pediatrics
Obsessive Compulsive Disorder (OCD) and Related Disorders in Children and Adolescents
Treatment
Cognitive-behavioral therapy (CBT): Graded exposure and response prevention ( Treatment references ) Usually selective serotonin reuptake inhibitors (SSRIs; [ Treatment references ]) Cognitive-behavioral therapy is helpful if children are motivated and can carry out the tasks and should be the first-line treatment. SSRIs are the most effective medications and are generally well tolerated (see table Drugs for Long-Term Treatment of Anxiety and Related Disorders* ); all are equally effective. For severe OCD, a combination of SSRI and CBT is recommended ( Treatment references ). For treatment-refractory OCD, the following strategies could be considered: Trial of a different SSRI Augmentation of the SSRI with an atypical antipsychotic ( Treatment references ) or less often Clomipramine ( Treatment references ) may be more effective and have a better response rate than SSRIs in children but not adults ( Transcranial magnetic stimulation is approved for adults by the U.S. Food and Drug Administration, and testing for use in children is in progress. If criteria for PANS/PANDAS are met, clinicians may try antibiotics (such as beta-lactams, which reduce glutamatergic activity). However, if symptoms persist, the typical treatments for OCD are helpful and should be implemented. 1.Uhre CF, Uhre VF, Lonfeldt NN, et al: Systematic review and meta-analysis: Cognitive-behavioral therapy for obsessive-compulsive disorder in children and adolescents.J Am Acad Child Adolesc Psychiatry59(1)59:64-77, 2020. doi: 10.1016/j.jaac.2019.08.480 2.Geller DA, Biederman J, Stewart SE, et al: Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder.Am J Psychiatry160(11):1919-1928, 2003. doi: 10.1176/appi.ajp.160.11.1919 3.Sanchez-Meca J, Rosa-Alcazar AI, Iniesta-Sepulveda M, et al: Differential efficacy of cognitive-behavioral therapy and pharmacological treatments for pediatric obsessive-compulsive disorder: A meta-analysis.J Anxiety Disord28(1):31-44. doi: 10.1016/j.janxdis.2013.10.007 4.Fitzgerald KD, Stewart CM, Tawile V, et al:Risperidoneaugmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder.J Child Adolesc Psychopharm9(2):115-123, 1999. doi: 10.1089/cap.1999.9.115 5.Figueroa Y, Rosenberg DR, Birmaher B, et al: Combination treatment withclomipramineand selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents.J Child Adolesc Psychopharmacol8(1):61-67, 1998. doi: 10.1089/cap.1998.8.61 6.Simeon JG, Thatte S, Wiggins D: Treatment of adolescent obsessive-compulsive disorder with aclomipramine-fluoxetinecombination.Psychopharmacol Bull26(3):285-290, 1990. 7.McDougle CJ, Price LH, Goodman WK, et al: A controlled trial oflithiumaugmentation influvoxamine-refractory obsessive-compulsive disorder: Lack of efficacy.J Clin Psychopharmacol11(3):175-184, 1991. 8.Grant PJ, Joseph LA, Farmer CA, et al: 12-week, placebo-controlled trial of add-onriluzolein the treatment of childhood-onset obsessive-compulsive disorder.Neuropsychopharmacology39(6):1453-1459, 2013. doi: 10.1038/npp.2013.343 9.Afshar H, Roohafza H, Mohammad-Beigi HM, et al: N-acetylcysteineadd-on treatment in refractory obsessive-compulsive disorder: A randomized, double-blind, placebo-controlled trial.J Clin Psychopharmacol32(6):797-803, 2012. doi: 10.1097/JCP.0b013e318272677d 10.Sarris J, Oliver G, Camfield DA, et al: N-acetylcysteine(NAC) in the treatment of obsessive-compulsive disorder: A 16-week, double-blind, randomised, placebo-controlled study.CNS Drugs29(9):801-809, 2015. doi: 10.1007/s40263-015-0272-9 11.DeVeaugh-Geiss J, Moroz G, Beiderman J, et al:Clomipraminehydrochloride in childhood and adolescent obsessive-compulsive disorder—A multicenter trial.J Am Acad Child Adolesc Psychiatry31(1):45-49, 1992. doi: 10.1097/00004583-199201000-00008 12.Mundo E, Maina G, Uslenghi C: Multicentre, double-blind, comparison offluvoxamineandclomipraminein the treatment of obsessive-compulsive disorder.Int Clin Psychopharmacol15(2):69-76, 2000. doi: 10.1097/00004850-200015020-00002 