Disorders - Obsessive Compulsive Disorder
Turner, C., O'Gorman, B., Nair, A., OKearney, R.
We report a systematic review of
moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs
reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared
to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children
with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained
superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics
but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family
accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small
Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in
properly conducted trials and about which clinicians need to show care in their treatment recommendations. Copyright © 2017 Elsevier B.V.
Psychiatry Research, 261 : 50-60
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Peris, T. S., Rozenman, M. S., Sugar, C. A., McCracken, J. T., Piacentini, J.
Objective Although evidence-based treatments for pediatric obsessive-compulsive disorder (OCD) exist, many youth fail to respond, and
interventions tailored to the needs of specific subsets of patients are lacking. This study examines the efficacy of a family intervention module
designed for cases of OCD complicated by poor family functioning. Method Participants were 62 youngsters aged 8 to 17 years (mean age = 12.71 years;
57% male; 65% white) with a primary diagnosis of OCD and at least 2 indicators of poor family functioning. They were randomized to receive 12
sessions of individual child cognitive-behavioral therapy (CBT) plus weekly parent psychoeducation and session review (standard treatment [ST]) or
the same 12 child sessions plus 6 sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving (positive family
interaction therapy [PFIT]). Blinded raters evaluated outcomes and tracked responders to 3-month follow-up. Results Compared to ST, PFIT demonstrated
better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% versus 40%, p =.03, phi = 0.28) and rates of remission
(58% PFIT versus 27% ST, p =.01, phi = 0.32). PFIT also produced significantly greater reductions in functional impairment, symptom accommodation,
and family conflict, and improvements in family cohesion. As expected, these shifts in family functioning constitute an important treatment
mechanism, with changes in accommodation mediating treatment response. Conclusion PFIT is efficacious for reducing OCD symptom severity and
impairment and for improving family functioning. Findings are discussed in terms of personalized medicine and mechanisms of change in pediatric OCD
treatment. Clinical trial registration information-Family Focused Treatment of Pediatric Obsessive Compulsive Disorder; http://clinicaltrials.gov/;
NCT01409642. Copyright © 2017 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 56(12) : 1034-
1042.e1
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Psychoeducation
Vattimo, E., Barros, V., Batistuzzo, M., Requena, G., Sato, J., Fatori, D., Shavitt, R., Miguel, E., Hoexter, M.
Background: Magnetic resonance imaging investigations in psychiatry have produced a sizable amount of data, contributing to a better
understanding of the neurobiological correlates of psychiatric illnesses. As a result, there is strong evidence of the role of the cortico-basal
ganglia-thalamocortical (CBGTC) circuitry in the pathophysiology of obsessive-compulsive disorder (OCD). These specific brain regions have also been
suggested as possible morphometric biomarkers of treatment response in adults undergoing cognitive-behavior therapy (CBT) or pharmacological
treatment (antidepressants). Morphometric measurements of CBGTC structures were also shown to correlate to treatment response in children, as our
group has previously demonstrated. The large amount of data produced by neuroimaging studies requires, however, improvements of statistical analysis
techniques. The aims of this study were to compare the power of simple linear regression (SLR) and support vector regression (SVR) as prediction
techniques of treatment response using structural neuroimaging parameters. Methods: A total of 29 children with OCD underwent magnetic resonance
imaging (MRI). Gray Matter (GM) volume and cortical thickness of CBGTC structures were selected a priori for analysis using FreeSurfer Software.
After MRI acquisition, patients were enrolled in a randomized clinical trial receiving either fluoxetine (n=12) or CBT (n=17) during 14 weeks.
