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Strouphauer ER, Morris OJ, Soileau KJ, Wiese AD, Quast T, Goodman WK, Sheth SA, Wojcik KD, Guzick AG, Storch EA. Economic Analyses of Obsessive-Compulsive Disorder Interventions: A Systematic Review. PHARMACOECONOMICS 2023; 41:499-527. [PMID: 36840747 DOI: 10.1007/s40273-023-01250-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition featuring patterns of obsessions, compulsions, and avoidant behaviors that are often time consuming and distressing to affected individuals. Cognitive-behavioral therapy (CBT) with exposure and response prevention and/or serotonin reuptake inhibitors are first-line treatments for OCD, though other therapeutic interventions may serve as economically practical modalities under various circumstances. Exploring and understanding the cost effectiveness of all indicated OCD interventions are important to inform therapeutic decisions and provide quality patient-centered care at a cost that is not burdensome to the patient and/or healthcare system. METHODS A systematic literature review was performed and studies were extracted from PubMed, Embase, Ovid MEDLINE, and Cochrane. All cost-effectiveness studies that included economic analyses with respect to OCD treatment modalities and were written in English and published between January 2010 and July 2022 were eligible for inclusion in the present study. We report a narrative synthesis of the findings and quality appraisal of the selected references. RESULTS Of the 707 references returned in the literature search, a total of 18 cost-effectiveness studies were included for review. Compared with treatment as usual, several studies reported clinical superiority and cost effectiveness of Internet-based CBT programs for adults and children with OCD at various willingness-to-pay thresholds and economic reference indicators, though cost effectiveness relative to in-person CBT with exposure and response prevention is unclear and estimates of efficacy are likely lower for Internet-based CBT. One study favored the cost utility of serotonin reuptake inhibitor monotherapy over CBT with exposure and response prevention although efficacy estimates of the former tend to be lower, and relative cost differences were low. Five studies evaluated the cost effectiveness of high-intensity neuroaugmentation, including deep brain stimulation and stereotactic radiosurgical capsulotomy, in the context of treatment-refractory OCD. CONCLUSIONS Despite the relatively high prevalence of OCD worldwide, cost-effectiveness data for therapeutic modalities remain sparse. Because of the chronic nature of OCD, the cost of treatment accumulates and may lead to a significant financial burden over time, particularly when non-evidence-based interventions are used. However, several alternative therapeutic modalities hold promise for economic practicality without significant sacrifice in clinical efficacy. Future studies are necessary to directly compare the cost effectiveness of such therapeutic alternatives with the current standard of care, CBT with exposure and response prevention.
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Affiliation(s)
- Emily R Strouphauer
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Olivia J Morris
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Keaton J Soileau
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Andrew D Wiese
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Troy Quast
- College of Public Health, University of South Florida, Tampa, FL, USA
| | - Wayne K Goodman
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Sameer A Sheth
- Department of Neurosurgery, Baylor College of Medicine, Houston, TX, USA
| | - Katharine D Wojcik
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Andrew G Guzick
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, One Baylor Plaza, MS: 350, Houston, TX, 77030, USA.
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Bennett SD, Coughtrey AE, Shafran R, Heyman I. Measurement Issues: The measurement of obsessive compulsive disorder in children and young people in clinical practice. Child Adolesc Ment Health 2017; 22:100-112. [PMID: 32680318 DOI: 10.1111/camh.12218] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/30/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND If left untreated, obsessive compulsive disorder (OCD) can cause significant distress and impact on functioning throughout the lifespan. Despite the severity of the disorder, there is often a significant delay between the onset of symptoms and successful treatment. This is in part due to delays in recognising OCD symptoms in young people, particularly if the symptom forms are less common. Once OCD is accurately diagnosed, cognitive behavioural therapy (CBT) is known to be an efficacious treatment, sometimes in combination with medication, producing good long-term prognosis. It is therefore important to accurately detect OCD in children and young people so that they can be offered timely intervention. Use of the best tools in clinical and research settings improves detection and diagnosis, as well as enabling the tracking of progress through treatment. The aim of this current paper was to review measurement tools for OCD in young people with a focus on the practicalities of using tools in busy child mental health clinical settings. METHOD To discover what measurement tools are available for OCD in young people, we conducted a pragmatic literature of measurement tools for OCD in young people. We searched PsycINFO, Med-Line and the Cochrane databases for reports relating to the measurement of OCD. Additionally, we sought information from the National Institute for Health and Care Excellence (NICE) guidance, the Child Outcomes Research Consortium (CORC) website and the Children and Young People's Improving Access to Psychological Therapies (CYP IAPT) Programme. We also reviewed large trials and meta-analyses of the treatment of OCD in young people and communicated with relevant researchers/clinicians. RESULTS Seventeen questionnaire measurement tools, with variable psychometric properties, and four commonly used semistructured clinician administered interview measures were identified. CONCLUSIONS There are several measurement tools with good psychometric properties that are useful for initial screening/identification of OCD, as well as formal diagnosis, symptom tracking and treatment evaluation. With the availability of brief screens, as well as online diagnostic measures, such tools should not be a burden on clinical practice, but rather a helpful aid to support clinicians' assessment and treatment of OCD.
