions and obsessions that interfere with the person's quality of life from a mild to severe degree. The following discussion reflects on current concepts in this condition, including its epidemiology and etiologic underpinnings (behavioral, neurological, immunological, gastroenterological, as well as genetic). The interplay of PANS and PANDAS are included in this review. In addition, the core concepts of OCD diagnosis, differential diagnosis, and co-morbidities are considered. It is stressed that the quality of life for persons with pediatric OCD as well as for family members can be quite limited and challenged. Thus, principles of management are presented as a guide to improve the quality of life for these persons as much as possible.
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Affiliation(s)
- Ahsan Nazeer
- Department of Psychiatry, Division of Child and Adolescent Psychiatry, Sidra Medicine, Doha, Qatar
| | - Finza Latif
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | - Aisha Mondal
- Division of Psychiatry and Behavioral Sciences, George Washington University, Children's National Medical Center, Washington, DC, USA
| | | | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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Ibrahim L, Abouhendy W, Raafat N, Fouad AA. Prevalence and correlates of attention deficit hyperactivity disorder in obsessive-compulsive disorder patients. MIDDLE EAST CURRENT PSYCHIATRY 2020. [DOI: 10.1186/s43045-019-0007-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Abstract
Background
High rates of history of childhood attention deficit hyperactivity disorder (ADHD) symptoms have been found in obsessive-compulsive disorder (OCD) adults. Both, when comorbid, cause the clinical course to be unfavorable, more susceptibility to substance use, and a bad response to treatment. We planned to assess the impact of childhood ADHD symptoms on OCD adults and the effect of this on clinical characteristics and comorbidities of the disorder.
Results
Our cross-sectional investigation uncovered that 44% of the OCD patients had childhood ADHD symptoms. Patients with childhood ADHD manifestations with at present grown-up ADHD had more elevated amounts of depression, anxiety, and impulsiveness. OCD patients with child ADHD symptoms but not continued symptoms till adulthood versus those without child ADHD symptoms had higher levels of depression, anxiety, and impulsiveness and more severe OCD symptoms.
Conclusion
ADHD in adults with OCD is associated with some features impairing the clinical picture including higher levels of anxiety, depression, and impulsiveness reflecting more chronic illness. A childhood history of ADHD symptoms, even if not continued till adulthood, caused more impulsiveness, more severe OCD symptoms, and more anxiety and depression comorbidity.
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6
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Mantz SC, O’Brien M, Waters FA, Abbott MJ. The Impact of Enhanced Responsibility and Threat Beliefs on Self-Report and Behavioural Indices During a Sorting Task for Young People with OCD. COGNITIVE THERAPY AND RESEARCH 2018. [DOI: 10.1007/s10608-018-9946-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Skapinakis P, Caldwell D, Hollingworth W, Bryden P, Fineberg N, Salkovskis P, Welton N, Baxter H, Kessler D, Churchill R, Lewis G. A systematic review of the clinical effectiveness and cost-effectiveness of pharmacological and psychological interventions for the management of obsessive-compulsive disorder in children/adolescents and adults. Health Technol Assess 2018; 20:1-392. [PMID: 27306503 DOI: 10.3310/hta20430] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a relatively common and disabling condition. OBJECTIVES To determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults. DATA SOURCES We searched the Cochrane Collaboration Depression, Anxiety and Neurosis Trials Registers, which includes trials from routine searches of all the major databases. Searches were conducted from inception to 31 December 2014. REVIEW METHODS We undertook a systematic review and network meta-analysis (NMA) of the clinical effectiveness and acceptability of available treatments. Outcomes for effectiveness included mean differences in the total scores of the Yale-Brown Obsessive-Compulsive Scale or its children's version and total dropouts for acceptability. For the cost-effectiveness analysis, we developed a probabilistic model informed by the results of the NMA. All analyses were performed using OpenBUGS version 3.2.3 (members of OpenBUGS Project Management Group; see www.openbugs.net ). RESULTS We included 86 randomised controlled trials (RCTs) in our systematic review. In the NMA we included 71 RCTs (54 in adults and 17 in children and adolescents) for effectiveness and 71 for acceptability (53 in adults and 18 in children and adolescents), comprising 7643 and 7942 randomised patients available for analysis, respectively. In general, the studies were of medium quality. The results of the NMA showed that in adults all selective serotonin reuptake inhibitors (SSRIs) and clomipramine had greater effects than drug placebo. There were no differences between SSRIs, and a trend for clomipramine to be more effective did not reach statistical significance. All active psychological therapies had greater effects than drug placebo. Behavioural therapy (BT) and cognitive therapy (CT) had greater effects than psychological placebo, but cognitive-behavioural therapy (CBT) did not. BT and CT, but not CBT, had greater effects than medications, but there are considerable uncertainty and methodological limitations that should be taken into account. In children and adolescents, CBT and BT had greater effects than drug placebo, but differences compared with psychological placebo did not reach statistical significance. SSRIs as a class showed a trend for superiority over drug placebo, but the difference did not reach statistical significance. However, the superiority of some individual drugs (fluoxetine, sertraline) was marginally statistically significant. Regarding acceptability, all interventions except clomipramine had good tolerability. In adults, CT and BT had the highest probability of being most cost-effective at conventional National Institute for Health and Care Excellence thresholds. In children and adolescents, CBT or CBT combined with a SSRI were more likely to be cost-effective. The results are uncertain and sensitive to assumptions about treatment effect and the exclusion of trials at high risk of bias. LIMITATIONS The majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents. CONCLUSIONS In adults, psychological interventions, clomipramine, SSRIs or combinations of these are all effective, whereas in children and adolescents, psychological interventions, either as monotherapy or combined with specific SSRIs, were more likely to be effective. Future RCTs should improve their design, in particular for psychotherapy or combined interventions. STUDY REGISTRATION The study is registered as PROSPERO CRD42012002441. FUNDING DETAILS The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
| | - Deborah Caldwell
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | | | - Peter Bryden
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Naomi Fineberg
- University of Hertfordshire and Hertfordshire Partnerships Mental Health Trust, Hatfield, UK
| | | | - Nicky Welton
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Helen Baxter
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - David Kessler
- School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Rachel Churchill
- Centre for Reviews and Dissemination, University of York, York, UK
| | - Glyn Lewis
- Division of Psychiatry, University College London, London, UK
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Abstract
Understanding obsessive-compulsive behavior in medical students and law students is necessary for administrators and educators to properly work with students struggling with obsessionality. We aim to compare the differences in obsessive symptoms between medical students, law students and a control population. A total of 100 third-year medical students, 102 third-year law students and 103 control subjects drawn from the general population completed the Leyton Obsessional Inventory (LOI). Subjects were examined on all three sections (symptoms/traits, resistance and interference) of the LOI. Obsessional symptom scores for medical students (14.29 ± 7.33) and law students (13.65 ± 6.61) were significantly greater than for the control group (11.58 ± 7.45). Medical and law students were both more likely to report checking, order, routine and attention to detail as obsessive symptoms. Medical students were more likely than law students to possess the obsessive symptoms of cleanliness and conscientiousness, while law students were more likely than medical students to possess obsessive symptoms related to difficulty in making up their mind and doubting themselves. While medical students and law students are more obsessional than the control population, each group is more likely to report different obsessive symptoms.