Baseline and post-treatment symptom severity was assessed using Yale Brown Obsessive- Compulsive Scale (Y-BOCS). Morphometric data from CBGTC
structures were, then, used to predict clinical response (Y-BOCS changes) in a SLR model. Predictive power of the SLR model was then compared to SVR
(with default and tuned parameters) through Root-Mean-Square Error calculations. Results: Larger GM volume of left caudate (r2= 0,175; p=0.024),
right lateral orbitofrontal cortex (OFC) (r2= 0,161; p=0.031) and right medial OFC (r2= 0,143; p=0.043) correlated with percentage improvement in Y-
BOCS considering both groups. Thicker right lateral OFC was also correlated with Y-BOCS improvement (r2= 0,181; p=0,021), markedly in patients that
underwent CBT (r2= 0,39; p=0,007). SVR was more accurate to predict treatment response in all cases and tuned parameters failed to improve even
further the technique was used only for the left caudate. Conclusions: This investigation presents a comparison of conventional and novel techniques
to analyze neuroimaging data as predictors of treatment response in pediatric patients with OCD. Our results raise the possibility that machine
learning methods, particularly support vector regression, may be useful to improve the predictive power of such neuroimaging studies.
Neuropsychopharmacology, 43 (Supplement
1) : S479
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT)
Wilhelm, S., Berman, N., Small, B.
J., Storch, E. A., Porth, R., Geller, D.
Background: Previous research suggests that cognitive behavioral therapy (CBT) is an efficacious treatment for pediatric OCD. However, up to
60% of children with OCD receiving CBT do not fully remit. Researchers have attempted to augment CBT with D-cycloserine (DCS), an N-methyl-D-
aspartate (NMDA) partial agonist that has been shown to enhance extinction learning, with mixed results. While results of the largest trial to date
(5R01MH093402-02) suggest that DCS did not improve outcomes for pediatric OCD patients, it may be that baseline factors moderate a patients'
response to DCS. The present study aimed to identify the predictors and moderators of DCS of CBT, or baseline characteristics that are associated
with outcomes and the conditions in which DCS augmentation worked best. Identifying these factors would allow clinicians to better direct pediatric
patients with OCD to the most appropriate treatment option. Methods: Two hundred and six children and adolescents were enrolled at either
Massachusetts General Hospital (MGH) in Boston, MA or University of South Florida (USF) in St. Petersburg, FL. One hundred and forty-two patients
with an OCD diagnosis per DSM-IV-TR criteria as determined by the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present
and Lifetime Version (KSADS-PL) (M = 12.79, SD = 2.99; range 7- 17-years-old) were randomized to either DCS + CBT (n = 70) or placebo + CBT (n = 72;
for full consort diagram, please refer to Storch et al., 2016). Eligible children received 10 sessions of cognitive behavioral treatment, with two
sessions per week for the first two weeks. Participants were randomized in a double-blind approach to either CBT augmented with DCS or CBT and
placebo before the fourth CBT session. They then received either DCS or a placebo pill one hour prior to exposure sessions. We adopted an exploratory
approach, as prior research on the predictors of CBT for pediatric OCD is conflicting. We looked at the extent to which demographics (age, gender,
race, ethnicity), OCD-specific features (symptom severity, family accommodation, impairment), comorbidity (number of comorbidities, a comorbid
anxiety, depression, or tic disorder, anxiety symptom severity, depression symptom severity, and externalizing behavior symptom severity), and
treatmentrelated factors (treatment alliance at randomization) predicted treatment response. We also looked at how demographic (age and gender) and
comorbidity (previous or current history of depression, anxiety and tics) variables interact with DCS augmentation to moderate outcome. All
procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Boards at the
USF and MGH. Written parental informed consent and child assent were obtained from all individual subjects participating in the study. Results:
Moderator analyses examined the extent to which age, gender, current history and previous history of depression, anxiety and tics predicted treatment
outcomes. Although there were significant improvements in all outcome measures (Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and CGI-
Severity), the treatment group by time by moderator term was not statistically significant for any of the outcome/moderator pairs. We next examined
the predictors of response across treatment groups, looking at changes in CY-BOCS total, CY-BOCS obsessions and compulsions, and CGI-Severity.
However, we found that none of the predictors were related to longitudinal changes. Conclusions: The results of the present study suggest that there
are no factors that moderate DCS augmentation of CBT and that no baseline variables predict outcomes, as pediatric patients with OCD with varying
initial symptom severity and baseline characteristics improved during CBT. This finding indicates that CBT is an effective treatment option for
pediatric patients with OCD regardless of baseline characteristics and moderators, and that baseline characteristics cannot determine whether DCS
augmentation is appropriate. However, because not all pediatric patients with OCD respond equally well to CBT, future research should look at the
interactions between other baseline variables, such as positive family history of OCD, oppositional behavior, and poor treatment expectancy.