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Affiliation(s)
- Sophie D Bennett
- UCL, Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Anna E Coughtrey
- UCL, Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Roz Shafran
- UCL, Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
| | - Isobel Heyman
- UCL, Great Ormond Street Institute of Child Health and Great Ormond Street Hospital for Children NHS Foundation Trust, 30 Guilford Street, London, WC1N 1EH, UK
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Cognitive-behavioral therapy for pediatric obsessive-compulsive disorder: Empirical review and clinical recommendations. Psychiatry Res 2015; 227:78-92. [PMID: 25771752 DOI: 10.1016/j.psychres.2015.02.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Revised: 02/08/2015] [Accepted: 02/11/2015] [Indexed: 11/24/2022]
Abstract
The efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD) has been the subject of much study over the past fifteen years. Building on a foundation of case studies and open clinical trials, the literature now contains many methodologically sound studies that have compared full CBT protocols to waitlist controls, pill placebo, psychosocial comparison conditions, active medication, combined treatments, and brief CBT. This review is part of a series commissioned by The Canadian Institute for Obsessive Compulsive Disorders (CIOCD) in an effort to publish in one place what is known about the efficacy of treatments for OCD. A total of fourteen studies were identified; collectively their findings support the efficacy of CBT for youth with OCD. CBT protocols that emphasized either strictly behavioral or cognitive conceptualizations have each been found efficacious relative to waitlist controls. Efforts to enhance CBT׳s efficacy and reach have been undertaken. These trials provide guidance regarding next steps to be taken to maximize efficacy and treatment availability. Findings from studies in community clinics suggest that significant treatment benefits can be realized and are not reported only from within academic contexts. These findings bode well for broader dissemination efforts. Recommendations for future research directions are provided.
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Psychological Treatment of Obsessive-Compulsive Disorder in Children and Adolescents: a Meta-Analysis. SPANISH JOURNAL OF PSYCHOLOGY 2015; 18:E20. [DOI: 10.1017/sjp.2015.22] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
AbstractAlthough several meta-analyses have investigated the efficacy of psychological treatments for pediatric obsessive-compulsive disorder (OCD), there is not yet a consensus on the most efficacious treatment components. A meta-analysis was carried out to examine the efficacy of the different treatment techniques used in the psychological interventions of pediatric OCD. An exhaustive literature search from 1983 to February 2014 enabled us to locate 46 published articles that applied some kind of cognitive-behavioral therapy (CBT). For each group the effect size was the standardized pretest-posttest mean change, and it was calculated for obsessive-compulsive symptoms and for other outcome measures. The results clearly showed large effect sizes for CBT in reducing obsessive-compulsive symptoms and, to a lesser extent, other outcome measures (d+ = 1.860; 95% CI: 1.639; 2.081). The most promising treatments are those based on multicomponent programs comprising ERP, cognitive strategies, and relapse prevention. The analysis of other potential moderator variables and the implications for clinical practice are discussed.
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Abstract
Cognitive behavior therapy (CBT) is considered a first-line intervention for obsessive-compulsive disorder (OCD) across the lifespan. Efficacy studies of CBT with exposure and response prevention suggest robust symptom reduction, often with sustained remission. Acceptability of CBT is high, and the treatment is devoid of adverse side effects. The primary mechanism of CBT is based on operant principles, specifically extinction learning. The efficacy of extinction-based treatments such as CBT is being shown for other obsessive-compulsive spectrum disorders. This article reviews the theoretic basis, clinical application, and relevant treatment outcome research for CBT and related therapies for several obsessive-compulsive spectrum disorders.
