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Navigating treatment options for pediatric OCD

Obsessive-compulsive disorder affects up to 4% of children and adolescents and represents a significant global burden, according to WHO.

OCD is characterized by a presence of obsessions — intrusive, repetitive thoughts, images or impulses — and compulsions — repetitive, overt and covert behaviors or rituals performed to decrease stress.

Pediatric OCD can cause impairment in numerous functional domains, including daily routines, school performance and family and friend relationships.

In a recent article in Psychiatric Annals, Ammar Albanna, MD, FRCPC, IFAPA, of Al Jalila Children’s Specialty Hospital, United Arab Emirates University, and colleagues provided an in-depth overview of pediatric OCD, including current and potential treatment options.

Nonpharmacological treatments include cognitive behavioral therapy (CBT), which often utilizes exposure/response prevention (ERP), and family-based CBT.

Albanna and colleagues stressed the importance of including family members in pediatric OCD treatment.

Pharmacological treatments include selective serotonin reuptake inhibitors such as sertraline, fluoxetine and fluvoxamine.

Citalopram and escitalopram, also SSRIs, are often used in treatment of pediatric OCD, but are not backed by randomized clinical trials.

Clomipramine has been shown to have greater efficacy compared with SSRIs.

Potential pharmacological treatments include riluzole, D-cycloserine as an adjunct to CBT, ketamine and memantine. However, these treatments have yet to be clinically proven.

“The first-line treatment for mild-to-moderate OCD is CBT, and its effectiveness has been demonstrated in different clinical trials. Family-based CBT may also be used as an effective intervention. For moderate-to-severe cases of pediatric OCD, medications alone or in combination with CBT are recommended,” the researchers wrote. “A family approach to the assessment and treatment is necessary in pediatric OCD. Most children with OCD achieve remission or significant improvement in their symptoms.”

To read more on the epidemiology, etiology, prognosis, long-term outcomes, assessment, symptoms and differential diagnosis of pediatric OCD, access the article in Psychiatric Annals here. – by Amanda Oldt

Disclosures: The authors report no relevant financial disclosures.