Neuropsychopharmacology, 43 (Supplement 1) : S350-
S351
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), D-cycloserine (DCS)
Locher, C., Koechlin,
H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., Kessler, R. C., Kossowsky, J.
IMPORTANCE: Depressive disorders (DDs), anxiety disorders (ADs), obsessive-compulsive disorder
(OCD), and posttraumatic stress disorder (PTSD) are common mental disorders in children and adolescents. OBJECTIVE: To examine the relative efficacy
and safety of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and placebo for the treatment of
DD, AD, OCD, and PTSD in children and adolescents. DATA SOURCES: PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Database from inception
through August 7, 2016. STUDY SELECTION: Published and unpublished randomized clinical trials of SSRIs or SNRIs in youths with DD, AD, OCD, or PTSD
were included. Trials using other antidepressants (eg, tricyclic antidepressants, monoamine oxidase inhibitors) were excluded. DATA EXTRACTION AND
SYNTHESIS: Effect sizes, calculated as standardized mean differences (Hedges g) and risk ratios (RRs) for adverse events, were assessed in a random-
effects model. MAIN OUTCOMES AND MEASURES: Primary outcomes, as defined by authors on preintervention and postintervention data, mean change data,
and adverse event data, were extracted independently by multiple observers following PRISMA guidelines. RESULTS: Thirty-six trials were eligible,
including 6778 participants (3484 [51.4%] female; mean [SD] age, 12.9 [5.1] years); 17 studies for DD, 10 for AD, 8 for OCD, and 1 for PTSD. Analysis
showed that SSRIs and SNRIs were significantly more beneficial compared with placebo, yielding a small effect size (g = 0.32; 95% CI, 0.25-0.40; P <
.001). Anxiety disorder (g = 0.56; 95% CI, 0.40-0.72; P < .001) showed significantly larger between-group effect sizes than DD (g = 0.20; 95% CI,
0.13-0.27; P < .001). This difference was driven primarily by the placebo response: patients with DD exhibited significantly larger placebo responses
(g = 1.57; 95% CI, 1.36-1.78; P < .001) compared with those with AD (g = 1.03; 95% CI, 0.84-1.21; P < .001). The SSRIs produced a relatively large
effect size for ADs (g = 0.71; 95% CI, 0.45-0.97; P < .001). Compared with participants receiving placebo, patients receiving an antidepressant
reported significantly more treatment-emergent adverse events (RR, 1.07; 95% CI, 1.01-1.12; P = .01 or RR, 1.49; 95% CI, 1.22-1.82; P < .001,
depending on the reporting method), severe adverse events (RR, 1.76; 95% CI, 1.34-2.32; P < .001), and study discontinuation due to adverse events
(RR, 1.79; 95% CI, 1.38-2.32; P < .001). CONCLUSIONS AND RELEVANCE: Compared with placebo, SSRIs and SNRIs are more beneficial than placebo in
children and adolescents; however, the benefit is small and disorder specific, yielding a larger drug-placebo difference for AD than for other
conditions. Response to placebo is large, especially in DD. Severe adverse events are significantly more common with SSRIs and SNRIs than placebo.
Copyright © 2017 American Medical Association. All rights reserved.
JAMA Psychiatry, 74(10) : 1011-
1020
- Year: 2017
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors
(SNRIs), Antidepressants
(any)
Marinova, Z., Chuang, D. M., Fineberg, N.
OBJECTIVE: Obsessive-compulsive disorder (OCD) is a mental disease commonly associated with severe distress and impairment of social
functioning. Serotonin reuptake inhibitors and/or cognitive behavioural therapy are the therapy of choice, however up to 40% of patients do not
respond to treatment. Glutamatergic signalling has also been implicated in OCD. The aim of the current study was to review the clinical evidence for
therapeutic utility of glutamate-modulating drugs as an augmentation or monotherapy in OCD patients.\rMETHODS: We conducted a search of the MEDLINE
database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD.\rRESULTS: Memantine is the compound most consistently
showing a positive effect as an augmentation therapy in OCD. Anti-convulsant drugs (lamotrigine, topiramate) and riluzole may also provide
therapeutic benefit to some OCD patients. Finally, ketamine may be of interest due to its potential for a rapid onset of action.\rCONCLUSION: Further
randomized placebo-controlled trials in larger study populations are necessary in order to draw definitive conclusions on the utility of glutamate-
modulating drugs in OCD. Furthermore, genetic and epigenetic factors, clinical symptoms and subtypes predicting treatment response to glutamate-
modulating drugs need to be investigated systematically.