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Sensory Over-Responsivity in Pediatric Obsessive Compulsive Disorder. JOURNAL OF PSYCHOPATHOLOGY AND BEHAVIORAL ASSESSMENT 2014. [DOI: 10.1007/s10862-014-9442-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
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Lewin AB, Park JM, Jones AM, Crawford EA, De Nadai AS, Menzel J, Arnold EB, Murphy TK, Storch EA. Family-based exposure and response prevention therapy for preschool-aged children with obsessive-compulsive disorder: A pilot randomized controlled trial. Behav Res Ther 2014; 56:30-8. [DOI: 10.1016/j.brat.2014.02.001] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 01/19/2023]
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Obsessions, Compulsions, and Repetitive Behavior: Autism and/or OCD. HANDBOOK OF AUTISM AND ANXIETY 2014. [DOI: 10.1007/978-3-319-06796-4_8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Lewin AB, Caporino N, Murphy TK, Geffken GR, Storch EA. Understudied clinical dimensions in pediatric obsessive compulsive disorder. Child Psychiatry Hum Dev 2010; 41:675-91. [PMID: 20644997 DOI: 10.1007/s10578-010-0196-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The present study aimed to assess the phenomenology and treatment sensitivity of insight, avoidance, indecisiveness, overvalued responsibility, pervasive slowness, and pathological doubting among youth with Obsessive-compulsive disorder (OCD) using the ancillary items on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). These factors are believed to be relevant to the clinical presentation of youth with OCD but remain understudied. Eighty-nine youth with OCD were administered the CY-BOCS, including six subsidiary items aimed at the constructs of interest in this research. Participants also completed measures of OCD symptom clusters, depressive and anxious symptoms, externalizing/internalizing behavioral problems, and functional impairment. Associations between OCD symptom clusters and insight, avoidance, indecisiveness, overvalued responsibility, pervasive slowness, and pathological doubting are presented. Low insight, significant avoidance, indecisiveness, pervasive slowness and excessive sense of responsibility were all related to elevations in functional impairment. Clinical improvement in OCD severity was related to reductions in avoidance, doubting, and sense of responsibility. The six ancillary items of the CY-BOCS appear to be a practical and valid assessment of several constructs that are prognostically linked to cognitive-behavioral therapy outcomes in youth with OCD. Implications for clinicians are discussed.
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Affiliation(s)
- Adam B Lewin
- Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida College of Medicine, 800 Sixth Street South, Saint Petersburg, FL 33701, USA.
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Lewin AB, Chang S, McCracken J, McQueen M, Piacentini J. Comparison of clinical features among youth with tic disorders, obsessive-compulsive disorder (OCD), and both conditions. Psychiatry Res 2010; 178:317-22. [PMID: 20488548 PMCID: PMC2902642 DOI: 10.1016/j.psychres.2009.11.013] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2008] [Revised: 08/28/2009] [Accepted: 11/10/2009] [Indexed: 11/19/2022]
Abstract
The comorbidity of tic disorders (TD) and obsessive-compulsive disorder (OCD) has long been recognized in the clinical literature and appears to be bidirectional, affecting 20-60% of individuals with each disorder. Coffey et al. (1998) found that adults with TD+OCD had a more severe comorbidity profile than adults with OCD or TD alone. This exploratory study in children attempts to evaluate whether heightened diagnostic severity, increased comorbidity load, and lower functioning is more commonplace in youth with TD+OCD in comparison to either syndrome alone. Participants were 306 children (seeking clinical evaluation) with TD, OCD, or TD+OCD. Assessment consisted of a diagnostic battery (including structured diagnostic interviews and standardized parent-report inventories) to evaluate diagnostic severity, comorbid psychopathology, behavioral and emotional correlates, and general psychosocial functioning. Data from this study sample were not supportive of the premise that youth with both a tic disorder and OCD present with elevated diagnostic severity, higher risk-for or intensity-of comorbidity, increased likelihood of externalizing/internalizing symptomatology, or lower broad-based adaptive functioning. The OCD group had elevated rates of comorbid anxiety disorders and attention-deficit hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) were more prevalent among youth in the TD group. The three groups also differed on key demographic variables. Our findings suggest that, in contrast to adults, TD+OCD in children and adolescents does not represent a more severe condition than either disorder alone on the basis of diagnostic comorbidity, symptom severity, or functional impairment.
