Tic-Related Obsessive-Compulsive Disorder (OCD): Phenomenology and Treatment Outcome in the Pediatric OCD Treatment Study II

Abstract

Objective Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of “tic-related” was used to examine whether children with tics in the Pediatric OCD Treatment Study II differed from those without tics in terms of demographic and phenomenological characteristics and acute treatment outcome. Method Participants were 124 youth aged 7-17 years with a primary diagnosis of OCD who were partial responders to an adequate serotonin reuptake inhibitor (SRI) trial. Participants were randomized to medication management, medication management plus instructions in cognitive behavioral therapy (CBT), or medication management plus full CBT. Tic status was based on the presence of motor and/or vocal tics on the Yale Global Tic Severity Scale. Results Tics were identified in 53% of the sample. Those with tic-related OCD did not differ from those with non-tic-related OCD in terms of age, family history of tics, OCD severity, OCD-related impairment, or comorbidity. Those with tics were responded equally in all treatment conditions. Conclusion Tic-related OCD was very prevalent using a broad definition of tic status. Results suggest that youth with this broad definition of tic-related OCD do not have increased OCD severity or inference, higher comorbidity rates or severity, or worsened functioning and support the use of CBT in this population. This highlights the importance of not making broad assumptions about OCD symptoms most likely to occur in an individual with comorbid tics. Clinical trial registration information--Treatment of Pediatric OCD for SRI Partial Responders; http://clinicaltrials.gov/show/; NCT00074815.

A Meta-Analysis of Cognitive Behavior Therapy and Medication for Child Obsessive-Compulsive Disorder: Moderators of Treatment Efficacy, Response, and Remission

“…Notably, the power to detect this statistical difference was largely constrained by the small number of trials that emphasized CT, as well as the possible overlap between “behavioral experiments” used in CT trials and “exposures” in ERP trials. Finally, the association between greater ES and a greater incidence of TS/CTD in active comparison trials is consistent with recent findings highlighting the benefit of CBT for tic‐related OCD …”

Evaluation of cognitive behaviour therapy for paediatric obsessive-compulsive disorder in the context of tic disorders

“…The current findings are in keeping with the results of previous studies which have explored the impact of TD on response to CBT for OCD in young people, albeit in smaller samples (Conelea et al, 2014;Ginsburg, 2008). Furthermore, they are also in keeping with other studies in childhood OCD and anxiety disorders showing that 'complex' patients, with comorbidities, do not have a worse outcome than those with one specific, circumscribed difficulty (e.g.…”

“…As in adults, some studies find a higher proportion of males with OCD+TD in comparison to OCD alone (e.g. Storch et al, 2008;Zohar et al, 1997), although some find no gender differences (Conelea et al, 2014;Hanna et al, 2002;Scahill et al, 2003). Scahill and colleagues (2003) found a trend towards greater levels of externalising symptoms and significantly greater levels of attention problems in those with OCD+TD.…”

“…Most studies find no difference in overall OCD severity in those with and without TD (Conelea et al, 2014;Hanna et al, 2002;Storch et al, 2008;Zohar et al, 1997). Some studies report fewer of some types of obsessions in OCD+TD groups compared to OCD alone (e.g.…”

“…Some studies find more compulsions in the comorbid TD groups (e.g. washing and ordering - Conelea et al, 2014; repetitive routine behaviours, ordering and arranging, unrelated to harm avoidance; Scahill et al, 2003;counting -Storch, 2008; harm-avoidance - Zohar et al, 1997) whereas others find fewer (ordering, hoarding, washing - Hanna et al, 2002;contamination, washing, reassurance seeking -Scahill et al, 2003).…”