Current Neuropharmacology, 15(7) : 977-
995
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
Murphy, T. K., Brennan,
E. M., Johnco, C., Parker-Athill, E. C., Miladinovic, B., Storch,
E. A., Lewin, A. B.
OBJECTIVES: Sudden and severe onset of obsessive-compulsive disorder (OCD) may present secondary to infectious and/or immune-mediated
triggers. We assessed the preliminary efficacy, tolerability, and safety of azithromycin compared with placebo in the treatment of OCD and associated
symptoms in children with pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS: Thirty-one youth aged 4-14 years (M=8.26+/-2.78 years,
62.5% male) were randomized to receive either placebo or azithromycin for 4 weeks (10mg/kg up to 500mg per day). Both groups were administered twice
daily probiotics. The primary outcome, obsessive-compulsive symptom severity, was assessed using the OCD Clinical Global Impressions Severity (CGI-S
OCD) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS: Participants in the azithromycin group (n=17) showed significantly
greater reductions in OCD severity on the CGI-S OCD than the placebo group (n=14) posttreatment (p=0.003), although there were no significant
differences on the CY-BOCS. Significantly more participants in the azithromycin condition met treatment responder criteria on the CGI-I OCD at the
end of week 4 (41.2%, n=7) in comparison to the placebo group (7.1%, n=1; p=0.045). Tic severity moderated treatment response, with greater tic
severity being associated with enhanced treatment response on the CGI-S OCD. Azithromycin was well tolerated with minimal adverse effects and no
study dropouts due to side effects. However, the azithromycin group showed a trend toward significantly greater electrocardiography QTc (p=0.060) at
the end of week 4, and significantly more reports of loose or abnormal stools (p=0.009). CONCLUSION: This double blind pilot study suggests that
azithromycin may be helpful in treating youth meeting the PANS diagnosis, especially those with elevated levels of both OCD and tic symptoms.
Azithromycin was well tolerated, but the potential for cardiac risks suggests that additional monitoring may be needed to ensure safety.
Journal of Child and
Adolescent Psychopharmacology, 27(7) : 640-651
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Other biological interventions
ONeill, J., Piacentini, J., Chang, S., Ly, R., Lai, T. M., Armstrong, C.
C., Bergman, L., Rozenman, M., Peris, T., Vreeland, A., Mudgway, R., Levitt, J. G., Salamon, N., Posse, S., Hellemann, G. S., Alger, J. R., McCracken, J. T., Nurmi, E. L.
Cognitive-
behavioral therapy (CBT) is effective for pediatric obsessive-compulsive disorder (OCD), but non-response is common. Brain glutamate (Glu) signaling
may contribute to OCD pathophysiology and moderate CBT outcomes. We assessed whether Glu measured with magnetic resonance spectroscopy (MRS) was
associated with OCD and/or CBT response. Youths aged 7-17 years with DSM-IV OCD and typically developing controls underwent 3 T proton echo-planar
spectroscopic imaging (PEPSI) MRS scans of pregenual anterior cingulate cortex (pACC) and ventral posterior cingulate cortex (vPCC)-regions possibly
affected by OCD-at baseline. Controls returned for re-scan after 8 weeks. OCD youth-in a randomized rater-blinded trial-were re-scanned after 12-14
weeks of CBT or after 8 weeks of minimal-contact waitlist; waitlist participants underwent a third scan after crossover to 12-14 weeks of CBT.