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Affiliation(s)
- Adam B Lewin
- University of South Florida College of Medicine, Department of Pediatrics, Rothman Center for Pediatric Neuropsychiatry, St. Petersburg, FL 33701, USA.
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Storch EA, Björgvinsson T, Riemann B, Lewin AB, Morales MJ, Murphy TK. Factors associated with poor response in cognitive-behavioral therapy for pediatric obsessive-compulsive disorder. Bull Menninger Clin 2010; 74:167-85. [DOI: 10.1521/bumc.2010.74.2.167] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lewin AB, Bergman RL, Peris TS, Chang S, McCracken JT, Piacentini J. Correlates of insight among youth with obsessive-compulsive disorder. J Child Psychol Psychiatry 2010; 51:603-11. [PMID: 20039994 PMCID: PMC2881587 DOI: 10.1111/j.1469-7610.2009.02181.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Individuals with Obsessive-Compulsive Disorder (OCD) may lack insight into the irrational nature of their symptoms. Among adults with OCD, poor insight has been linked to greater symptom severity, increased likelihood of comorbid symptoms, lower adaptive functioning, and worse treatment outcomes. Parallel work regarding insight among children and adolescents, with OCD, is lacking. The aim of this research was to examine links between insight and demographic, cognitive, and clinical factors among youth with OCD. METHODS Seventy-one youths with OCD (mean age = 11.7; 63% = male) were assessed as part of a larger treatment trial. Insight was measured via clinician interview. RESULTS Youth with low insight had poorer intellectual functioning and reported decreased perception of control over their environment. Additionally, youth with low insight were more likely to be younger, to report higher levels of depressive symptoms, and to report lower levels of adaptive functioning. CONCLUSION This set of cognitive, developmental and clinical factors that may predispose youth with OCD to have diminished insight. Data provide initial empirical support for diagnostic differences between youth and adults with regard to requiring intact insight. Implications for treatment are discussed.
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Affiliation(s)
- Adam B. Lewin
- University of South Florida, Rothman Center for Pediatric Neuropsychiatry, St. Petersburg, FL,UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA,Corresponding Author: Adam B. Lewin, Ph.D., Assistant Professor, Department of Pediatrics, University of South Florida, 800 6th Street South, 4th Floor North, Box 7523, St. Petersburg, FL 33701, Fax: 727-767-7786,
| | - R. Lindsey Bergman
- UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Tara S. Peris
- UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - Susanna Chang
- UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - James T. McCracken
- UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
| | - John Piacentini
- UCLA Semel Institute for Neuroscience and Human Behavior, Department of Psychiatry & Biobehavioral Sciences, Los Angeles, CA
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Storch EA, McKay D, Reid JM, Geller DA, Goodman WK, Lewin AB, Murphy TK. D-Cycloserine Augmentation of Cognitive-Behavioral Therapy: Directions for Pilot Research in Pediatric Obsessive-Compulsive Disorder. CHILD & YOUTH CARE FORUM 2010. [DOI: 10.1007/s10566-010-9094-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Evidence-Based Assessment of Child Obsessive Compulsive Disorder: Recommendations for Clinical Practice and Treatment Research. CHILD & YOUTH CARE FORUM 2010; 39:73-89. [PMID: 20376181 PMCID: PMC2847172 DOI: 10.1007/s10566-009-9092-8] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Obsessive-compulsive disorder (OCD) presents heterogeneously and can be difficult to assess in youth. This review focuses on research-supported assessment approaches for OCD in childhood. Content areas include pre-visit screening, diagnostic establishment, differential diagnosis, assessment of comorbid psychiatric conditions, tracking symptom severity, determining psychosocial functioning, and evaluating clinical improvement. Throughout this review, similarities and differences between assessment approaches geared towards clinical and research settings are discussed.
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Sturm R. Obsessive-compulsive disorder in children: The role of nurse practitioners. ACTA ACUST UNITED AC 2009; 21:393-401. [DOI: 10.1111/j.1745-7599.2009.00414.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by disturbing thoughts, impulses, or images (obsessions); repetitive or ritualistic behaviors (compulsions); or the presence of both. Although some may believe this disorder is isolated to the adult population, it affects anywhere from 1% to 4% of children in the United States. However, symptom presentation of this psychiatric condition may be different in the pediatric population. School-age children who are affected by the condition or their parents may attempt to hide these behaviors due to embarrassment or fear of peer victimization. If left untreated, OCD can interfere with the ability to play, socialize, attend school, and function as a part of a family, ultimately affecting success not only in school but in life. It is imperative school nurses are aware of this condition, its symptoms, and treatments and techniques to help students with OCD cope effectively.
