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Disorders - Obsessive Compulsive Disorder
Riddle, M. A., Reeve, E. A., Yaryura-Tobias, J. A., Yang, H.
M., Claghorn, J. L., Gaffney, G., Greist, J. H., Holland, D., McConville, B. J., Pigott, T., Walkup, J. T.
OBJECTIVE: To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-
compulsive disorder (OCD) with a double-blind, placebo-controlled, multicenter study. METHOD: Subjects, aged 8 to 17 years, meeting DSM-III-R
criteria for OCD were recruited from July 1991 to August 1994. After a 7- to 14-day single-blind, placebo washout/screening period, subjects were
randomly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks. Subjects who had not responded after 6 weeks could discontinue the
double-blind phase of the study and enter a long-term, open-label trial of fluvoxamine. Analyses used an intent-to-treat sample with a last-
observation-carried-forward method. RESULTS: Mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) scores with fluvoxamine were
significantly (p < .05) different from those with placebo at weeks 1, 2, 3, 4, 6, and 10. Significant (p < .05) differences between fluvoxamine and
placebo were observed for all secondary outcome measures at all visits. Based on a 25% reduction of CY-BOCS scores, 42% of subjects taking
fluvoxamine were responders compared with 26% taking placebo. Forty-six (19 fluvoxamine, 27 placebo) of 120 randomized subjects discontinued early.
Adverse events with a placebo-adjusted rate greater than 10% were insomnia and asthenia. CONCLUSIONS: Fluvoxamine has a rapid onset of action and is
well tolerated and efficacious for the short-term treatment of pediatric OCD.
Journal of the American Academy of Child & Adolescent Psychiatry, 40(2) : 222-
9
- Year: 2001
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
Perlmutter, S. J., Leitman, S. F., Garvey, M. A., Hamburger, S., Feldman, E., Leonard, H. L., Swedo, S. E.
Background. In children, exacerbations of tics and obsessive symptoms may occur after infection with group A beta-haemolytic
streptococci. If post-streptococcal autoimmunity is the cause of the exacerbations, then children might respond to immunomodulatory treatments such
as plasma exchange or intravenous immunoglobulin (IVIG). We studied whether plasma exchange or IVIG would be better than placebo (sham IVIG) in
reducing severity of neuropsychiatric symptoms. Methods. Children with severe, infection-triggered exacerbations of obsessive-compulsive disorder
(OCD) or tic disorders, including Tourette syndrome, were randomly assigned treatment with plasma exchange (five single-volume exchanges over 2
weeks), IVIG (1 g/kg daily on 2 consecutive days), or placebo (saline solution given in the same manner as IVIG). Symptom severity was rated at
baseline, and at 1 month and 12 months after treatment by use of standard assessment scales for OCD, ties, anxiety, depression, and global function.
Findings. 30 children entered the study and 29 completed the trial. Ten received plasma exchange, nine IVIG, and ten placebo. At 1 month, the IVIG
and plasma-exchange groups showed striking improvements in obsessive-compulsive symptoms (mean improvement on children's Yale-Brown obsessive
compulsive scale score of 12 [45%] and 13 [58%], respectively), anxiety (2.1 [31%] and 3.0 [47%] improvement on National Institute of Mental Health
anxiety scale), and overall functioning (2.9 [33%] and 2.8 [35%] improvement on National Institute of Mental Health global scale). Tic symptoms were
also significantly improved by plasma exchange (mean change on Tourette syndrome unified rating scale of 49%). Treatment gains were maintained at 1
year, with 14 (82%) of 17 children 'much' or 'very much' improved over baseline (seven of eight for plasma exchange, seven of nine for IVIG).
Interpretation. Plasma exchange and IVIG were both effective in lessening of symptom severity for children with infection-triggered OCD and tic
disorders. Further studies are needed to determine the active mechanism of these interventions, and to determine which children with OCD and tic
disorders will benefit from immunomodulatory therapies.
Lancet, 354(9185) : 1153-1158
- Year: 1999
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Pallanti, S., Quercioli, L., Paiva, R. S., Koran, L. M.
We investigated the comparative efficacy of citalopram vs. citalopram administered
with clomipramine, in treatment-resistant obsessive-compulsive disorder (OCD). Sixteen adult outpatients participated in a 90-day, randomized, open-
label trial. Eligible patients were aged 18 to 45 years, had moderate to severe DSM-III-R OCD of [greater-than or equal to] one year's duration, a
baseline Yale-Brown scale (Y-BOCS) score of [greater-than or equal to] 25 and no other active axis I diagnosis, and had failed adequate clomipramine
and fluoxetine trials. The citalopram-plus-clomipramine group (n = 9) experienced a significantly larger percent decrease in mean Y-BOCS score by day
90 than the citalopram alone group (n = 7). Only one citalopram patient decreased her score by [greater-than or equal to] 35%, and two by [greater-
than or equal to] 25%. All nine citalopram-plus-clomipramine patients experienced decreases of [greater-than or equal to] 35%. Side effects were mild
to moderate in both groups. We also treated with citalopram six OCD patients who had not tolerated fluoxetine alone and clomipramine alone; three
achieved Y-BOCS score decreases of [greater-than or equal to] 35% at 90 days. Since citalopram does not significantly affect clomipramine metabolism,
the improvement in the combined drug group is unlikely to have resulted from increased plasma clomipramine levels. Double-blind controlled trials are
needed of citalopram in OCD, and of combining citalopram with clomipramine in treatment-resistant OCD. copyright 1999 Elsevier, Paris.
