Pharmacotherapy in Paediatric Obsessive-Compulsive Disorder

Masi, Gabriele; Millepiedi, Stefania; Perugi, Giulio; Pfanner, Chiara; Berloffa, Stefano; Pari, Cinzia; Mucci, María

doi:10.2165/00023210-200923030-00005

Cited by 46 publications

(44 citation statements)

References 27 publications

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“…7 This finding has been reported consistently across many studies of BD-OCD. 7,15,16,23,24 Our study found a higher number of suicidal attempts in BD-OCD. Many previous studies also report the same finding.…”

Section: Discussionsupporting

confidence: 51%

“…4,7,8,12 OCD in BD is a poor prognostic factor too, as poor treatment response and polypharmacy are well documented in BD-OCD comorbidity. 7,[13][14][15] A recent large sample study from India showed that OCD is severe in BD-OCD. 9 In another study, severity of OCD in BD was significantly higher when compared with pure OCD and subjects had moderate to severe scores on the Y-BOCS severity scale.…”

Section: Introductionmentioning

confidence: 99%

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Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Kazhungil

Cholakottil

Kattukulathil

et al. 2017

Trends Psychiatry Psychother.

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Introduction Comorbid obsessive-compulsive disorder (OCD) is common in bipolar disorder (BD). Clinical characteristics, functionality and familial pattern of this comorbidity are largely understudied. Objective To assess clinical profile, familial loading of psychiatric disorders and level of functioning in remitted BD patients who have comorbid OCD and to compare results with those of remitted BD patients without OCD. Methods Remitted BD-I subjects were assessed using the Structured Clinical Interview for DSM-IV Axis I Disorders, Global Assessment of Functioning Scale (GAF), Hamilton Depression Rating Scale (HDRS), Young Mania Rating Scale (YMRS), Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and Family Interview for Genetic Studies (FIGS). BD patients with and without OCD were compared. Group differences were analyzed using the chi-square test and the independent samples t test. Values <0.05 were considered statistically significant. Results Of the 90 remitted BD-I patients, 35.5% (n=32) had obsessive-compulsive symptoms/OCD. The BD-OCD group showed significantly lower GAF scores, higher rates of suicidal attempts, hospitalizations, manic and depressive episodes compared to the group with BD only (p<0.05). In addition, first and second-degree relatives had higher rates of BD-OCD and OCD, but not of BD. Conclusions BD-OCD is characterized by more severe BD, more dysfunction and higher familial loading of BD-OCD and OCD. Larger studies involving relatives of probands will help to confirm our findings and to delineate nosological status of BD-OCD comorbidity.

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Section: Discussionsupporting

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Kazhungil

Cholakottil

Kattukulathil

et al. 2017

Trends Psychiatry Psychother.

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“…When restricting the analysis to studies with sample size greater than 250, the BD-OCD prevalence range was narrower (11-15.7%) (17,51,53), and the mean prevalence rate of BD-I comorbidity was 3.7%, while BD-II was 9.5% (17,51,53,58). Hospital-based studies conducted in OCD children and adolescents described prevalence of comorbid BD ranging between 1.8% and 35.8% (43,(59)(60)(61)(62)(63). Only one study differentiated BD comorbidity by type in child and adolescent population (62).…”

