A randomized controlled clinical trial of Citalopram versus Fluoxetine in children and adolescents with obsessive-compulsive disorder (OCD) Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. Fluoxetine in children and adolescents with OCD: a placebo-controlled trial. Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial. Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: the Pediatric OCD Treatment Study (POTS) randomized controlled trial. Randomized, placebo-controlled trial of cognitive-behavioral therapy alone or combined with sertraline in the treatment of pediatric obsessive-compulsive disorder. Long-term outcomes of obsessive-compulsive disorder: follow-up of 142 children and adolescents. Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? Perinatal factors affecting expression of obsessive compulsive disorder in children and adolescents. An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics. Long-term sertraline treatment of children and adolescents with obsessive-compulsive disorder. Predictors of drug treatment response in obsessive-compulsive disorder. Remission status after long-term sertraline treatment of pediatric obsessive-compulsive disorder. Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial. Platelet serotonin transporter in children and adolescents with obsessive-compulsive disorder or Tourette's syndrome. Placebo-controlled trial of fluoxetine and phenelzine for obsessive-compulsive disorder. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder A randomised controlled trial of cognitive behavioural treatment for obsessive compulsive disorder in children and adolescents Continued cognitive-behavior therapy versus sertraline for children and adolescents with obsessive–compulsive disorder that were non-responders to cognitive-behavior therapy: a randomized controlled trial Fluoxetine, but not Tricyclic Antidepressants, Potentiates the 5-Hydroxytryptophan-Mediated Increase in Plasma Cortisol and Prolactin Secretion in Subjects with Major Depression or with Obsessive Compulsive Disorder Sertraline and Fluoxetine Treatment of Obsessive-Compulsive Disorder: Results of a Double-Blind, 6-Month Treatment Study
ObjectiveS everal controlled trials have demonstrated the efficacy and safety of Fluoxetine in children and adolescents with Obsessive-Compulsive Disorder ( OCD ) , but there is no controlled study on the effectiveness of Citalopram in this group . This report describes the use of Citalopram in comparison with Fluoxetine in childhood-onset OCD . Method This study is a r and omized , double blind , fixed-does ( 20 mg ) trial of Fluoxetine versus Citalopram in 29 children and adolescents ( 17 boys and 12 girls ) with OCD , aged 7–18 years ( mean 13.8 and SD 3.05 ) . The length of study was 6 weeks . Obsessive-Compulsive symptom severity was measured by Yale – Brown Obsessive-Compulsive Scale ( CY-BOCS ) and Clinician ’s Global Impression Scale ( CGI ) . DICA ( Diagnostic Interview of Children and Adolescents ) was used to diagnose the psychiatric disorders . Results Each group showed significant improvement over the baseline as measured by the CY-BOCS ( p < 0.01 ) but not by CGI ( p = NS ) . The Comparison between two groups showed no significant differences in efficacy and safety of the drugs . Most common adverse effects were headache for Citalopram and tremor for Fluoxetine . Conclusion The results suggest that Citalopram is as safe and effective as Fluoxetine for children and adolescents with OCD . Further studies are needed to replicate our findings Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD OBJECTIVE This study assesses the efficacy and tolerability of fluoxetine in the acute treatment of child and adolescent obsessive-compulsive disorder ( OCD ) during a 13-week , double-blind , placebo-controlled study . METHOD Eligible patients aged 7 to 17 ( N = 103 ) were r and omized at a ratio of 2:1 to receive either fluoxetine or placebo . Dosing was initiated at 10 mg daily for 2 weeks , then increased to 20 mg daily . After 4 weeks of treatment , and again after 7 weeks of treatment , non-responders could have their dosage increased by 20 mg daily , for a maximum possible dosage of 60 mg daily . Primary measure of efficacy was improvement in OCD symptoms as measured by the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . All analyses were intent-to-treat . RESULTS Fluoxetine was associated with significantly greater improvement