Forty-nine children with OCD (mean age 12.2+/- 2.9 years) and 29 controls (13.2+/-2.2 years) provided at least one MRS scan. At baseline, Glu did not
differ significantly between OCD and controls in pACC or vPCC. Within controls, Glu was stable from scan-to-scan. Within OCD subjects, a treatment-
by-scan interaction (p=0.034) was observed, driven by pACC Glu dropping 19.5% from scan-to-scan for patients randomized to CBT, with minor increases
(3.8%) for waitlist participants. The combined OCD participants (CBT-only plus waitlist-CBT) also showed a 16.2% (p= 0.004) post-CBT decrease in pACC
Glu. In the combined OCD group, within vPCC, lower pre-CBT Glu predicted greater post-CBT improvement in symptoms (CY-BOCS; r= 0.81, p= 0.00025). Glu
may be involved in the pathophysiology of OCD and may moderate response to CBT. Copyright © 2017 American College of Neuropsychopharmacology.
Neuropsychopharmacology, 42(12) : 2414-2422
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Exposure therapy, Exposure
and response prevention
Conelea, C. A., Selles, R. R., Benito, K. G., Walther, M.
M., Machan, J. T., Garcia, A. M., Sapyta, J., Morris, S., Franklin, M., Freeman, J.
B.
The Pediatric Obsessive-Compulsive Disorder Treatment Study II (POTS II) investigated the benefit of serotonin reuptake inhibitor (SRI)
augmentation with cognitive behavioral therapy (CBT). Primary outcomes focused on OCD symptom change and indicated benefit associated with a full
course of CBT. Given that the majority of youth with OCD suffer from significant comorbid symptoms and impaired quality of life, the current study
examined POTS II data for effects on secondary outcomes. Participants were 124 youth ages 7-17 years with a primary diagnosis of OCD who were partial
responders to an adequate SRI trial. Participants were randomized to medication management, medication management plus instructions in cognitive
behavioral therapy (CBT), or medication management plus full CBT. Acute effects on non-OCD anxiety, depression, inattention, hyperactivity, and
quality of life were examined across treatment conditions. Improvement across treatment was observed for non-OCD anxiety, inattention, hyperactivity,
and quality of life. Changes were generally significantly greater in the group receiving full CBT. Child-rated depression was not found to change.
OCD-focused treatment lead to improvement in other areas of psychopathology and functioning. For youth who are partial responders to SRI monotherapy,
augmentation with full CBT may yield the greatest benefit on these secondary outcomes. Clinical trials registration Treatment of Pediatric OCD for
SRI Partial Responders, Clinicaltrials.gov Identifier: NCT00074815, http://clinicaltrials.gov/show/NCT00074815. Copyright © 2017 Elsevier Ltd
Journal of Psychiatric Research, 92 : 94-
100
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Other service delivery and improvement
interventions
Ghanizadeh, A., Mohammadi, M. R., Bahraini, S., Keshavarzi,
Z., Firoozabadi, A., Shoshtari, A. A.
Objective: Glutamate is considered a target for treating obsessive-compulsive
disorder (OCD). The efficacy and safety of the nutritional supplement of N-Acetylcysteine (NAC) as an adjuvant to serotonin reuptake inhibitor (SSRI)
for treating children and adolescents with OCD has never been examined. Methods: This was a 10-week randomized double-blind placebo-controlled
clinical trial with 34 OCD outpatients. The patients received citalopram plus NAC or placebo. Yale-Brown Obsessive-Compulsive Scale (YBOCS) and
Pediatric Quality of Life Inventory (PedsQLTM) were used. Adverse effects were monitored. Results: YBOCS score was not different between the two
groups at baseline, but the score was different between the two groups at the end of this trial (P < 0.02). The YBOCS score of NAC group
significantly decreased from 21.0(8.2) to 11.3(5.7) during this study. However, no statistically significant decrease of YBOCS was found in the
placebo group. The Cohen's d effect size was 0.83. The mean change of score of resistance/control to obsessions in the NAC and placebo groups was
1.8(2.3) and 0.8(2.1), respectively (P = 0.2). However, the mean score of change for resistance/control to compulsion in the NAC and placebo groups
was 2.3(1.8) and 0.9(2.3), respectively. Cohen's d effect size was 0.42. The score of three domains of quality of life significantly decreased in
N-Acetylcysteine group during this trial. However, no statistically significant decrease was detected in the placebo group. No serious adverse effect
was found in the two groups. Conclusion: This trial suggests that NAC adds to the effect of citalopram in improving resistance/control to compulsions
in OCD children and adolescents. In addition, it is well tolerated.