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Affiliation(s)
- Michael D Harries
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, 5841 S. Maryland Avenue, MC3077, Chicago, IL, 60637, USA.
| | - Suck Won Kim
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
| | - Jon E Grant
- Department of Psychiatry, University of Minnesota, 2450 Riverside Ave, Minneapolis, MN, 55454, USA
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9
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Abstract
Nail biting, a common behavior seen in children, is typically short-lived and does not cause significant problems. However, when nail biting remains unresolved, physical and emotional consequences may occur. Exploring the etiological factors and underlying function of nail biting may help providers recommend appropriate interventions. [Journal of Psychosocial Nursing and Mental Health Services, 55(2), 23-26.].
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Obsessive-Compulsive Disorder in Paediatric and Adult Samples: Nature, Treatment and Cognitive Processes. A Review of the Theoretical and Empirical Literature. BEHAVIOUR CHANGE 2017. [DOI: 10.1017/bec.2017.6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The appraisal model of obsessive-compulsive disorder (OCD) suggests that six key appraisal domains contribute to the aetiology and maintenance of OCD symptoms. An accumulating body of evidence supports this notion and suggests that modifying cognitive appraisals may be beneficial in reducing obsessive-compulsive symptomatology. This literature review first summarises the nature of OCD and its treatment, followed by a summary of the existing correlational and experimental research on the role of cognitive appraisal processes in OCD across both adult and paediatric samples. While correlational data provide some support for the relationship between cognitive appraisal domains and OCD symptoms, results are inconclusive, and experimental methods are warranted to determine the precise causal relationship between specific cognitive appraisal domains and OCD symptoms.
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11
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The link between autoimmune diseases and obsessive-compulsive and tic disorders: A systematic review. Neurosci Biobehav Rev 2016; 71:542-562. [DOI: 10.1016/j.neubiorev.2016.09.025] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 09/08/2016] [Accepted: 09/24/2016] [Indexed: 12/12/2022]
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12
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Whiteside SP, Abramowitz JS. Relapse Following Successful Intensive Treatment of Pediatric Obsessive-Compulsive Disorder. Clin Case Stud 2016. [DOI: 10.1177/1534650105278456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This case study describes the use of intensive exposure and response prevention (ERP) for the treatment of pediatric obsessive-compulsive disorder (OCD). The adolescent described in this report lives a long distance from treatment providers with expertise in managing severe OCD symptoms. Thus, he has to travel out of town for effective therapy. The treatment program results in substantial immediate benefits. However, gradual relapse is noted once treatment is over and the patient returns to his home environment. Obstacles to the accessibility of ERP for pediatric OCD, conducting successful treatment, and generalizing and maintaining gains are discussed with the aim of drawing attention to, and facilitating the prevention of, these difficulties. Suggestions for addressing the shortcomings highlighted by this case are presented.
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Sabuncuoglu O, Berkem M. The Presentation Of Childhood Obsessive–Compulsive Disorder Across Home and School Settings. SCHOOL PSYCHOLOGY INTERNATIONAL 2016. [DOI: 10.1177/0143034306064551] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study aimed to determine the exact pattern of obsessive–compulsive disorder (OCD) symptoms in children displayed across school and home settings. Twenty-six school children (aged 7 through 17) with OCD were tested using the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), the Clinical Global Impression (CGI) – severity subscale and a questionnaire which consists of items serving to compare the symptoms between home and school settings. The mean obsession and compulsion subscores on the CY-BOCS were found to be 10.73 ± 3.14 and 10.88 ± 3.17, respectively, both summing up a Total score of 21.61 ± 5.52. The mean CGI-severity scores, rated for home and school settings were 4.42 ± 0.90 and 2.42 ± 1.13 respectively, indicating a strong difference in the presentation of OCD between those settings ( t= 7.02, df = 50, p< 0.0001). No gender, diagnosis (pure versus comorbid) and age effect (7 to = 12 years versus > 12 to 17 years) was found on the CY-BOCS and CGI-severity subscale (Mann–Whitney U test, all p> 0.05). The presentation difference we have noted in this study is a significant finding. Further studies are needed to delineate the characteristics of this phenomenon with possible implications for diagnosis, management and treatment.
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Affiliation(s)
| | - Meral Berkem
- Department of Child Psychiatry, School of Medicine, Marmara University, Istanbul, Turkey
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14
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Oldham-Cooper R, Glasman D, Loades M. The Advantages of Parental Involvement in Cognitive-Behavioral Treatment of Childhood Obsessive-Compulsive Disorder: A Single-Case Example. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2016; 29:44-53. [PMID: 27091103 DOI: 10.1111/jcap.12134] [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: 12/11/2015] [Revised: 02/07/2016] [Accepted: 02/15/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND Interventions for the treatment of anxiety disorders in children have a growing evidence base. Cognitive-behavioral therapy for the treatment of specific anxiety disorders in children and adolescents, including obsessive-compulsive disorder, is now an established intervention. However, a question remains concerning the benefits of parental involvement in treatment. Some studies report limited or no benefit of including parents in treatment, whereas other studies have indicated additional advantages of parental involvement. INTERVENTION The present case report describes the treatment of an 11-year-old girl with obsessive-compulsive disorder using cognitive-behavioral therapy derived largely from the treatment approaches outlined in Carr (2006), March and Mulle (1998), and Derisley, Heyman, Robinson, and Turner (2008). The child's mother attended all sessions and also a one-off parent-only session toward the end of treatment. The report considers the benefits of involving the child's mother in treatment and possible factors that could suggest parental involvement is indicated in future cases. OUTCOMES Both child and mother, and the therapist, believed that parental involvement had been an important and useful element of treatment. Possible reasons for benefits of parental involvement were considered to be high parental anxiety at the outset of treatment, age of the client, and involvement of the parent in obsessions and compulsions.
