Clinical profile and outcome in a large sample of children and adolescents with obsessive-compulsive disorder: A chart review from a tertiary care center in India

Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis

BACKGROUND

Cognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).

METHODS

PubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis).

RESULTS

Thirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95-11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [-2.51, 4.21]; moderate), SRIs (MD: 3.07 [-0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: -1.20 [-5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.

CONCLUSIONS

In-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.

Phenomenology of obsessive-compulsive disorder in children and adolescents: Sample from a tertiary care center in Istanbul, Turkey

BACKGROUND

Obsessive-compulsive disorder (OCD) is a heterogeneous disease in many respects and exhibits this diversity in terms of phenomenology. It also displays several different characteristics in children compared to adults.

AIM

To describe the socio-demographic and phenomenological features of children with OCD and to investigate the impact of these features on response to pharmacotherapy.

METHODS

This retrospective study was carried out with 150 children and adolescents who had been diagnosed with OCD between 2014 and 2018. Data was collected by examining the files of the patients with diagnosis of OCD and similar disorders from the hospital database. Yale-Brown Obsessive-Compulsive Scale for Children was used for the assessment of obsession-compulsion subtypes. The Clinical Global Impression (CGI) scale was used to evaluate the severity of the disease (CGI-S) and global improvement (CGI-I). The predictors of treatment response were evaluated using linear regression analysis. The level of significance for all statistic tests was set as P < 0.05.

RESULTS

The sample was divided into prepubertal (44%) and adolescent (56%) age groups. The most prevalent obsessions were contamination and aggression obsessions, and the most frequent compulsions were washing and checking. While contamination was observed more commonly in the prepubertal age group, the religious obsession was seen more frequently in adolescents. Patients with aggression obsession presented a higher frequency of comorbid anxiety (P = 0.022) and mood (P = 0.047) disorder. CGI-I scores did not differ according to phenomenological subgroups (P > 0.05). A lower CGI-I score was linked to a lower CGI-S score (95% confidence interval 0.21-0.39, P < 0.001) and the prepubertal age of admission (95% confidence interval 0.03-0.87, P = 0.020).

CONCLUSION

The phenomenology of OCD shows differences depending on the age group and the comorbid psychiatric disorders. Earlier identification and treatment of OCD may help to prevent the impairment of the mental health of children and adolescents.

Preschool-onset OCD: A review of literature and clinical experience

Obsessive-compulsive disorder (OCD) has been described in preschool children as young as 2-3 years old. A preschool age onset of OCD has unique diagnostic and therapeutic challenges. In this article, the authors review published literature on preschool onset OCD and present data on preschool-onset OCD (age of onset ≤ 5 years) from clinical records at a tertiary care child and adolescent psychiatry center in India. Literature suggests that OCD that starts this early is phenomenologically similar to OCD in older individuals; however, it has very high rates of comorbidity and a family history of OCD. There is a paucity of data on course, treatment, and long-term outcome in this group. At their center, the authors found a 3% prevalence of preschool-onset OCD, with a male predominance (69%) and fairly high comorbidity rates (62%). Qualitative review highlighted delay in treatment seeking, poor follow-up rates, frequent use of pharmacological treatment, and a high remission rate in those treated adequately.

Cross-sectional study of internalised stigma and medication adherence in patients with obsessive compulsive disorder

Background

Patients suffering from psychiatric disorders tend to stigmatise themselves which had been linked to poor adherence to treatment.

Aims

The aim of the present study was to study internalised stigma and medication adherence and to assess the relationship between them in patients with obsessive compulsive disorder (OCD).

Methods

A cross-sectional study was conducted on 112 patients diagnosed with OCD who were attending the Out-patient's department at Department of Psychiatry of a tertiary care hospital in North India. Internalised stigma and current medication adherence were assessed with Internalized Stigma of Mental Illness Scale (ISMI) and Medication Adherence Rating Scale, respectively. Yale-Brown Obsessive Compulsive Scale was used to assess the current severity of OCD symptoms. Sociodemographic and clinical details were also obtained from the patients by using a semistructured sociodemographic proforma.

Results

Most of the patients reported moderate level of internalised stigma with a mean ISMI score of 77.98 (10.82). Most of the patients were compliant while 41.96% reported poor medication adherence. Internalised stigma was negatively correlated with the current medication adherence. Current severity of OCD symptoms also showed a significant positive correlation with internalised stigma and a significant negative correlation with medication adherence.

Conclusion

High levels of internalised stigma were associated with lower adherence to treatment which suggests that internalised stigma may be a very important factor influencing medication adherence in patients with OCD.