Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents

Micali, Nadia; Heyman, Isobel; Pérez, Marco Antonio Castillo; Hilton, Kristina; Nakatani, Eriko; Turner, Cynthia; Mataix‐Cols, David

doi:10.1192/bjp.bp.109.075317

Cited by 181 publications

(104 citation statements)

References 27 publications

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“…Focusing on the studies that have used non-clinical samples, the remission rate is even higher, at 74%. Some more recent studies from the USA 97,98 and the UK 99 have also been published. The results of more recent studies are similar to those seen in the Stewart et al review, 96 despite the use of selected samples from tertiary centres.…”

Section: Natural History: Prognosismentioning

confidence: 99%

“…In the Yale cohort, 98 58% of the patients had complete remission after a mean follow-up duration of 9 years. In the Maudsley cohort, 99 approximately 60% of the patients had at least a partial remission after 5 years' mean follow-up. From these findings it can be concluded that remission rates in children and adolescents may be higher than those in adults.…”

Section: Natural History: Prognosismentioning

confidence: 99%

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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

Skapinakis

Caldwell

Hollingworth

et al. 2016

Health Technol Assess

100

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BackgroundObsessive–compulsive disorder (OCD) is a relatively common and disabling condition.ObjectivesTo determine the clinical effectiveness, acceptability and cost-effectiveness of pharmacological and psychological interventions for the treatment of OCD in children, adolescents and adults.Data sourcesWe 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 methodsWe 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; seewww.openbugs.net).ResultsWe 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.LimitationsThe majority of psychological trials included patients who were taking medications. There were few studies in children and adolescents.ConclusionsIn 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 registrationThe study is registered as PROSPERO CRD42012002441.Funding detailsThe National Institute for Health Research Health Technology Assessment programme.

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Section: Natural History: Prognosismentioning

confidence: 99%

Section: Natural History: Prognosismentioning

confidence: 99%

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

Skapinakis

Caldwell

Hollingworth

et al. 2016

Health Technol Assess

100

View full text Add to dashboard Cite

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“…Quality of life is seriously impaired in OCD, more so than, for instance, in depression (Srivastava et al, 2011). Various longitudinal clinical studies have established that in contrast to children/adolescents in whom OC symptoms seem to remit somewhat more often (Fernández de la Cruz et al, 2013;Leckman et al, 2009;Micali et al, 2010;Stewart et al, 2004), in adults, OC symptoms tend to be more stable with respect to symptom dimensions, with probability estimates of full remission between 17% and 27%, and of partial remission of between 22% and 53% in the course of up to 40 years, depending on study methodology (prospective vs. retrospective), and country of origin (Alonso et al, 2001;Eisen et al, 2013;Mancebo et al, 2014;Orloff et al, 1994;Reddy et al, 2005;Skoog & Skoog, 1999;Steketee et al, 1999). Specifically, in patients who only experience partial treatment response, symptoms recur in up to 70% of patients within 5 years of follow-up (Eisen et al, 2013).…”

mentioning

confidence: 99%

Genetic and Environmental Contributions to Stability in Adult Obsessive Compulsive Behavior

Zilhão

Smit²,

Braber³

et al. 2014

Twin Res Hum Genet

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This study investigates the relative contribution of genetic and environmental factors to the stability of obsessive-compulsive (OC) symptoms in an adult population-based sample. We collected data from twin pairs and their siblings, using the Padua Inventory Revised Abbreviated, from the population-based Netherlands Twin Register (NTR) in 2002 (n = 10.134) and 2008 (n = 15.720). Multivariate twin analyses were used to estimate the stability of OC symptoms as a function of genetic and environmental components. OC symptoms were found to be highly stable, with a longitudinal phenotypic correlation of 0.63. Longitudinal broad sense heritability was found to be 56.0%. Longitudinal correlations for genetic (r = 0.58 for additive, r = 1 for non-additive genetic factors) and non-shared environment (r = 0.46) reflected stable effects, indicating that both genes and environment are influencing the stability of OC symptoms in adults. For the first time, evidence is reported for non-additive genetic effects on the stability of OC symptoms. In conclusion, this study showed that OC symptoms are highly stable across time in adults, and that genetic effects contribute mostly to this stability, both in an additive and non-additive way, besides non-shared environmental factors. These data are informative with respect to adult sample selection for future genetic studies, and suggest that gene-gene interaction studies are needed to further understand the dominance effect found in this study.