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Affiliation(s)
| | - David Glasman
- Clinical Psychologist, North Bristol NHS Trust, South Gloucestershire, UK
| | - Maria Loades
- Clinical Psychologist and Clinical Tutor for the Doctorate in Clinical Psychology Program, University of Bath, Bath, UK
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Abstract
AbstractThe early identification and referral of students with obsessive-compulsive disorder (OCD) is crucial for the implementation of timely intervention and therapy. Classroom teachers could be well positioned to identify and refer students with OCD to the school counsellor or support services team due to their extensive interaction with these students. However, teachers need to become more knowledgeable about OCD to successfully identify and thus be able to refer students with OCD (Purcell, 1999). These students also need to be managed differently within the classroom. However, there is limited support to guide teacher practice in this area. This paper provides a general overview of childhood OCD and explores the role of teachers in the identification, referral and management of students with OCD.
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Whiteside SPH, McKay D, De Nadai AS, Tiede MS, Ale CM, Storch EA. A baseline controlled examination of a 5-day intensive treatment for pediatric obsessive-compulsive disorder. Psychiatry Res 2014; 220:441-6. [PMID: 25070176 DOI: 10.1016/j.psychres.2014.07.006] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 06/30/2014] [Accepted: 07/06/2014] [Indexed: 01/22/2023]
Abstract
This study extends support for a 5-day intensive exposure and response prevention (ERP) treatment protocol for pediatric obsessive compulsive disorder (OCD). Twenty-two children with OCD received ERP treatment twice daily for 5 days. The treatment also emphasized teaching children and parents how to conduct ERP independently after they returned home. Symptoms were assessed at four time-points: Baseline, 4 weeks later at pre-treatment, one week after the intensive treatment 5-day treatment, and at 3 month follow-up. Changes on the primary outcome measure, clinician severity ratings on the Anxiety Disorders Interview Schedule for Children, and secondary measures, indicated that OCD symptoms remained stable from the evaluation to baseline and improved significantly from baseline to follow-up. Moreover, parental accommodation of OCD decreased significantly from baseline to post-treatment and from post-treatment to follow-up. These data suggest that the 5-day intervention demonstrates efficacy in reducing OCD symptoms and may initiate change in parent accommodation that continues to improve after the family returns home.
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Affiliation(s)
| | - Dean McKay
- Department of Psychology, Fordham University, Bronx, NY, USA
| | - Alessandro S De Nadai
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA
| | - Michael S Tiede
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Chelsea M Ale
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, USA
| | - Eric A Storch
- Departments of Pediatrics and Psychiatry & Behavioral Neurosciences, University of South Florida, St. Petersburg, FL, USA; Rogers Behavioral Health - Tampa Bay, Tampa, FL, USA; All Children׳s Hospital - Johns Hopkins Medicine, St. Petersburg, FL, USA
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17
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Mohapatra S, Agarwal V, Sitholey P. Pediatric anxiety disorders. Asian J Psychiatr 2013; 6:356-63. [PMID: 24011680 DOI: 10.1016/j.ajp.2013.06.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Revised: 06/24/2013] [Accepted: 06/28/2013] [Indexed: 11/20/2022]
Abstract
Anxiety disorders are the most common group of psychiatric disorders in children and adolescents. Anxiety disorders in children and adolescents can be chronic and disabling, and they can increase the risk of comorbid disorders. Anxiety is associated with substantial negative effects on children's social, emotional and academic success. Identifying and treating children and adolescents with anxiety disorders would reduce the burden of this disorder and may help in better management of the co-morbid conditions in these patients.
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Affiliation(s)
- Satyakam Mohapatra
- Mental Health Institute, S.C.B. Medical College, Cuttack, Odisha 753001, India.
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Whiteside SPH, Ale CM, Vickers Douglas K, Tiede MS, Dammann JE. Case Examples of Enhancing Pediatric OCD Treatment With a Smartphone Application. Clin Case Stud 2013. [DOI: 10.1177/1534650113504822] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
These case examples depict the use of a smartphone application, Mayo Clinic Anxiety Coach, to enhance the treatment of pediatric obsessive-compulsive disorder (OCD). The presented cases highlight the use of Anxiety Coach as a stand-alone intervention for mild OCD symptoms and as an adjunct to treatment for severe OCD complicated by geographical barriers. Each case includes a description of treatment, patient use of the application, objective assessment of clinical symptoms, and a qualitative interview with the families. Both patients responded well to treatment and had a positive experience with Anxiety Coach. The application encouraged the families to complete exposures between sessions and allowed a detailed examination of the patients’ engagement in homework assignments. Potential uses of smartphone applications to address challenges facing treatment of, and research on, OCD are discussed.
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de Ross RL, Gullone E, Chorpita BF. The Revised Child Anxiety and Depression Scale: A Psychometric Investigation with Australian Youth. BEHAVIOUR CHANGE 2012. [DOI: 10.1375/bech.19.2.90] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe Revised Child Anxiety and Depression Scale (RCADS) is a 47-item self-report measure intended to assess children's symptoms corresponding to selected DSM-IV anxiety and major depressive disorders. The scale comprises six subscales (e.g., Separation Anxiety Disorder; Social Phobia; Obsessive Compulsive Disorder; Panic Disorder; Generalised Anxiety Disorder; and Major Depressive Disorder). To date, only one normative study of youth has been published with results providing strong initial support for the reliability and validity of this new measure (Chorpita, Yim, Moffitt, Umemoto, & Francis, 2000). The present investigation provides additional psychometric data derived from an Australian sample comprising 405 youth aged 8 to 18 years. In general, the data were found to be consistent with those reported in the initial normative study. Internal consistency for the overall scale and its subscales was found to be adequate. Good convergent validity was demonstrated through moderate to strong correlations between the subscales of the RCADS with scores on the Revised Children's Manifest Anxiety Scale (RCMAS) and the Children's Depression Inventory (CDI). Confirmatory factor analysis suggested reasonable fit for the six-factor model by Chorpita et al. (2000). Notwithstanding the need for additional validation, it is concluded that the RCADS is a promising instrument for use in both clinical and research settings.
