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Niemeyer L, Mechler K, Dittmann RW, Banaschewski T, Buitelaar J, Durston S, Häge A. Memantine as treatment for compulsivity in child and adolescent psychiatry: Descriptive findings from an incompleted randomized, double-blind, placebo-controlled trial. Contemp Clin Trials Commun 2022; 29:100982. [PMID: 36092975 PMCID: PMC9450066 DOI: 10.1016/j.conctc.2022.100982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/29/2022] [Accepted: 08/09/2022] [Indexed: 11/28/2022] Open
Abstract
Background Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) are mental disorders with a considerable overlap in terms of their defining symptoms. The glutamatergic agent memantine appears to be a promising candidate for the treatment of ASD and OCD in children and adolescents. The aim of this study was to investigate the clinical efficacy and tolerability/safety of memantine in this population. Methods This randomized, double-blind, placebo-controlled multicenter add-on trial comprised patients aged 6 to 17; 9 years with a confirmed diagnosis of ASD and/or OCD. Participants were randomized to either memantine or placebo for 10 consecutive weeks, including an up-titration phase. Results A total of 7 patients were included in the study. N = 4 (57.1%) participants were treated with verum (memantine) and n = 3 (42.9%) received placebo. Patients receiving memantine showed a more pronounced reduction in their CY-BOCS score, as well as greater CGI-Improvement, compared to patients receiving placebo. No serious adverse events (SAEs) were reported. Conclusions Our findings, although based on a very small number of patients and therefore insufficient to draw clear conclusions, appear to be in line with the hypothesis that memantine is an effective, tolerable and safe agent for children and adolescents. Trial registration EudraCT Number: 2014-003080-38, Registered 14 July 2014, https://www.clinicaltrialsregister.eu/ctr-search/search?query=2014-003080-38.
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Affiliation(s)
- Larissa Niemeyer
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Konstantin Mechler
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Ralf W Dittmann
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Tobias Banaschewski
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Jan Buitelaar
- Department of Cognitive Neuroscience, Donders Institute for Brain, Cognition and Behavior, Radboud University Nijmegen Medical Center, Nijmegen, the Netherlands
| | - Sarah Durston
- Department of Psychiatry, University Medical Center Utrecht Brain Center, Utrecht, the Netherlands
| | - Alexander Häge
- Pediatric Psychopharmacology, Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
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Abrishami MH, Noras MR, Soltanifar A, Salari R, Jarahi L, Pazhouh HK. Clinical Evidence for the Effectiveness of Herbal Medicines in the Treatment of an Obsessive- Compulsive Disorder: A Review Study. Curr Drug Discov Technol 2022; 19:e160622206086. [PMID: 35713134 DOI: 10.2174/1570163819666220616122543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 04/11/2022] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Obsessive-compulsive disorder (OCD) is a potentially debilitating disease that affects 1-4% of the general population. It is characterized by the presence of obsessions and compulsions which interfere with the individual's life and functioning. Although conventional treatments such as drug therapies and cognitive behavioral therapy exist for OCD, these treatments are not universally successful and can cause side effects, which has created a demand for alternative and complementary therapies. METHODS In this review, we summarize randomized clinical trials on the effectiveness of herbal medicines for the treatment of OCD, and review the possible mechanisms of action for these medicines. A search in PubMed, Scopus, and The Cochrane Library found 1022 studies, of which 7 were included in our review. RESULTS The studies that we found were conducted over 6 to 12 weeks, and had an average sample size of 37. The plant species studied included Crocus sativus, Echium amoenum, Hypericum perforatum, Silybum marianum, Valeriana officinalis, and Withania somnifera. The trials demonstrated the effectiveness of all plants as treatments for OCD except H. perforatum. The phytochemicals found in these plants produce their effects through a variety of means such as inhibiting the reuptake of monoamines, GABAergic effects, and neuroendocrine modulation. The small number of studies and their small sample sizes, poor methodology, and lack of replication highlight the need for further research into herbal medicines for the treatment of OCD. CONCLUSION Overall, herbal medicines can be used as stand-alone therapies for OCD or in conjunction with other methods.
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Affiliation(s)
- Maryam Hosseini Abrishami
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mohamad Reza Noras
- Department of Persian Medicine, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Atefeh Soltanifar
- Psychiatry and Behavioral Sciences Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Roshanak Salari
- Department of Clinical Persian Pharmacy, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Lida Jarahi
- Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamideh Khorram Pazhouh
- Persian Medicine Research Center, School of Persian and Complementary Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Van Noppen B, Sassano-Higgins S, Appasani R, Sapp F. Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder: 2021 Update. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2021; 19:430-443. [PMID: 35747293 PMCID: PMC9063577 DOI: 10.1176/appi.focus.20210015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
In this update of a previous review, the authors discuss cognitive-behavioral therapy (CBT) with exposure and response prevention for obsessive-compulsive disorder (OCD). This efficacious modality avoids side effects common to psychotropic medication and reduces risk of relapse once treatment has ended. Psychotherapy involves identification and ranking of stimuli that provoke obsessions, exposure to these stimuli while preventing compulsions, and cognitive restructuring. The family of the OCD patient plays a significant role in treatment. This article includes expanded research on family-focused CBT and treatment of pediatric OCD. The family's accommodation and emotional response to a patient's symptoms may interfere with therapy and perpetuate the disorder. The treatment of pediatric OCD involves the same considerations. However, the form of obsessions and compulsions may differ and therapeutic techniques are modified to make them age appropriate.