Iranian Journal of Psychiatry, 12(2) : 134-
141
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions
(any), Selective serotonin reuptake inhibitors (SSRIs), Antidepressants
(any), Other biological interventions
Iniesta-Sepulveda, M., Rosa-Alcazar, A. I., Sanchez-Meca, J., Parada, Navas, J. L., Rosa-Alcazar, A.
A meta-analysis on the efficacy of cognitive-behavior-family treatment
(CBFT) on children and adolescents with obsessive-compulsive disorder (OCD) was accomplished. The purposes of the study were: (a) to estimate the
effect magnitude of CBFT in ameliorating obsessive-compulsive symptoms and reducing family accommodation on pediatric OCD and (b) to identify
potential moderator variables of the effect sizes. A literature search enabled us to identify 27 studies that fulfilled our selection criteria. The
effect size index was the standardized pretest-postest mean change index. For obsessive-compulsive symptoms, the adjusted mean effect size for CBFT
was clinically relevant and statistically significant in the posttest (dadj = 1.464). For family accommodation the adjusted mean effect
size was also positive and statistically significant, but in a lesser extent than for obsessive-compulsive symptoms (dadj = 0.511).
Publication bias was discarded as a threat against the validity of the meta-analytic results. Large heterogeneity among effect sizes was found.
Better results were found when CBFT was individually applied than in group (d+ = 2.429 and 1.409, respectively). CBFT is effective to
reduce obsessive-compulsive symptoms, but offers a limited effect for family accommodation. Additional modules must be included in CBFT to improve
its effectiveness on family accommodation. Copyright © 2017 Elsevier Ltd
Journal of Anxiety Disorders, 49 : 53-
64
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Family therapy, Other Psychological Interventions
Lenhard, F., Andersson, E., Mataix-Cols,
D., Ruck, C., Vigerland, S., Hogstrom, J., Hillborg, M., Brander, G., Ljungstrom, M., Ljotsson, B., Serlachius, E.
Objective: Cognitive-behavioral therapy (CBT) is the first-line treatment
for young people with obsessive-compulsive disorder (OCD), but most patients do not have access to this treatment. Thus, innovative ways to increase
the accessibility of CBT are needed. The objective of this trial was to evaluate the efficacy of therapist-guided internet-based CBT (ICBT) for
adolescents with OCD. Method: Sixty-seven adolescents (12-17 years old) with OCD were randomly assigned to a 12-week clinician- and parent-supported
ICBT program (BiP OCD) or a waitlist condition. The primary outcome was the Children Yale-Brown Obsessive Compulsive Scale (CY-BOCS) administered by
blinded assessors before and after the intervention. All patients were followed up 3 months after the intervention. Results: In intention-to-treat
analyses, BiP OCD was superior to waitlist on the CY-BOCS (time-by-group interaction, B = -4.53, z = -3.74, p < .001; Cohen's d = 0.69; 95% CI 0.19
-1.18) and on most secondary outcome measurements. Patients randomized to BiP OCD also showed further improvement from post-treatment to 3-month
follow-up, with a within-group pretreatment to follow-up effect size (Cohen's d) equal to 1.68 (95% CI 1.00-2.36). Patient satisfaction with BiP OCD
was high. There were no relevant adverse events. Average clinician support time was 17.5 minutes per patient per week. Conclusion: Therapist-guided
ICBT is a promising low-intensity intervention for adolescents with OCD and has the potential to increase access to CBT. It might be particularly
useful in a stepped-care approach, in which a large proportion of patients with moderately severe OCD could first be offered ICBT, thus freeing
limited resources for more complex cases. (PsycINFO Database Record (c) 2017 APA, all rights reserved)
Journal of the American Academy of Child & Adolescent Psychiatry, 56(1) : 10-
19
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions
(any), Cognitive & behavioural therapies (CBT), Technology, interventions delivered using technology (e.g. online, SMS)