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Anholt GE, Cath DC, van Oppen P, Eikelenboom M, Smit JH, van Megen H, van Balkom AJLM. Autism and ADHD symptoms in patients with OCD: are they associated with specific OC symptom dimensions or OC symptom severity? J Autism Dev Disord 2010; 40:580-9. [PMID: 20039111 PMCID: PMC2855859 DOI: 10.1007/s10803-009-0922-1] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
In obsessive-compulsive disorder (OCD), the relationship between autism spectrum disorders (ASD), attention-deficit/hyperactivity disorder (ADHD) symptom, and obsessive-compulsive (OC) symptom dimensions and severity has scarcely been studied. Therefore, 109 adult outpatients with primary OCD were compared to 87 healthy controls on OC, ADHD and ASD symptoms. OCD patients showed increased ADHD and autism symptom frequencies, OCD + ADHD patients reporting more autism symptoms (particularly attention switching and social skills problems) than OCD − ADHD patients. Attention switching problems were most significant predictors of OC symptom dimensions (except hoarding) and of symptom severity. Hoarding was not associated with elevated autism scale scores, but with inattention. In conclusion, attention switching problems may reflect both symptom overlap and a common etiological factor underlying ASD, ADHD and OCD.
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Affiliation(s)
- Gideon E. Anholt
- Department of Psychiatry and Institute for Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands
| | - Danielle C. Cath
- Outpatient Clinic for Anxiety Disorders, GGZ-inGeest, Amsterdam, The Netherlands
- Department of Clinical and Health Psychology, Utrecht University/Altrecht, Anxiety Outpatient Program, Utrecht, The Netherlands
- Altrecht Anxiety Outpatient Program, Mimosastraat 2-4, 3551 DC Utrecht, The Netherlands
| | - Patricia van Oppen
- Department of Psychiatry and Institute for Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands
- Outpatient Clinic for Anxiety Disorders, GGZ-inGeest, Amsterdam, The Netherlands
| | - Merijn Eikelenboom
- Department of Psychiatry and Institute for Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands
| | - Johannes H. Smit
- Department of Psychiatry and Institute for Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands
| | | | - Anton J. L. M. van Balkom
- Department of Psychiatry and Institute for Extramural Medicine, VU-University Medical Centre, Amsterdam, The Netherlands
- Outpatient Clinic for Anxiety Disorders, GGZ-inGeest, Amsterdam, The Netherlands
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An uncontrolled examination of a 5-day intensive treatment for pediatric OCD. Behav Ther 2010; 41:414-22. [PMID: 20569789 DOI: 10.1016/j.beth.2009.11.003] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2009] [Revised: 11/15/2009] [Accepted: 11/16/2009] [Indexed: 11/20/2022]
Abstract
This study examined the feasibility of a 5-day intensive treatment for pediatric obsessive-compulsive disorder (OCD). Fifteen children with OCD received a week-long treatment based on exposure and response prevention (ERP). The intervention also emphasized teaching children and parents how to conduct ERP independently at home. All families completed the week-long treatment and symptoms improved significantly as measured by self- and parent-report forms, as well as the Children's Yale-Brown Obsessive-Compulsive Scale, F(2, 22)=45.67, p<.05. Total CY-BOCS scores decreased significantly from pretreatment (M=28.00, SD=4.24) to posttreatment [M=16.00, SD=6.0, F(1, 11)=34.38, p<.05] and from posttreatment to 5-month follow-up [M=11.5, SD=7.3; F(1, 11)=12.94, p<.05]. This level of improvement was consistent with other intensive treatments for pediatric OCD. The study suggests that the 5-day program is a promising treatment for children with OCD who do not have access to local providers.
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An experimental manipulation of responsibility in children: a test of the inflated responsibility model of obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2010; 41:228-33. [PMID: 20153459 DOI: 10.1016/j.jbtep.2010.01.007] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2009] [Revised: 01/11/2010] [Accepted: 01/13/2010] [Indexed: 11/22/2022]
Abstract
The objective of this study was to investigate whether Salkovskis (1985) inflated responsibility model of obsessive-compulsive disorder (OCD) applied to children. In an experimental design, 81 children aged 9-12 years were randomly allocated to three conditions: an inflated responsibility group, a moderate responsibility group, and a reduced responsibility group. In all groups children were asked to sort sweets according to whether or not they contained nuts. At baseline the groups did not differ on children's self reported anxiety, depression, obsessive-compulsive symptoms or on inflated responsibility beliefs. The experimental manipulation successfully changed children's perceptions of responsibility. During the sorting task time taken to complete the task, checking behaviours, hesitations, and anxiety were recorded. There was a significant effect of responsibility level on the behavioural variables of time taken, hesitations and check; as perceived responsibility increased children took longer to complete the task and checked and hesitated more often. There was no between-group difference in children's self reported state anxiety. The results offer preliminary support for the link between inflated responsibility and increased checking behaviours in children and add to the small but growing literature suggesting that cognitive models of OCD may apply to children.
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Abstract
Obsessive-compulsive disorder is a common debilitating condition affecting individuals from childhood through adult life. There is good evidence of genetic contribution to its etiology, but environmental risk factors also are likely to be involved. The condition probably has a complex pattern of inheritance. Molecular studies have identified several potentially relevant genes, but much additional research is needed to establish definitive causes of the condition.
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Affiliation(s)
- Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Johns Hopkins Hospital, Meyer 113, 600 North Wolfe Street, Baltimore, MD 21287, USA.
| | - Marco Grados
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - J F Samuels
- Department of Psychiatry and Behavioral Sciences, The Johns Hopkins University School of Medicine, Baltimore, MD
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Crye J, Laskey B, Cartwright-Hatton S. Non-clinical obsessions in a young adolescent population: frequency and association with metacognitive variables. Psychol Psychother 2010; 83:15-26. [PMID: 19744358 DOI: 10.1348/147608309x468176] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES Little is known about normal obsessions in adolescence. This study examined the frequency and content of intrusions in adolescence, and a number of process variables that have been associated with obsessions in adults. DESIGN AND METHODS Sixty-two adolescents (aged 12-14 years) participated. They completed measures of obsessions and metacognitive beliefs. They were interviewed about recent episodes of obsessional thought, including content, frequency, acceptability, distress, dismissibilty, interference, and avoidance. RESULTS Seventy-seven per cent of participants reported obsessions. Frequency, distress, dismissibility, acceptability, interference, and avoidance, were associated with metacognitive appraisals. CONCLUSIONS Obsessions are a normal experience in adolescence and are associated with metacognitive appraisals in the same way as for adults, indicating that adult models may be relevant for this younger population.
