Magazine article Clinical Psychiatry News
CBT Key for Most Childhood Obsessive-Compulsive Disorder. (Best for Mild to Moderate Cases)
ALBUQUERQUE -- Congnitive-behavioral therapy is a key part of the contemporary first-line treatment strategy in virtually all cases of childhood obsessive-compulsive disorder, John C. Piacentini, Ph.D., said at a psychiatric symposium sponsored by the University of New Mexico.
Both cognitive-behavioral therapy and selective serotonin reuptake inhibitors (SSRIs) have been shown to be effective and well-tolerated treatments in childhood obsessive-compulsive disorder (OCD).
However, the sole randomized comparative trial to date as well as other evidence suggests cognitive behavioral therapy (CBT) has a higher response rate than SSRIs, achieves larger reductions in symptoms, and provides more durable responses. Plus, CBT avoids the problem of drug side effects in a pediatric population, said Dr. Piacentini, director of the Child & Adolescent OCD, Anxiety, and Tourette Disorders Program at the University of California, Los Angeles.
In Dr. Piacentini's own recent 42patient open study 12 sessions of exposure and response prevention--type CBT resulted in a 79% response rate. That's similar to the therapeutic success rates reported by other investigators using CBT. Symptom severity as assessed by the National Institute of Mental Health global score dropped by 45%. The response rate was the same in the one-half of patients who were on an SSRI as in those who weren't.
Predictors of a favorable response to CBT included having fewer baseline obsessive and more compulsive symptoms on the Children's Yale-Brown Obsessive-Compulsive Scale. Greater impairment of academic and social functioning predicted worse outcome with CBT, the psychologist continued.
In contrast to the roughly 80% response rates reported with exposure and response prevention CBT, clinical trials of SSRIs have typically reported response rates of around 50%. And when children are taken off medication, their OCD symptoms often recur, while improvement after CBT lasts for years, especially in patients who come in occasionally for a refresher session. …