An Effective Augmentation Therapy in Pediatric OCD

by Robert L. Findling, MD

Hello. My name is Dr. Robert Findling. I am the Director of the Division of Child and Adolescent Psychiatry at University Hospitals Case Medical Center and Professor of Psychiatry and Pediatrics at Case Western Reserve University.

Today I will be talking about a treatment study in youngsters suffering from obsessive-compulsive disorder, otherwise known as OCD. This paper was recently published in JAMA and the lead author was Dr. Martin Franklin.[1]

This article is noteworthy because it provides new information about cognitive-behavioral therapy (CBT). Pediatric OCD is an important condition for a couple of different reasons. First, it is reasonably prevalent and reasonably common. It is also associated with substantial human suffering and psychosocial dysfunction.

What we knew about the treatment of OCD in youngsters suggested that pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) could be beneficial in these children. However, youngsters often have substantial OCD symptoms even after they have had a treatment course of SSRIs.

We also know that CBT can be an effective intervention for youngsters who suffer from OCD. Often the real issue with CBT is that its accessibility may be limited and less than that of SSRIs. The question that remained and that the study tried to address was how to best help youngsters who are partially responsive to SSRIs, or who are on SSRIs but have residual OCD symptoms.

The authors conducted a 12-week clinical trial in which 124 youngsters with OCD were randomly assigned to 1 of 3 treatment arms. The patients were between the ages of 7 and 17 and the 3 treatment arms each had about the same number of patients.

Of those 3 treatment arms, one consisted of youngsters who simply continued medication management. Another group had continued medication management and in addition they received instructions about CBT. These brief instructions were intended to be provided by prescribing physicians as part of empathic medication management.

The third group received continued medication management, just like the other two, but also received CBT proper. What did the authors find? They noted that the group that received adjunctive CBT sessions did better than the other treatment groups regardless of how the outcome was assessed. CBT proper was better than brief instructions or no addition of CBT.

This study adds to compelling literature that suggests that CBT really can have a beneficial role in youngsters suffering from OCD. In my clinical experience, it is not uncommon to have a presenting patient who has previously received some form of psychotherapy for OCD. However, the psychotherapy did not consist of CBT, and that sometimes leads parents or the youngsters themselves to believe that psychotherapy does not work.

This study suggests that CBT may be a distinctly pivotal intervention for youngsters suffering from OCD, and our audience certainly knows that not all psychotherapy is CBT.

I should also mention that these data bring to mind the fact that although SSRIs may be of benefit to youngsters with OCD, many patients may not get well. A partial response is what one might expect from many pediatric patients suffering from OCD. Of course, if a better-than-expected response occurs, then that’s great.

This paper adds further data to what we know about the treatment of OCD in youngsters, and it supports the role of CBT, either alone or as a specific adjunct to SSRIs, and certainly suggests that CBT really is a cornerstone intervention for youngsters suffering from OCD.

 

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