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Affiliation(s)
- Jenny Crye
- University of Manchester, Manchester, UK
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Whiteside SP, Brown AM, Abramowitz JS. Five-day intensive treatment for adolescent OCD: a case series. J Anxiety Disord 2008; 22:495-504. [PMID: 17543497 DOI: 10.1016/j.janxdis.2007.05.001] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2007] [Revised: 04/30/2007] [Accepted: 05/02/2007] [Indexed: 12/15/2022]
Abstract
This case series describes the use of an intensive 5-day treatment for obsessive-compulsive disorder (OCD) with three adolescents. The treatment is based on traditional cognitive-behavioral therapy consisting primarily of exposures and response prevention (ERP) and involves 10 sessions over 5 days. In addition, the treatment emphasizes instructing the adolescent and the parents on how to conduct ERP at home following the completion of the 5 days of therapy. The treatment is designed for adolescents who do not have local access to mental health practitioners with expertise in ERP for OCD. The three patients who participated in the experimental program each experienced substantial improvements in their OCD symptoms and overall functioning. The present study suggests that brief, 5-day intensive treatment may be an effective means of delivering CBT for adolescents with OCD and may be of use to mental health practitioners who provide services to large catchments.
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Affiliation(s)
- Stephen P Whiteside
- Deaprtment of Psychiatry and Psychology, Mayo Clinic, Rochester, MN 55905, United States.
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Abstract
AbstractCognitive models of obsessive compulsive disorder (OCD) have been influential in understanding and treating the disorder in adults. Cognitive models may also be applicable to children and adolescents and would have important implications for treatment. The aim of this systematic review was to evaluate research that examined the applicability of the cognitive model of OCD to children and adolescents. Inclusion criteria were set broadly but most studies identified included data regarding responsibility appraisals, thought-action fusion or meta-cognitive models of OCD in children or adolescents. Eleven studies were identified in a systematic literature search. Seven studies were with non clinical samples, and 10 studies were cross-sectional. Only one study did not support cognitive models of OCD in children and adolescents and this was with a clinical sample and was the only experimental study. Overall, the results strongly supported the applicability of cognitive models of OCD to children and young people. There were, however, clear gaps in the literature. Future research should include experimental studies, clinical groups, and should test which of the different models provide more explanatory power.
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Abstract
Obsessive-compulsive disorder (OCD) is an extremely common form of child and adolescent psychopathology. Obsessive-compulsive disorder in children and adolescents has garnered a significant amount of attention from mental health practitioners and mental health researchers over the past decades. In order to provide a comprehensive account of this attention, the phenomenology, theoretical perspectives, empirical literature and interventions used to treat OCD in children and adolescents are reviewed in this paper. While by no means an exhaustive review, the information presented in this paper provides health and mental health professionals interested in OCD in children and adolescents with the knowledge required to enhance their understanding of this complicated form of child and adolescent psychopathology.
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Affiliation(s)
- C L Cameron
- Mental Health and Addictions Services, Calgary Health Region, 2675-36th Street NE, Calgary, Alberta, Canada.
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Abstract
Pharmacological management of obsessive-compulsive disorder (OCD) is achieved using drugs that inhibit the synaptic uptake of serotonin, such as clomipramine, a tricyclic antidepressant, and the selective serotonin reuptake inhibitors (SSRIs). Recent studies suggest that the improved tolerability profile of the SSRIs relative to clomipramine may offer a more suitable treatment choice. Escitalopram, the therapeutically active S-enantiomer of citalopram, is the most selective SSRI currently available. In a 24-week randomized, placebo-controlled, double-blind study, escitalopram (20 mg) was associated with significantly lower symptom scores at 12 weeks (P<0.01) and increased response rate (Yale-Brown Obsessive-compulsive Scale [Y-BOCS]) (70.2%) compared with placebo (50.4%). Escitalopram (10 mg) was more effective in reducing symptom scores than placebo at 24 weeks (P=0.052). Escitalopram 20 mg was also associated with improved remitter status (Y-BOCS total score ≤10) compared with paroxetine (40 mg) or placebo from week 12. In a relapse-prevention study, 10 and 20 mg escitalopram showed a statistically significant superior effect relative to placebo on time to relapse of OCD with a hazard ratio of 2.74. Escitalopram was well-tolerated by patients with OCD. In conclusion, escitalopram provides significant symptom relief and prevention of relapse during long-term use and deserves consideration as a first-line agent in the long-term pharmacotherapy of OCD.
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Affiliation(s)
- Naomi A Fineberg
- National OCD Treatment Service, Herts Partnership NHS Trust, Queen Elizabeth II Hospital, Welwyn Garden City, Hertfordshire, UK
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Pavone P, Parano E, Rizzo R, Trifiletti RR. Autoimmune neuropsychiatric disorders associated with streptococcal infection: Sydenham chorea, PANDAS, and PANDAS variants. J Child Neurol 2006; 21:727-36. [PMID: 16970875 DOI: 10.1177/08830738060210091401] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Streptococcal infection in children is usually benign and self-limited. In a small percentage of children, prominent neurologic and/or psychiatric sequelae can occur. Sydenham chorea is the best defined and best recognized. PANDAS (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection) is a well-defined syndrome in which tics (motor and/or vocal) and/or obsessive-compulsive disorder consistently exacerbate in temporal correlation to a group A beta-hemolytic streptococcal infection. PANDAS constitutes a subset of children with tics, Tourette syndrome, and obsessive-compulsive disorder. In addition to strictly defined PANDAS, we and others have recognized several PANDAS variants, including adult-onset variant, a dystonic variant, a myoclonic variant, and a "chronic" PANDAS variant. The nosology and classification of these entities are rapidly evolving. The recognition that some pediatric neurobehavioral syndromes have infectious and/or immunologic triggers points to important new avenues of disease treatment. In this review, we summarize this complex and rapidly evolving area of clinical research.
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Affiliation(s)
- Piero Pavone
- Department of Pediatrics, Division of Clinical Pediatrics, University of Catania, Viale Andrea Doria 6, 95125 Catania, Italy.