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Affiliation(s)
- Mary-Lee C Helbing
- Cardiac Intensive Care Unit, Geisinger Medical Center, Danville, PA, USA
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Impact of comorbidity on cognitive-behavioral therapy response in pediatric obsessive-compulsive disorder. J Am Acad Child Adolesc Psychiatry 2008; 47:583-592. [PMID: 18356759 DOI: 10.1097/chi.0b013e31816774b1] [Citation(s) in RCA: 155] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the impact of psychiatric comorbidity on cognitive-behavioral therapy response in children and adolescents with obsessive-compulsive disorder. METHOD Ninety-six youths with obsessive-compulsive disorder (range 7-19 years) received 14 sessions of weekly or intensive family-based cognitive-behavioral therapy. Assessments were conducted before and after treatment. Primary outcomes included scores on the Children's Yale-Brown Obsessive-Compulsive Scale, response rates, and remission status. RESULTS Seventy-four percent of participants met criteria for at least one comorbid diagnosis. In general, participants with one or more comorbid diagnoses had lower treatment response and remission rates relative to those without a comorbid diagnosis. The number of comorbid conditions was negatively related to outcome. The presence of attention-deficit/hyperactivity disorder and disruptive behavior disorders was related to lower treatment response rates, and the presence of disruptive behavior disorders and major depressive disorder were related to lower remission rates. CONCLUSIONS The presence of a comorbid disorder, particularly disruptive behavior, major depressive, and attention-deficit/hyperactivity disorders, has a negative impact on treatment response. Assessing for psychiatric disorders before treatment entry and treating these comorbid conditions before or during cognitive-behavioral therapy may improve final outcome. Comorbid anxiety or tic disorders do not seem to negatively affect response.
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Gallant J, Storch EA, Valderhaug R, Geffken GR. School Psychologists' Views and Management of Obsessive-Compulsive Disorder in Children and Adolescents. CANADIAN JOURNAL OF SCHOOL PSYCHOLOGY 2007. [DOI: 10.1177/0829573507306448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Over the past decade, an increasing body of research has been conducted on evidence-based psychological and psychiatric treatment for pediatric obsessive-compulsive disorder (OCD). Despite this improved understanding, however, these treatments are not being performed. This study descriptively examined the practices and views of school psychologists on the management of pediatric OCD. Two hundred twenty-seven clinicians responded to a survey adapted from previous work by Valderhaug, Gotestam, and Larsson. Results suggested that school psychologists preferred cognitive-behavioral, medical, and family/systemic orientations relative to psychodynamic and humanistic approaches. Although respondents reported an adherence to evidence-based treatment, only 7% reported using behavioral exposure. Many respondents reported only moderate treatment success and expressed an overwhelming need for further training in both the assessment and treatment of pediatric OCD. Our results suggest that school psychologists are not adequately trained to assess and provide evidence-based treatment of pediatric OCD.
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Sloman GM, Gallant J, Storch EA. A school-based treatment model for pediatric obsessive-compulsive disorder. Child Psychiatry Hum Dev 2007; 38:303-19. [PMID: 17570056 DOI: 10.1007/s10578-007-0064-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2007] [Accepted: 05/14/2007] [Indexed: 10/23/2022]
Abstract
School psychologists have expertise in the realm of school-based assessment and intervention for behavioral, educational, and psychological difficulties. Recent evidence indicates that many school psychologists lack evidenced based knowledge about assessment and treatment of pediatric Obsessive-Compulsive Disorder (OCD). Pediatric OCD is a relatively common disorder that contributes to substantial impairment in educational and psychosocial domains. Evidence based treatment of pediatric OCD, particularly cognitive-behavioral therapy, has shown to be efficacious. Therefore, the aims of this paper are to provide a review of empirically established treatments for pediatric OCD, and present a school-based problem-solving model that school psychologists can utilize to conceptualize, assess, and treat OCD.
