A solid majority remit following evidence-based OCD treatments: a 3-year naturalistic outcome study in pediatric OCD

• Published in: European child & adolescent psychiatry 2018-10, Vol.27 (10), p.1373-1381
• Main Authors: Melin, Karin, Skarphedinsson, Gudmundur, Skärsäter, Ingela, Haugland, Bente Storm Mowatt, Ivarsson, Tord
• Format: Article
• Language: English
• Subjects: Adolescent; Adolescents; Antidepressants; Antipsychotics; Augmentation; Behavior; Child; Child & adolescent psychiatry; Child and Adolescent Psychiatry; Child, Preschool; Children; Cognitive ability; Cognitive aspects; Cognitive behavioral therapy; cognitive-behavior therapy; Combined Modality Therapy - methods; convergent; Evaluation; Female; Follow-up; functional; Humans; impairment; Long term; Male; Medical diagnosis; Medicine; Medicine & Public Health; Mental depression; metaanalysis; Obsessive compulsive disorder; Obsessive-Compulsive Disorder - psychology; Obsessive-Compulsive Disorder - therapy; Original Contribution; Pediatric; Pediatrics; Psychiatry; Psychology; Psychosocial factors; Psychosocial functioning; Psykologi; reliability; Remission; Remission (Medicine); scale; Second generation; Serotonin reuptake inhibitors; Serotonin uptake inhibitors; Social interactions; Time Factors; Treatment Outcome; validity
• ISSN: 1018-8827; 1435-165X; 1435-165X
• DOI: 10.1007/s00787-018-1137-9

This study reports follow-up 2 and 3 years after the initial assessment of a sample of youth with a primary diagnosis of OCD. Participants were 109 children and adolescents, aged 5–17 years, recruited from a specialized, outpatient OCD clinic in Sweden. Patients were treated with cognitive behavioral therapy (CBT), augmented when indicated by selective serotonin reuptake inhibitor (SSRI). In cases where SSRIs were insufficient, augmentation with a second-generation antipsychotic (SGA) was applied. Participants were assessed with the Children’s Yale–Brown Obsessive–Compulsive Scale (CY-BOCS), Children’s OCD Impact Scale (COIS), and Children’s Depressive Inventory (CDI) at follow-ups 2 and 3 years after baseline assessment. Treatment response was defined as CY-BOCS total score ≤ 15, and remission was defined as CY-BOCS total score ≤ 10. Analyzing the outcomes with linear mixed-effects models (LME) showed a decrease in OCD symptom load from 23 to 6.9 at the 3-year follow-up. Moreover, two of three (66.1%) participants were in remission, and another 19.2% had responded to treatment at the 3-year follow-up. Thus, 85.3% of participants responded to treatment. Moreover, during the follow-up period, participants’ psychosocial functioning had significantly improved, and depressive symptoms had significantly decreased. The results suggest that evidence-based treatment for pediatric OCD, following expert consensus guidelines, has long-term positive effects for most children and adolescents diagnosed with OCD. The results also indicate that improvements are maintained over a 3-year period, at least, and that improvement is also found with regard to psychosocial functioning and depressive symptoms.