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Masi G, Millepiedi S, Mucci M, Bertini N, Pfanner C, Arcangeli F. Comorbidity of obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in referred children and adolescents. Compr Psychiatry 2006; 47:42-7. [PMID: 16324901 DOI: 10.1016/j.comppsych.2005.04.008] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2004] [Accepted: 04/21/2005] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE The aim of this study was to explore whether comorbid attention-deficit/hyperactivity disorder (ADHD) affects the clinical expression and outcome of obsessive-compulsive disorder (OCD) in a clinical sample. METHOD A consecutive series of 94 children and adolescents (mean age, 13.6 +/- 2.8 years) with current diagnosis of OCD were included in the study. Twenty-four (25.5%) patients were diagnosed as having a comorbid ADHD. Subjects with OCD plus ADHD were compared with subjects with OCD but without ADHD. RESULTS Comorbid ADHD with OCD was significantly associated with a higher rate of males, an earlier onset of OCD, a greater psychosocial impairment, and a heavier comorbidity, namely, with bipolar disorder, tic disorder, and oppositional defiant disorder/conduct disorder. Phenomenology of obsessions and compulsions and outcome were not affected by ADHD comorbidity. CONCLUSIONS A screening for ADHD should be performed in patients with OCD, as these patients and their parents are frequently not aware that the impairment may be partly due to a comorbid ADHD.
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Affiliation(s)
- Gabriele Masi
- IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone, 56018 Calambrone Pisa, Italy.
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Valderhaug R, Ivarsson T. Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder. Eur Child Adolesc Psychiatry 2005; 14:164-73. [PMID: 15959662 DOI: 10.1007/s00787-005-0456-9] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2004] [Indexed: 02/06/2023]
Abstract
UNLABELLED The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments. METHOD Sixty-eight patients aged 8-17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions. RESULTS Overall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings. CONCLUSIONS Our study supports findings of previous research suggesting multiple impacts of OCD symptoms on children's psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.
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Affiliation(s)
- Robert Valderhaug
- Norwegian University of Science and Technology, Department of Neuroscience Center for Child and Adolescent Psychiatry, MTFS, 7489 Trondheim, Norway.
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Miguel EC, Leckman JF, Rauch S, do Rosario-Campos MC, Hounie AG, Mercadante MT, Chacon P, Pauls DL. Obsessive-compulsive disorder phenotypes: implications for genetic studies. Mol Psychiatry 2005; 10:258-75. [PMID: 15611786 DOI: 10.1038/sj.mp.4001617] [Citation(s) in RCA: 162] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Obsessive-compulsive disorder (OCD) clinical presentation is remarkably diverse, and can vary both within and across patients over time. This variability in the phenotypic expression has led to the hypothesis that OCD is a heterogeneous disorder and that this heterogeneity obscures the findings of clinical, natural history and treatment response studies and complicates the search for vulnerability genes. A complete understanding of what comprises OCD and the underlying etiological mechanisms will require a dramatic change in how the disorder is conceptualized. In this review, several different approaches that may represent the first steps in this reconceptualization are discussed. These approaches include (1) narrowing the phenotype to identify categorically defined more homogeneous and mutually exclusive subtypes of OCD, (2) considering OC symptom dimensions as quantitative components of the more complex OCD phenotype and (3) broadening the phenotype to include other etiologically related conditions. A combined dimensional approach within distinctive subgroups is proposed as probably the most effective in helping to identify the heritable components of OCD. By identifying heritable components of OCD, it should be possible to find genes for these separate components. The review continues with the illustration of the possible role of some epigenetic risk and protective factors in the OCD presentation and the relevance of examining associated traits and/or endophenotypes to enhance our ability to understand the genetic basis of OCD. To conclude, we discuss the variability in treatment outcome and the significance of the development of specific pharmacological and/or behavioral based therapies tailored to each of these phenotypes.
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Affiliation(s)
- E C Miguel
- Department of Psychiatry, University of São Paulo Medical School, Rua Dr. Ovídio Pires de Campos, s/n, 05403-010, São Paulo, SP, Brazil.
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Abstract
Obsessive-compulsive symptoms have long held interest for psychoanalysts. Currently, pharmacological and behavioral treatments are commonly viewed as the standard of care, and psychoanalytic clinicians are often uncertain of how best to approach these patients. The successful two-year psychoanalytic treatment of a ten-year-old boy with obsessivecompulsive disorder, who remained symptom-free eight years after termination, is reported. While this is but a single case, its outcome implies that for some patients psychoanalysis may be the treatment of choice.
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Becker K, Jennen-Steinmetz C, Holtmann M, el-Faddagh M, Schmidt MH. [Comorbidity of compulsive disorders in childhood and adolescence]. ZEITSCHRIFT FUR KINDER- UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2003; 31:175-85. [PMID: 12942790 DOI: 10.1024/1422-4917.31.3.175] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The cross-sectional comorbidity of child and adolescent inpatients with obsessive-compulsive disorder (OCD) was assessed. METHODS The hospital records of all inpatients treated for OCD since 1976 (31 girls, 46 boys) were compared with data from a prospective epidemiological longitudinal study (90 girls, 84 boys) in two age cohorts (< 15 years; > or = 15 years) with regard to comorbid psychiatric diagnoses. Additionally, psychiatric Axis I diagnoses of patients with a supplementary diagnosis of compulsive symptoms (n = 45) were descriptively assessed in the client population. RESULTS In the subgroup of OCD patients < 15 years, boys showed a higher incidence of tic disorders. OCD girls > or = 15 years showed a tendency toward more frequent comorbid affective disorders and a significant result regarding concurrent eating disorders. Eighteen of 27 female patients with supplementary compulsive symptoms requiring clinical intervention had an Axis I diagnosis of eating disorder. CONCLUSIONS Due to different criteria of classification, diverging definitions of comorbidity and different age cohorts and samples, studies on comorbidity in OCD patients are difficult to compare. The frequency of comorbid psychiatric disorders may be over-estimated if the general prevalence of psychiatric disorders in terms of gender and age is not taken into account.
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Affiliation(s)
- K Becker
- Klinik für Psychiatrie und Psychotherapie des Kindes- und Jugendalters am Zentralinstitut für Seelische Gesundheit, Mannheim.
