Preparation for Child Psych PRITE and Boards
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* OCD is more likely to persist in youth with younger age of onset and longer duration of symptoms. | * OCD is more likely to persist in youth with younger age of onset and longer duration of symptoms. | ||
* Also more likely to persist are religious, hoarding, and sexual subtypes of OCD. | * Also more likely to persist are religious, hoarding, and sexual subtypes of OCD. | ||
+ | * '''Separation anxiety''' is a common comorbidity in children with OCD. | ||
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==Treatment== | ==Treatment== | ||
+ | ===POTS trial=== | ||
+ | '''the Pediatric OCD Treatment Study''' (POTS) randomized controlled trial (JAMA, 2004). | ||
+ | * 112 patients randomized to 4 groups for 12 weeks; | ||
+ | * The groups were: CBT alone, sertraline alone (SER), combination (COMB), and placebo. | ||
+ | * Remission rates were statistically similar for CBT and COMB groups (39% and 53%). | ||
+ | * COMB group was superior to SER (21% remission rate) and placebo (3.6%). | ||
{{stub}} | {{stub}} | ||
[[Category:Disorders]] | [[Category:Disorders]] |
Revision as of 21:31, 30 October 2012
Contents
Introduction
Epidemiology
OCD in children and adolescents often goes unrecognized and undiagnosed due to its idiosyncratic, not always obvious nature.
- Point prevalence of pediatric OCD is 0.25% (British study 5-15 y.o., Heyman I, IntRevPsych 2003);
- Overall pediatric prevalence rate is 1-2% (USA studies, Apter A, JAACAP 1996)
- Incidence of OCD peaks during two developmental periods, pre-adolescents, and young adults (mean 20 y.o.). (Geller D, March J, Practice Parameter, JAACAP 2012)
Genetic and non-genetic factors
- OCD has a significant familial/genetic component with higher concordance rates in monozygotic twins vs. dizygotic twins.
- Environmental triggers and immunological cross-reactions, particularly to Strep infection had been implicated.
- PANDAS - Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus, is attributed to immune response to Group A Strep, which can cause cross-reactivity and inflammation of basal ganglia. This can produce (the somewhat controversial) syndrome of PANDAS, which involves tics, OCD, and hyperactivity.
Developmental trajectory
- Insistence on certain rituals and routines is common and normal in toddlers and pre-schoolers, as long as family functioning is not disrupted and a child can tolerate some disruption in the ritual (JACAAP parameter 2012)
- Severity of pediatric OCD may diminish and become sub-clinical with time.
- OCD is more likely to persist in youth with younger age of onset and longer duration of symptoms.
- Also more likely to persist are religious, hoarding, and sexual subtypes of OCD.
- Separation anxiety is a common comorbidity in children with OCD.
Presentation
Children may have compulsions without obsessions.
Common obsessions
- The most common obsessions in children and adolescents involve aggressive and catastrophic worries (e.g death of parent); these become less common in adults. (Geller DA, J Nerv Men D/o 2001)
- Sexual and religious obsessions are more common in adolescents.
- Contamination worries are common throughout the developmental spectrum.
Common compulsions
- Most common compulsions across the developmental spectrum involve checking, cleaning, and ordering rituals.
- Hoarding compulsions are more common in children in adolescents and become less common in adults. (Geller DA, J Nerv Men D/o 2001)
Diagnosis
Treatment
POTS trial
the Pediatric OCD Treatment Study (POTS) randomized controlled trial (JAMA, 2004).
- 112 patients randomized to 4 groups for 12 weeks;
- The groups were: CBT alone, sertraline alone (SER), combination (COMB), and placebo.
- Remission rates were statistically similar for CBT and COMB groups (39% and 53%).
- COMB group was superior to SER (21% remission rate) and placebo (3.6%).