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Affiliation(s)
- Glenn M Sloman
- Department of Educational Psychology, University of Florida, Gainesville, FL, USA
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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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Keeley ML, Storch EA, Dhungana P, Geffken GR. Pediatric obsessive-compulsive disorder: a guide to assessment and treatment. Issues Ment Health Nurs 2007; 28:555-74. [PMID: 17613156 DOI: 10.1080/01612840701354570] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Obsessive-compulsive disorder (OCD) is an anxiety disorder characterized by recurrent or persistent thoughts, impulses, or images that are experienced as intrusive or distressing (obsessions), and repetitive behaviors or mental acts (compulsions) often performed in response to an obsession. Recent epidemiological studies have found lifetime prevalence of pediatric OCD to be approximately 1-4% in the USA. OCD begins before the age of 18 years for as many as 80% of cases and follows a chronic, unremitting course. Due to the distressing, time-consuming, and debilitating nature of OCD, impairments in academic, social, and family functioning are often substantial. Despite the relatively high prevalence rate of OCD, dissemination about effective assessment and treatment has lagged. Increasing the awareness of OCD symptoms and its treatment among nurses and other health professionals will enhance identification of children presenting with unrecognized or untreated symptoms of OCD and will stimulate appropriate referrals for treatment to improve children's psychological functioning and overall quality of life. This paper reviews the nature, etiology, assessment, and treatment of OCD, highlighting clinical implications for nurses involved in mental health care.
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Affiliation(s)
- Mary L Keeley
- University of Florida, Gainesville, Florida 32610, USA
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Storch EA, Murphy TK, Adkins JW, Lewin AB, Geffken GR, Johns NB, Jann KE, Goodman WK. The children's Yale-Brown obsessive-compulsive scale: psychometric properties of child- and parent-report formats. J Anxiety Disord 2007; 20:1055-70. [PMID: 16503111 DOI: 10.1016/j.janxdis.2006.01.006] [Citation(s) in RCA: 98] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Revised: 12/08/2005] [Accepted: 01/23/2006] [Indexed: 10/25/2022]
Abstract
The children's Yale-Brown obsessive-compulsive scale (CY-BOCS) is a commonly used, psychometrically sound clinician-rated instrument of pediatric obsessive-compulsive disorder (OCD) severity. Given the relatively direct rating format and potential benefits of alternative versions that could be easily administered to patients and parents, we developed and examined the psychometric properties of child- and parent-report formats of the CY-BOCS severity items. A total of 53 children and adolescents (8-17 years old) with OCD and their parents was administered the CY-BOCS, children's Yale-Brown obsessive-compulsive scale-child report (CY-BOCS-CR), children's Yale-Brown obsessive-compulsive scale-parent report (CY-BOCS-PR), and other measures of obsessive-compulsive symptoms, internalizing, and externalizing symptoms. In general, reliability and convergent and divergent validity of the CY-BOCS-CR/PR were satisfactory. Psychometric properties for the CY-BOCS-CR in those children and adolescents with externalizing behavior problems were lower relative to those without externalizing problems. Exploratory factor analyses identified a two-factor structure in both measures comprised of disturbance and severity factors. This study provides preliminary support for the use of child- and parent-report versions of the CY-BOCS.
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Affiliation(s)
- Eric A Storch
- Department of Pediatrics, University of Florida, Gainesville, FL 32610, USA.
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Merlo LJ, Storch EA, Murphy TK, Goodman WK, Geffken GR. Assessment of pediatric obsessive-compulsive disorder: a critical review of current methodology. Child Psychiatry Hum Dev 2006; 36:195-214. [PMID: 16228147 DOI: 10.1007/s10578-005-4079-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Obsessive-compulsive disorder (OCD) is a relatively common disorder among children and adolescents, and is associated with increased risk for concurrent and future distress and impairment. Many youth who suffer from OCD go undiagnosed or misdiagnosed, and do not attain appropriate treatment in a timely manner. As a result, researchers have focused greater attention to the assessment of pediatric OCD. This paper provides an overview of recent advances in this area, including an introduction to several new assessment instruments. Descriptions of new and commonly used instruments and their clinical/research utility are described. Psychometric properties are also reported. Finally, a critical review is offered of major trends in the assessment of pediatric OCD (e.g., diagnostic interviews, self-report and parent-report measures, and clinician-administered inventories).
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Affiliation(s)
- Lisa J Merlo
- Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA
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Intensive Cognitive Behavioral Therapy for Pediatric Obsessive Compulsive Disorder: A Treatment Protocol for Mental Health Providers. Psychol Serv 2005. [DOI: 10.1037/1541-1559.2.2.91] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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