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Bamber D, Tamplin A, Park RJ, Kyte ZA, Goodyer IM. Development of a short leyton obsessional inventory for children and adolescents. J Am Acad Child Adolesc Psychiatry 2002; 41:1246-52. [PMID: 12364847 DOI: 10.1097/00004583-200210000-00015] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a short, cost-effective screening measure for adolescent obsessive-compulsive disorder (OCD). METHOD The 20-item Leyton Obsessional Inventory-Child Version and the Mood and Feelings Questionnaire were completed by five groups of adolescents: those with a predominant diagnosis of OCD (n = 9), major depressive disorder with comorbid OCD ( n = 14), major depressive disorder without comorbid OCD ( n = 65), a community sample including subjects at high risk for psychopathology ( n = 253), and well controls ( n= 50). Leyton Obsessional Inventory scores for the community sample ( n= 253) were factor analyzed, whereas the remaining groups' scores served as validation. RESULTS Factor analysis yielded a robust 11-item solution with three distinct components accounting for 47.6% of total variance. Internal reliability was high for the short scale total (Cronbach alpha =.86) and three subscales: Compulsions (alpha =.73), Obsessions/Incompleteness (alpha =.79), and Cleanliness (alpha =.75). Logistic regression found the Compulsions subscale discriminated OCD cases from community controls and discriminated major depressive disorder with and without comorbid OCD. The Obsessions subscale discriminated OCD cases from community, well control, and depressed nonobsessional groups. CONCLUSIONS The Short Leyton Obsessional Inventory-Child Version is a psychometrically sound, quick, economical screen that discriminates OCD cases from noncases irrespective of comorbid major depressive disorder.
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Affiliation(s)
- Diane Bamber
- Developmental Psychiatry Section, Department of Psychiatry, Cambridge Clinical School, University of Cambridge and Brookside Family Consultation Clinic, Cambridge, England.
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Abstract
OBJECTIVE In child and adolescent psychiatry the validation of the diagnosis must be seen in the context of development. Comparing different diagnostic formulations DSM-IV and ICD-10-DCR in a clinical sample of children and adolescents suffering from obsessive-compulsive disorder (OCD) and their validation on external criteria represent such a heuristic approach. METHOD We investigated 61 children seen consecutively in a specialized out-patient clinic for OCD. All of them were assessed by the International Diagnostic Checklists (IDCL). Diagnosis and diagnostic certainty were validated regarding age, age of onset and duration of illness. RESULTS The agreement between the two diagnostic systems was low. The diagnostic stability of ICD-10-DCR was highly dependent on age, whereas that of the criteria DSM-IV did not depend on age and almost all subjects could be diagnosed definitely. CONCLUSION This study suggests that the DSM-IV criteria are superior to that of ICD-10-DCR for diagnosing OCD in children and younger adolescents.
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Affiliation(s)
- K Steinberger
- Department of Neuropsychiatry of Childhood and Adolescence, University of Vienna, Medical school, General Hospital, Vienna, Austria.
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39
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Abstract
OBJECTIVE A postinfectious, autoimmune response may be associated with the development of pediatric obsessive-compulsive disorder (OCD). According to this model, antistreptococcal antibodies cross-react with basal ganglia neurons following streptococcus infection. This autoimmune reaction disrupts a basal ganglia-thalamocortical circuit and generates obsessive-compulsive symptoms. One implication of this model is that prolonged immunologic stress may be a risk factor for OCD. That is, immunologic stress may compromise the blood-brain barrier and permit the influx of antistriatal antibodies into the central nervous system. This article explores one part of this putative relationship by investigating whether adult OCD patients, compared to members of other psychiatric groups, demonstrate a higher incidence of recurrent infections and other conditions suggestive of compromised immune function. METHOD To test this hypothesis, we conducted a medical records review of 100 consecutive patients evaluated at a private psychiatric clinic specializing in the treatment of anxiety disorders. Sixty-five patients met diagnostic criteria for an Axis-I syndrome. Primary diagnoses included OCD, posttraumatic stress disorder, social anxiety disorder, generalized anxiety disorder, panic disorder with agoraphobia, and dysthymic disorder. Each medical record was reviewed for the presence of target syndromes or presenting symptoms suggestive of compromised immune function. RESULTS Chart review revealed an increased rate of immune-related symptoms and syndromes among OCD patients in comparison to other anxiety and mood disorder groups. Groups did not differ significantly in the incidence of non-immune symptoms and syndromes. CONCLUSION Adult OCD patients appear to have an increased rate of immune-related diseases above and beyond that seen in other psychiatric disorders.
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Affiliation(s)
- W M Dinn
- Boston University, Massachusetts, USA.
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40
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Bottas A, Richter MA. Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Pediatr Infect Dis J 2002; 21:67-71. [PMID: 11791105 DOI: 10.1097/00006454-200201000-00017] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Alexandra Bottas
- Center for Addiction and Mental Health, Clarke Institute Division, and Department of Psychiatry, University of Toronto, Toronto, Canada
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Rosario-Campos MCD. Peculiaridades do transtorno obsessivo-compulsivo na infância e na adolescência. BRAZILIAN JOURNAL OF PSYCHIATRY 2001. [DOI: 10.1590/s1516-44462001000600008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Obsessive-compulsive disorder (OCD) in children and adolescents is often a disabling condition, which demands treatment with medication. Research shows that serotonin is involved in the disorder and empirical treatment studies show that antidepressants with serotonin activity are effective. The first choice of treatment in the psychopharmacological approach to OCD in children and adolescents are the SSRI agents, which have been documented as being effective as well as well-tolerated in children and adolescents. The best-documented SSRI to this point is sertraline. However, fluoxetine and fluoxamine have also undergone systematic studies in children and adolescents. Clomipramine has been proven effective, however, side effects caused by this agent would suggest that an SSRI is a better choice. Treatment with an SSRI seems to have effect in approximately 75 % of patients with OCD. There are still no systematic studies analyzing augmenting medication for children and adolescents with OCD. Research indicates that the combination of medication and psychotherapy (cognitive behavioural therapy) is important in most cases. Based on a few long-term follow-up studies on OCD children and adolescents there is not evidence that all children and adolescents suffer a lifetime course of the disease. It is therefore recommended that discontinuation is attempted after 1-1.5 years of successful treatment.
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Affiliation(s)
- P H Thomsen
- Psychiatric Hospital for Children and Adolescents, University Hospital of Aarhus, Denmark
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Geller D, Biederman J, Faraone SV, Frazier J, Coffey BJ, Kim G, Bellordre CA. Clinical correlates of obsessive compulsive disorder in children and adolescents referred to specialized and non-specialized clinical settings. Depress Anxiety 2001; 11:163-8. [PMID: 10945136 DOI: 10.1002/1520-6394(2000)11:4<163::aid-da3>3.0.co;2-3] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The objective of this study was to assess the extent of referral bias by comparing children and adolescents with Obsessive Compulsive Disorder (OCD) ascertained through a specialized pediatric OCD and a general child psychiatry clinic. Subjects were juveniles meeting DSM-III-R and DSM IV criteria for OCD referred to a general pediatric psychopharmacology clinic and to a specialized OCD clinic within the same academic medical center. Subjects were evaluated clinically and with structured diagnostic interviews using the Kiddie SADS-E. OCD was identified in 8.6% of the general psychiatry clinic subjects. The only differences between ascertainment sources in clinical or sociodemographic characteristics of OCD subjects were higher rates of social phobia and ADHD in the non-specialized clinic, while specialty clinic subjects had a greater lifetime severity of OCD and were more likely to have received treatment of their OCD. Because we found limited evidence for referral biases, our results suggest that findings from studies using either of these sources may generalize to the other. It also suggests that pooling subjects from the two sources is justified. Nevertheless, because some group differences did emerge, researchers should acknowledge referral bias as a potential limitation of their work.
