Treatment Outcome for Adolescent Obsessive-Compulsive Disorder in a Specialized Hospital Setting

Abstract

Although few data are available concerning adolescents with obsessive-compulsive disorder (OCD), the existing literature suggests that cognitive-behavioral therapy (CBT) is the first-line treatment of choice for adolescents with mild to moderate OCD. A combination of CBT and serotonin reuptake inhibitors (SRIs) is recommended for more severe forms of OCD, based on the Expert Consensus Guidelines for the Treatment of Obsessive-Compulsive Disorder and the Pediatric OCD Treatment Study (POTS). Despite the effectiveness of CBT, a recent meta-analysis found that 27% of adolescent outpatients fail to show clinically significant improvement following CBT and many also fail to show improvement with pharmacotherapy. One alternative for those who do not improve with outpatient treatment is an intensive inpatient program. Within the last 10 years, two specialty hospitals have created programs that provide intensive CBT milieu treatment with multidisciplinary support (e.g., nursing, psychopharmacology) to treat adolescents with OCD. This naturalistic study describes treatment outcomes in 23 patients who received treatment in one of these programs between 2005 and 2006. Results suggest significant improvements on the majority of outcome measures, with 70% of the patients judged to meet criteria for clinically significant change. Thus, inpatient treatment appears potentially efficacious, although future controlled trials with larger samples are needed.

Eficacia de los tratamientos cognitivo-conductuales en el trastorno obsesivo-compulsivo en niños y adolescentes: Una revisión cualitativa

“…No se encontraron diferencias significativas en aquellos sujetos que padecían síntomas en cualquier otra dimensión de las citadas. En este mismo año, Bjorgvinsson et al (2008) trataron a 23 adolescentes de entre 13 y 17 años, en régimen hospitalario. El programa terapéu-tico incluyó 90 minutos de EPR asistida por el terapeuta por las mañanas, mientras que por la tarde los sujetos se autoexponían durante 60 minutos, tres veces por semana.…”

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

“…Constant staff supervision provides both added emotional support and dutiful roadblocks to preventing ritualistic or compulsive behaviors (Björgvinsson et al, 2008). Milieu treatment may also provide the opportunity to uncover maladaptive family accommodation of OCD symptoms and temporarily remove the patient from these circumstances (Björgvinsson et al, 2008). The inpatient setting also provides patients with a setting where they can model after peers, which may increase willingness to perform exposures (Björgvinsson et al, 2008).…”

“…However, some studies have shown a beneficial effect of a highly structured environment offered by a milieu setting in treating adolescent OCD (Scahill, Walker, Lechner & Tynan, 1993). There are several advantages of treating adolescent OCD in a residential or inpatient setting, including a constant support system, greater time devoted to treatment, and the presence of staff to minimize ritualistic and compulsive behaviors (Björgvinsson et al, 2008). Constant staff supervision provides both added emotional support and dutiful roadblocks to preventing ritualistic or compulsive behaviors (Björgvinsson et al, 2008).…”

“…There are several advantages of treating adolescent OCD in a residential or inpatient setting, including a constant support system, greater time devoted to treatment, and the presence of staff to minimize ritualistic and compulsive behaviors (Björgvinsson et al, 2008). Constant staff supervision provides both added emotional support and dutiful roadblocks to preventing ritualistic or compulsive behaviors (Björgvinsson et al, 2008). Milieu treatment may also provide the opportunity to uncover maladaptive family accommodation of OCD symptoms and temporarily remove the patient from these circumstances (Björgvinsson et al, 2008).…”

“…Milieu treatment may also provide the opportunity to uncover maladaptive family accommodation of OCD symptoms and temporarily remove the patient from these circumstances (Björgvinsson et al, 2008). The inpatient setting also provides patients with a setting where they can model after peers, which may increase willingness to perform exposures (Björgvinsson et al, 2008). However, a potential drawback to milieu treatment may be the lack of being able to generalize treatment gains to other setting, as treatment gains may prove transient when the patient is discharged and parents are unable to provide the same level of supervision in absence of milieu environment (Scahill et al, 1993).…”