Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Pediatric Obsessive-Compulsive Disorder

Storch, Eric A.; Merlo, Lisa J.; Larson, Michael J.; Geffken, Gary R.; Lehmkuhl, Heather D.; Jacob, Marni L.; Murphy, Tanya K.; Goodman, Wayne K.

doi:10.1097/chi.0b013e31816774b1

Cited by 244 publications

(185 citation statements)

References 48 publications

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“…Interestingly, family accommodation does not seem to be associated with the clinical outcome when CBT follows a more intensive family approach [29]. Moreover, tic disorders do not seem to be a predictor of poor outcome either [27,29,30].…”

Section: Cbtmentioning

confidence: 99%

“…In addition, up to 30 % show little or no improvement [9,20]. Factors have been found that can predict a poor outcome of CBT, such as higher initial OCD severity [27][28][29], more internalizing and externalizing symptoms/disorders [28][29][30], and family dysfunction or high family accommodation [27,28,31]. Interestingly, family accommodation does not seem to be associated with the clinical outcome when CBT follows a more intensive family approach [29].…”

Section: Cbtmentioning

confidence: 99%

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Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

Skarphéðinsson

Ivarsson

2015

Curr Behav Neurosci Rep

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Pediatric obsessive-compulsive disorder (OCD) is a chronic, disabling, and common disorder. In this paper, we describe evidence-based treatments in treatment-naïve and treatment-refractory pediatric OCD patients. We conducted a PubMed search to identify randomized controlled trials, reviews, and expert guidelines. The evidence for cognitive behavior therapy (CBT) and specific serotonin reuptake inhibitors (SSRIs) among treatment-naïve patients is substantial and shows that both treatments are effective. Head-to-head trials in pediatric OCD only show that CBT is significantly more effective than SSRI. The evidence among CBT and SSRI non-responders is limited. One trial among CBT non-responders showed that both continued CBT and switching to an SSRI are effective strategies. Likewise, one trial among SSRI non-responders showed that augmenting with CBT is necessary. Evidence of treatments for treatment-refractory pediatric OCD is lacking. We describe the treatments available and evidence from studies of adult OCD. Evidence for emerging treatments such as modifying CBT and glutamatergic drugs is also described.

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Section: Cbtmentioning

confidence: 99%

Section: Cbtmentioning

confidence: 99%

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

Skarphéðinsson

Ivarsson

2015

Curr Behav Neurosci Rep

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“…Response rates seem to be similar in pediatric patients, although few experience complete symptom relief after treatment with CBT and SSRIs (27,36). As yet, no standardized predictors for determining whether a patient with childhood-onset OCD will respond to treatment with an SSRI have been established, but studies have shown a poorer response among children with comorbid ADHD, oppositional defiant disorder, conduct disorder, and tic disorders (50), as well as those with more severe symptoms of OCD, higher parental stress, and greater functional impairment (51,52). For adult patients who do not, or only partially, respond to SSRIs, a combination of an SSRI and a drug that antagonizes dopamine function (e.g., pimozide, haloperidol, and risperidone) has been shown to be beneficial (49).…”

Section: Cbt the Optimum Treatment For Childhood-onset Ocd Is A Combi-mentioning

confidence: 99%

Children with obsessive-compulsive disorder: are they just “little adults”?

Kalra¹,

Swedo²

2009

J. Clin. Invest.

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Childhood-onset obsessive-compulsive disorder (OCD) affects 1%-2% of children and adolescents. It is characterized by recurrent obsessions and compulsions that create distress and interfere with daily life. The symptoms reported by children are similar to those seen among individuals who develop OCD in adulthood, and the two groups of patients are treated with similar symptom-relieving behavior therapies and medications. However, there are differences in sex ratios, patterns of comorbidity, and the results of neuroimaging studies that might be important. Here we review the diagnosis and treatment of childhood-onset OCD in light of pediatric and adult studies. We also discuss current knowledge of the pathophysiology of the disorder. Despite advances in this area, further research is needed to understand better the etiopathogenesis of the disorder and to develop new, more effective therapeutic options.

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“…In CBT, comorbid conditions may reduce treatment adherence and participation in sessions. 78,[80][81][82] Furthermore, comorbid disorders can adversely affect response rates to serotonin reuptake inhibitors and result in greater rates of relapse. 81,83,84 With paroxetine, for example, the full sample response rate of 71% decreased significantly when examining responses for comorbid subgroups (attention deficit/hyperactivity disorder, 56%; chronic tic disorder, 53%; oppositional defiant disorder, 39%).…”

Section: Comorbiditymentioning

confidence: 99%

“…83 Consequently, a child who has a comorbid condition such as major depression, disruptive behavior disorder, or attention deficit hyperactivity disorder may require a different treatment approach considering how the comorbid disorder might affect presentation and/or treatment course. 20,82,[85][86][87] For example, if depression could impact the course of treatment, sequentially providing evidence-based depression therapies (eg, antidepressant medication, CBT, or interpersonal psychotherapy) may be indicated. Similarly, those with uncontrolled attention deficit hyperactivity disorder may benefit from concurrent pharmacologic intervention.…”

Section: Comorbiditymentioning

confidence: 99%

Optimal management of pediatric obsessive-compulsive disorder

Ung¹,

Ale²,

Storch³

2012

PHMT

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Abstract:The last two decades have seen an increase in evidence supporting behavioral and pharmacologic treatments of pediatric obsessive-compulsive disorder, a debilitating anxiety disorder that affects about 1% of youth. However, dissemination of knowledge about these treatments to pediatric health care providers and families of affected children has been less successful. Following best practice guidelines, specific evidence for cognitive-behavioral therapy with exposure and response prevention and pharmacotherapy with serotonin reuptake inhibitors are presented. A discussion of clinical features and their impact on treatment delivery and empirically based suggestions for overcoming these barriers are also presented. Future directions for enhancing treatment implementation and dissemination are discussed.

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Impact of Comorbidity on Cognitive-Behavioral Therapy Response in Pediatric Obsessive-Compulsive Disorder

Cited by 244 publications

References 48 publications

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

Evidence-Based Treatments in Treatment-Naïve and Treatment-Resistant Pediatric Obsessive-Compulsive Disorder

Children with obsessive-compulsive disorder: are they just “little adults”?

Optimal management of pediatric obsessive-compulsive disorder

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