Section: Included Studiesmentioning

confidence: 99%

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

Amerio

Odone

Liapis

et al. 2014

Acta Psychiatr Scand

107

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Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review Amerio A, Odone A, Liapis CC, Ghaemi SN. Diagnostic validity of comorbid bipolar disorder and obsessive-compulsive disorder: a systematic review.Objective: At least 50% of bipolar disorder (BD) patients have an additional diagnosis, one of the most difficult to manage being obsessive-compulsive disorder (OCD). Defining the nosology of BD-OCD comorbidity has important clinical implications, given that treatments for OCD can worsen BD outcomes. Method: A systematic review was conducted on: i) BD-OCD comorbidity lifetime prevalence and ii) on standard diagnostic validators: phenomenology, course of illness, heredity, biological markers, and treatment response. Relevant papers published through March 30th 2013 were identified searching the electronic databases MEDLINE, Embase, PsycINFO, and the Cochrane Library. Results: Sixty-four articles met inclusion criteria. Lifetime comorbidity prevalence was 11-21% in BD patients and 6-10% in OCD patients. Compared to non-comorbid subjects, BD-OCD has a more episodic course of OC symptoms (up to 75% vs. 3%), typically with worsening during depression (78%) and improvement during mania/hypomania (64%), as well as a higher total mean number of depressive episodes (8.9 AE 4.2 vs. 4.1 AE 2.7) and perhaps more antidepressant-induced mania/hypomania (39% vs. 9%). Conclusion: In this first systematic review of BD-OCD comorbidity, it appears that OC symptoms are usually secondary to BD, rather than representing a separate disease. • The evidence so far on BD-OCD nosology-mainly based on the course of illness-supports the view that the majority of cases of comorbid BD-OCD are in fact cases of BD. OC symptoms usually are secondary manifestations of depressive or manic mood episodes.• BD-OCD patients may respond for both groups of symptoms with adequate doses of mood stabilizers and atypical antipsychotics. Because of the risk of worsening BD via SRI-induced mania/hypomania, antidepressants should only be used in a minority of refractory OCD. Considerations• Course of illness is the only diagnostic validator that clearly supports the OCD-BD construct as a subtype of BD. Findings on the phenomenology, heredity, biological markers, and treatment were fragmented and heterogeneous and mainly suggested increased severity of illness or functioning without helping us to answer the nosological question.• The use of retrospective assessment scales with unclear sensitivity in discriminating true ego-dystonic obsessions from depressive ruminations may have biased results toward an overestimation of obsession's prevalence. In addition, small sample sizes, mainly from out-patients units, may have limited the generalizability of the results to a whole community.

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Section: Risperidonementioning

confidence: 99%

“…Most studies herald the usefulness of antipsychotics as an augmenting agent to SSRIs (Masi et al, 2009). One study showed that over half of children who received an atypical antipsychotic as an augmenting strategy for OCD showed improvement (Masi et al, 2009). In adults with treatment-refractory OCD, antipsychotics have the largest body of evidence supporting their use as augmenting agents (Decloedt & Stein, 2010).…”

Section: Risperidonementioning

confidence: 99%

A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

Nguyen¹,

Shapiro²,

Welch³

2012

Journal of Behavioral Addictions

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Background:The initial treatment of obsessive-compulsive disorder (OCD) has generally been limited to serotonergic agents, cognitive-behavioral therapy (CBT), or a combination of the two. These findings were supported by the POTS study for OCD in children and adolescents. However, treatment with serotonergic agents or CBT can take several weeks before benefit is seen; severe cases of OCD may require more immediate treatment. Case report: The authors present a case of severe OCD in an adolescent that required immediate treatment due to her critical medical condition. The patient's symptoms included not eating or taking medications or fluids by mouth due to fears of contamination. A medical hospitalization was previously required due to dehydration. As treatment with an SSRI would not have quick enough onset and the patient was initially resistant to participating in CBT, the patient was psychiatrically hospitalized and first started on liquid risperidone. After several doses of risperidone, the patient was able to participate in CBT and start sertraline. Discussion: The authors discuss the differential diagnosis of such a patient, including the continuum of OCD symptoms and psychotic symptoms. The authors discuss the different treatment options, including the utilization of inpatient psychiatric hospitalization. The authors discuss the potential risks and benefits of using atypical antipsychotics in lieu of benzodiazepines for the initial treatment of severe adolescent OCD. The authors also discuss other current treatment recommendations and rationale for the treatment that was pursued. Conclusions: This patient received benefit of her symptoms relatively quickly with psychiatric hospitalization and an atypical antipsychotic. The diagnosis of a psychotic disorder should be considered. These treatment options must be weighed against the risks of atypical antipsychotics, including extrapyramidal symptoms, weight gain, and metabolic syndrome; benzodiazepines also have their risks and benefits. Additionally, the cost of time and finances of inpatient hospitalization must be considered. More research is needed regarding the short-and long-term efficacy and safety of antipsychotics in the treatment of OCD in the child and adolescent population.

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Pharmacotherapy in Paediatric Obsessive-Compulsive Disorder

Abstract: Our study suggests that putative variables associated with response to pharmacological treatment of paediatric OCD can be defined, and can help improve treatment strategies.

Cited by 46 publications

References 27 publications

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Clinical and familial profile of bipolar disorder with and without obsessive-compulsive disorder: an Indian study

Diagnostic validity of comorbid bipolar disorder and obsessive–compulsive disorder: a systematic review

A case of severe adolescent obsessive-compulsive disorder treated with inpatient hospitalization, risperidone and sertraline

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