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Affiliation(s)
- D Geller
- Joint Pediatric Psychopharmacology Program, Massachusetts General Hospital, Boston, USA.
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Eichstedt JA, Arnold SL. Childhood-onset obsessive-compulsive disorder: a tic-related subtype of OCD? Clin Psychol Rev 2001; 21:137-57. [PMID: 11148894 DOI: 10.1016/s0272-7358(99)00044-6] [Citation(s) in RCA: 87] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a psychiatric condition characterized by recurrent obsessions or compulsions that cause significant impairment or distress. Although OCD was once perceived to be relatively rare in childhood, current estimates suggest that as many as half of all adult OCD cases may have their onset in childhood or adolescence. In general, there appears to be a great deal of continuity between the clinical presentation of OCD in children and that in adults. Yet, numerous differences have also been found between child and adult OCD, including differences in sex distribution, patterns of comorbidity, and degree of familial loading. These differences raise the issue of whether obsessive-compulsive symptoms that have their onset in childhood, but perhaps persist into adult life, are meaningfully different from those that emerge de novo in adulthood. In this article, current research on child- and adult-onset OCD is critically reviewed. It is proposed that child-onset OCD represents a phenomenologically and etiologically distinct subtype of OCD, bearing a close genetic relationship to tic-disorders and possibly sharing a common or similar pathogenesis. Clinical implications of the child- versus adult-onset OCD distinction are discussed.
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Affiliation(s)
- J A Eichstedt
- Centre for Research in Human Development and Department of Psychology, Concordia University, 7141 Sherbrooke St. West, Montréal, Québec, H4B 1R6, Canada.
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Rosario-Campos MCD, Mercadante MT. Transtorno obsessivo-compulsivo. BRAZILIAN JOURNAL OF PSYCHIATRY 2000. [DOI: 10.1590/s1516-44462000000600005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Hughes CW, Emslie GJ, Crismon ML, Wagner KD, Birmaher B, Geller B, Pliszka SR, Ryan ND, Strober M, Trivedi MH, Toprac MG, Sedillo A, Llana ME, Lopez M, Rush AJ. The Texas Children's Medication Algorithm Project: report of the Texas Consensus Conference Panel on Medication Treatment of Childhood Major Depressive Disorder. J Am Acad Child Adolesc Psychiatry 1999; 38:1442-54. [PMID: 10560232 DOI: 10.1097/00004583-199911000-00020] [Citation(s) in RCA: 82] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To develop consensus guidelines for medication treatment algorithms for childhood major depressive disorder (MDD) based on scientific evidence and clinical opinion when science is lacking. The ultimate goal of this approach is to synthesize research and clinical experience for the practitioner and to increase the uniformity of preferred treatment for childhood MDD. A final goal is to develop an approach that can be tested as to whether it improves clinical outcomes for children and adolescents with MDD. METHOD A consensus conference was held. Participants included academic clinicians and researchers, practicing clinicians, administrators, consumers, and families. The focus was to review and use clinical evidence to recommend specific pharmacological approaches for treatment of MDD in children and adolescents. After a series of presentations of current research evidence and panel discussion, the consensus panel met, agreed on assumptions, and drafted the algorithms. The process initially addressed strategies of treatment and then tactics to implement the strategies. RESULTS Consensually agreed-upon algorithms for major depressions (with and without psychosis) and comorbid attention deficit disorders were developed. Treatment strategies emphasized the use of selective serotonin reuptake inhibitors. The algorithm consists of systematic strategies for treatment interventions and recommended tactics for implementation of the strategies, including medication augmentation and medication combinations. Participants recommended prospective evaluation of the algorithms in various public sector settings, and many volunteered as sites for such an evaluation. CONCLUSIONS Using scientific and clinical experience, consensus-derived algorithms for children and adolescents with MDD can be developed.
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Affiliation(s)
- C W Hughes
- University of Texas Southwestern Medical Center, Dallas, USA.
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Adams GB, Burke RW. Children and Adolescents withObsessive-Compulsive Disorder:A Primer for Teachers. ACTA ACUST UNITED AC 1999. [DOI: 10.1080/00094056.1999.10522061] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Emslie GJ, Walkup JT, Pliszka SR, Ernst M. Nontricyclic antidepressants: current trends in children and adolescents. J Am Acad Child Adolesc Psychiatry 1999; 38:517-28. [PMID: 10230183 DOI: 10.1097/00004583-199905000-00013] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES First, to review the extant data on the safety and efficacy of the use of nontricyclic antidepressants in children and adolescents; second, to identify the main limitations of our current knowledge in this area; and third, to point to future research directions. METHOD A Medline search and a review of previous scientific meetings were conducted; all available reports on the efficacy and safety of nontricyclic antidepressants in children and adolescents were critically reviewed. RESULTS As in adults, also in children nontricyclic antidepressants are potentially useful in treating a variety of psychiatric disorders. The data supporting their efficacy, however, are quite limited. Obsessive-compulsive disorder is the only psychiatric diagnosis for which pediatric use of selective serotonin reuptake inhibitors has been approved. One placebo-controlled study in children and adolescents with major depression supports the efficacy of fluoxetine. Other clinical trials of nontricyclic antidepressants in depressed adolescents are in progress. Available data indicate that the safety of these medications is good, at least in the short term. CONCLUSIONS The potential usefulness of nontricyclic antidepressants for children and adolescents suffering from a range of disorders is considerable. While information from adults can suggest potential areas of possible efficacy in pediatric patients suffering from similar psychopathology, further research is essential to provide the necessary information on the efficacy, safety, and pharmacokinetics of these medications in children and adolescents.
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Affiliation(s)
- G J Emslie
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas 75235-8897, USA
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