European
Psychiatry, 14(2) : 101-106
- Year: 1999
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Tricyclic antidepressants
March, J. S., Biederman,
J., Wolkow, R., Safferman, A., Mardekian, J., Cook, E. H., Cutler, N. R., et-al
Context. - The serotonin reuptake inhibitors are the treatment of choice for
patients with obsessive-compulsive disorder; however, empirical support for this assertion has been weaker for children and adolescents than for
adults. Objective. - To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and
adolescents with obsessive-compulsive disorder. Design. - Randomized, double- blind, placebo-controlled trial. Patients. - One hundred eighty-seven
patients: 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years randomized to receive either sertraline (53 children, 39
adolescents) or placebo (54 children, 41 adolescents). Setting. - Twelve US academic and community clinics with experience conducting randomized
controlled trials. Intervention. - Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy,
after which patients continued to receive this dosage of medication for 8 more weeks. Control patients received placebo. Main Outcome Measures. - The
Children's Yale- Brown Obsessive Compulsive Scale (CY-BOCS), the National Institute of Mental Health Global Obsessive Compulsive Scale (NIMH GOCS),
and the NIMH Clinical Global Impressions of Severity of Illness (CGI-S) and Improvement (CGI-I) rating scales. Results. - In intent-to-treat
analyses, patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS (adjusted mean,
-6.8 vs -3.4, respectively; P=.005), the NIMH GOCS (-2.2 vs -1.3, respectively; P = .02), and the CGI-I (2.7 vs 3.3, respectively; P = .002) scales.
Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study. Based on CGI-I
ratings at end point, 42% of patients receiving sertraline and 26% of patients receiving placebo were very much or much improved. Neither age nor sex
predicted response to treatment. The incidence of insomnia nausea, agitation, and tremor were significantly greater in patients receiving sertraline;
12 (13%) of 92 sertraline-treated patients and 3 (3.2%) of 95 placebo-treated patients discontinued prematurely because of adverse medical events (P
= .02). No clinically meaningful abnormalities were apparent on vital sign determinations, laboratory findings, or electrocardiographic measurements.
Conclusion. - Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder.
JAMA, 280(20) : 1752-
1756
- Year: 1998
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs)
DeHaan, E., Hoogduin, K. A. L., Buitelaar, J.
K., Keijsers, G. P. J.
Objective: To compare, via a pilot study, the effectiveness of behavior therapy and
of drug treatment in children and adolescents with obsessive- compulsive disorder. Method: Twenty-two children aged between 8 and 18 years were
randomly assigned to behavior therapy (n = 12) or open clomipramine (n = 10) in a parallel design lasting 12 weeks. Behavior therapy included
exposure and response prevention administered in weekly sessions. The mean dosage of clomipramine was 2.5 mg/kg (range = 1.4-3.3 mg/kg). The main
outcome variables were the Children's Yale-Brown Obsessive Compulsive Scale (CY- BOCS) and the Leyton Obsessional Inventory-Child Version (LOI-CV).
Results: Significant improvement was obtained in both treatment conditions. Behavior therapy produced stronger therapeutic changes than clomipramine
on the CY- BOCS (p < .05), whereas on the LOI-CV no significant differences between the results of the two treatments were found. Five of the nine
initial nonresponders showed significant changes after extension of treatment for another 12 weeks. Conclusion: Behavior therapy is shown to be a
good alternative for drug treatment and deserves further study in larger samples of children with obsessive-compulsive disorder.
Journal of the American Academy of Child & Adolescent Psychiatry., 37(10) : 1022-
1029
- Year: 1998
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Tricyclic antidepressants, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Franklin, M. E., Kozak, M. J., Cashman, L. A., Coles, M. E., Rheingold, A. A., Foa, E. B.
Objective: The purpose of this open clinical trial was to examine the
efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD). Method:
Children and adolescents with diagnosed OCD (N = 14) received cognitive- behavioral treatment; seven patients received intensive treatment (mean = 18
sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment
with serotonin reuptake inhibitors and six received cognitive- behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-
Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale.
Results: Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over
pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at
follow-up (mean time to follow-up = 9 months). Conclusions: Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is
effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-
behavioral, pharmacological, and combined treatments.
Journal of the
American Academy of Child & Adolescent Psychiatry., 37(4) : 412-419
- Year: 1998
- Problem: Obsessive Compulsive Disorder
- Type: Controlled clinical trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)