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Affiliation(s)
- Barbara Van Noppen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Sean Sassano-Higgins
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Raghu Appasani
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
| | - Felicity Sapp
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles (Van Noppen); private practice, Los Angeles (Sassano-Higgins, Appasani); OCD and Anxiety Psychological Services, Calgary, Alberta, Canada (Sapp)
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Aksu GG, Dogdu PA, Dag P, Kutuk MO, Toros F. Safe and Effective Use of Venlafaxine, Mirtazapine, and Aripiprazole in an Adolescent with Treatment-Resistant Obsessive-Compulsive Disorder. Psychiatr Ann 2020. [DOI: 10.3928/00485713-20201005-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Belschner L, Lin SY, Yamin DF, Best JR, Edalati K, McDermid J, Stewart SE. Mindfulness-based skills training group for parents of obsessive-compulsive disorder-affected children: A caregiver-focused intervention. Complement Ther Clin Pract 2020; 39:101098. [PMID: 32379640 DOI: 10.1016/j.ctcp.2020.101098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 01/15/2020] [Accepted: 01/15/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE Parents of children with obsessive-compulsive disorder (OCD) report significant emotional and socio-occupational impacts. There is, however, currently insufficient support for these parents. This study examined a mindfulness-based intervention for parents of OCD-affected children, investigating its feasibility and impact on parental ability to tolerate their child's OCD-related distress, in addition to exploring potential indirect effects. MATERIALS AND METHODS Parents of OCD-affected children (n = 39) completed an eight-week baseline observation period followed by eight, weekly manualized mindfulness-based intervention group sessions. Measures of parental tolerance of child distress, dispositional mindfulness, family accommodation, family functioning, and OCD symptom severity were collected. RESULTS In comparison to the baseline observation period, parental tolerance of child distress and dispositional mindfulness significantly improved following mindfulness training. No other temporal differences were observed. Parents reported high satisfaction. CONCLUSION Mindfulness-based skills training for parents of OCD-affected youth appears to be feasible and to significantly increase tolerance related to the child's distress. CLINICAL TRIAL REGISTRATION NUMBER NCT03212703.
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Affiliation(s)
- Laura Belschner
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Sarah Yao Lin
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Diana Franco Yamin
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - John R Best
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Kourosh Edalati
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - Joanna McDermid
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Children's Hospital Centre for Mindfulness, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
| | - S Evelyn Stewart
- Psychiatry, Faculty of Medicine, University of British Columbia, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; British Columbia Children's Hospital Research Institute, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada; BC Children's Hospital Centre for Mindfulness, A3-121, 938 West 28th Avenue, Vancouver, BC, V5Z 4H4, Canada.
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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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Rohanachandra YM, Vipulanandan S. A case of an unusual presentation of obsessive compulsive disorder in an adolescent. Asian J Psychiatr 2019; 43:34-36. [PMID: 31078093 DOI: 10.1016/j.ajp.2019.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 03/28/2019] [Accepted: 05/02/2019] [Indexed: 11/29/2022]
Abstract
Children and adolescents with Obsessive Compulsive Disorder (OCD) can present in atypical and unusual ways. We present the case of a 13 year old boy with an unusual presentation of OCD. He presented with irritability, aggression, poor sleep, reduced attention, hyperreligiosity, social withdrawal and disinhibition (i.e. inappropriately touching females) for 1 week and was found to have obsessional thoughts and impulses related to sex and the compulsion of seeking absolution from lord buddha. He was diagnosed as OCD after excluding organic causes, manic episode, acute psychotic episode, drug induced psychosis and sexual abuse. He initially responded to fluoxetine 20mg, olanzapine 2.5 and a short course of lorazepam. He was functioning well for 2 weeks and thus olanzapine and lorazapam were tailed off. A week later he presented with similar symptoms with the added symptoms of singing, masturbating in public and talking excessively to his mother about sex. He was found to have obsessional thoughts, impulses and images and the compulsions of reassurance seeking from his mother and seeking absolution from lord buddha. He responded to an increase in fluoxetine to 40mg and olanzapine 2.5mg. He has now remained in remission for 4 months with good functioning. This case shows that in contrast to adults, children may not recognize that their obsessional thoughts are irrational and may not be able to resist the obsessions as a result. It stresses the importance of being mindful of the atypical presentations of OCD in children to avoid misdiagnosis.
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Affiliation(s)
- Yasodha Maheshi Rohanachandra
- Department of Psychiatry, Faculty of Medical Sciences, University of Sri Jayewardenepura, Sri Soratha Mawatha, Nugegoda, Sri Lanka.
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