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Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.

ABSTRACT: Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of "tic-related" was used to examine whether children with tics in the Pediatric OCD Treatment Study II differed from those without tics in terms of demographic and phenomenological characteristics and acute treatment outcomes.Participants were 124 youth aged 7 to 17 years, inclusive, with a primary diagnosis of OCD who were partial responders to an adequate serotonin reuptake inhibitor (SRI) trial. Participants were randomized to medication management, medication management plus instructions in cognitive-behavioral therapy (CBT), or medication management plus full CBT. Tic status was based on the presence of motor and/or vocal tics on the Yale Global Tic Severity Scale.Tics were identified in 53% of the sample. Those with tic-related OCD did not differ from those with non-tic-related OCD in terms of age, family history of tics, OCD severity, OCD-related impairment, or comorbidity. Those with tics responded equally in all treatment conditions.Tic-related OCD was very prevalent using a broad definition of tic status. Results suggest that youth with this broad definition of tic-related OCD do not have increased OCD severity or inference, higher comorbidity rates or severity, or worsened functioning, and support the use of CBT in this population. This highlights the importance of not making broad assumptions about OCD symptoms most likely to occur in an individual with comorbid tics. Clinical trial registration information-Treatment of Pediatric OCD for SRI Partial Responders; http://clinicaltrials.gov; NCT00074815.

SUBMITTER: Conelea CA

PROVIDER: S-EPMC4254546 | biostudies-literature | 2014 Dec

REPOSITORIES: biostudies-literature

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Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.

Conelea Christine A CA Walther Michael R MR Freeman Jennifer B JB Garcia Abbe M AM Sapyta Jeffrey J Khanna Muniya M Franklin Martin M

Journal of the American Academy of Child and Adolescent Psychiatry 20141002 12

<h4>Objective</h4>Prior research has shown that youth with co-occurring tic disorders and obsessive-compulsive disorder (OCD) may differ from those with non-tic-related OCD in terms of clinical characteristics and treatment responsiveness. A broad definition of "tic-related" was used to examine whether children with tics in the Pediatric OCD Treatment Study II differed from those without tics in terms of demographic and phenomenological characteristics and acute treatment outcomes.<h4>Method</h4 ...[more]

PMID: 25457929

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Project description:ContextThe extant literature on the treatment of pediatric obsessive-compulsive disorder (OCD) indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit.ObjectiveTo examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in CBT delivered in the context of medication management.Design, setting, and participantsA 12-week randomized controlled trial conducted at 3 academic medical centers between 2004 and 2009, involving 124 pediatric outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial.InterventionsParticipants were randomly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks: 42 in the medication management only, 42 in the medication management plus instructions in CBT, and 42 in the medication management plus CBT; the last included 14 concurrent CBT sessions.Main outcome measuresWhether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30% or more and demonstrating a change in their continuous scores over 12 weeks.ResultsThe medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures. In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered responders, which was significantly better than the 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group, and 30.0% (95% CI, 14.9%-45.1%) in the medication management only group. The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies (P < .01 for both). The plus instructions in CBT strategy was not statistically superior to medication management only (P = .72). The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25.ConclusionsAmong patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not.Trial registrationclinicaltrials.gov Identifier: NCT00074815.

Dataset Information

Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.

Publications

Tic-related obsessive-compulsive disorder (OCD): phenomenology and treatment outcome in the Pediatric OCD Treatment Study II.

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