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“…Obsessions and compulsions are behaviors that do not feel consistent with the patient's own beliefs about what is reasonable. For a long time, the disorder was thought to be rare in children and adolescents, but we now know that OCD often starts in childhood and adolescence and can develop into a chronic disorder with high rates of persistence [7]. The prevalence of OCD in childhood and adolescence is reported to be between 0,5% and 4% [8][9][10].…”

Section: Introductionmentioning

confidence: 99%

Suggestive obsessive-compulsive disorder in students attending a public high school in Istanbul, Turkey

Özdemi̇r¹,

Hıdıroğlu²,

Sarioz³

et al. 2016

MMJ

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Objectives: Obsessive-compulsive disorder (OCD) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates. The prevalence of OCD in this group is between 0.5-4%. It may occur in children as young as 6-7 years of age. The aim of the present study is to explore suggestive OCD in adolescents in a public high school and factors related with suggestive OCD. Patients and Methods:Ninth, 10th, 11th and 12th grade students attending a public high school were included in the study. In our study, we used a questionnaire made up of a sociodemographic survey form and the Leyton's Obsessional Inventory. The inventory was applied as a self-report questionnaire.Results: A high suggestive OCD prevalence was found among students (14.3%). Students who declared to be traumatized in childhood had 3,55 times higher odds to exhibit suggestive OCD than those who declared to be not traumatized. Also students who reported to possess a psychological disorder had 2,22 times higher odds to exhibit suggestive OCD than students who reported not having a psychological disorder. Conclusion:The prevalence of suggestive OCD was high in students who participated to our study. More comprehensive studies are needed to be done. Keywords:Suggestive obsessive-compulsive disorder, Superstition, Trauma, High school ÖZ Amaç: Obsesif-kompulsif bozukluk (OKB) genellikle çocukluk ve ergenlik döneminde başlayabilir ve kronik bir rahasızlık haline gelebilir. OKB'nin çocuk ve yetişkinlerdeki prevelansı 0,5% ile 4% arasında değişmektedir. OKB 6-7 yaşlarında başlayabilmektedir ve her iki cinsiyet grubunda eşit oranda gözlenmektedir. Amacımız bir devlet lisesine kayıtlı öğrencilerde muhtemel OKB sıklığını ve ilişkili faktörleri incelemektir. Hastalar ve Method:Bir devlet lisesindeki 9, 10, 11 ve 12. sınıf öğrenciler araştırmaya dahil edilmiştir. Öğrencilere sosyodemoğrafik değişkenleri ve Leyton obsesyon skalasını da içeren bir soru formu uygulanmıştır. Anketler öğrencilerin kendi bildirimlerine göre doldurulmuştur. Bulgular: Çalışmamızda muhtemel OKB sıklığı öğrencilerde yüksek bulunmuştur (14,3%). Çocukluk çağında travma yaşayan öğrencilerde diğerlerine göre 3,55 kat daha yüksek oranda muhtemel OKB mevcut idi. Ayrıca psikolojik bozukluğu olduğunu ifade eden öğrencilerin psikolojik bozukluğu olmadığını bildiren öğrencilere göre muhtemel OKB görülme oranı 2,22 kat daha fazla bulunmuştur.Sonuç: Araştırmamıza katılan öğrencilerde muhtemel OKB sıklığı beklenenin üzerinde çıkmıştır. Bu sonuç ülkemiz genelinde daha kapsamlı bir çalışmaya ihtiyaç olduğunu göstermektedir.

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Long-term outcomes of obsessive–compulsive disorder: follow-up of 142 children and adolescents

Abstract: This study confirms that paediatric OCD can be a chronic condition that persists into adulthood. Early recognition and treatment might prevent chronicity. Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services.

Cited by 181 publications

References 27 publications

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

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

Genetic and Environmental Contributions to Stability in Adult Obsessive Compulsive Behavior

Suggestive obsessive-compulsive disorder in students attending a public high school in Istanbul, Turkey

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