in OCD as assessed by the CY-BOCS ( p = .026 ) and other measures than was placebo . Fluoxetine was well tolerated and had a rate of discontinuation for adverse events similar to that of placebo ( p = 1.00 ) . CONCLUSIONS Fluoxetine 20 to 60 mg daily was effective and well tolerated for treatment of OCD in this pediatric population OBJECTIVE To examine the safety and efficacy of fluoxetine in child and adolescent obsessive-compulsive disorder ( OCD ) . METHOD Between 1991 and 1998 , 43 patients were r and omly assigned to fluoxetine or placebo for 8 weeks . Dosing was fixed for the first 6 weeks ( up to 60 mg/day ) and then could be increased to 80 mg/day . Responders entered an 8-week maintenance phase . The primary outcome measures were the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinical Global Impression-Improvement ( CGI-I ) scale . Analyses were done on the intent-to-treat sample . RESULTS Fluoxetine patients ( n = 21 ) had significantly lower CY-BOCS scores than placebo patients ( n = 22 ) after 16 ( but not 8) weeks . Fluoxetine responders ( n = 11 ) had significantly lower CY-BOCS scores than placebo responders ( n = 7 ) after an additional 8 weeks of treatment . After 16 weeks , 57 % of fluoxetine ( versus 27 % of placebo ) patients were much or very much improved on the CGI-I scale ( p < .05 ) . No patient terminated the study because of adverse medication effects . CONCLUSION Fluoxetine was well tolerated and effective for the treatment of child and adolescent OCD , but fluoxetine 's full effect took more than 8 weeks to develop This work aims is to evaluate the therapeutic efficacy of cognitive behavior therapy ( CBT ) in pediatric patients with obsessive-compulsive disorder ( OCD ) who had not previously been treated with either pharmacotherapy or psychotherapy and who remained medication-free during CBT . Sixteen OCD out patients , 8 - 17 years of age , were treated in a 12-week open trial with manualized CBT . Target symptoms were rated at two-week intervals with the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive-Compulsive Scale ( NIMH Global ) , the Clinical Global Impression Scale ( CGI ) , and the Hamilton Anxiety Rating Scale ( Ham-A ) . Statistical analyses showed a significant benefit for treatment . Ten patients experienced at least a 50 % reduction in symptoms on the CY-BOCS ; seven were asymptomatic on the NIMH Global . These results build on previous reports that CBT may be effective in the acute treatment of pediatric OCD . Further , the results of this study suggest that CBT can be efficacious in alleviating OCD symptoms in the absence of pharmacotherapy . These results must be considered preliminary , given the small sample size and open administration of treatment CONTEXT The empirical literature on treatment of obsessive-compulsive disorder ( OCD ) in children and adolescents supports the efficacy of short-term OCD-specific cognitive-behavior therapy ( CBT ) or medical management with selective serotonin reuptake inhibitors . However , little is known about their relative and combined efficacy . OBJECTIVE To evaluate the efficacy of CBT alone and medical management with the selective serotonin reuptake inhibitor sertraline alone , or CBT and sertraline combined , as initial treatment for children and adolescents with OCD . DESIGN , SETTING , AND PARTICIPANTS The Pediatric OCD Treatment Study , a balanced , masked r and omized controlled trial conducted in 3 academic centers in the United States and enrolling a volunteer outpatient sample of 112 patients aged 7 through 17 years with a primary Diagnostic and Statistical Manual of Mental Disorders , Fourth Edition diagnosis of OCD and a Children 's Yale-Brown Obsessive-Compulsive Scale ( CY-BOCS ) score of 16 or higher . Patients were recruited between September 1997 and December 2002 . INTERVENTIONS Participants were r and omly assigned to receive CBT alone , sertraline alone , combined CBT and sertraline , or pill placebo for 12 weeks . MAIN OUTCOME MEASURES Change in CY-BOCS score over 12 weeks as rated by an independent evaluator masked to treatment status ; rate of clinical remission defined as a CY-BOCS score less than or equal to 10 . RESULTS Ninety-seven of 112 patients ( 87 % ) completed the full 12 weeks of treatment . Intent-to-treat r and om regression analyses indicated a statistically significant advantage for CBT alone ( P = .003 ) , sertraline alone ( P = .007 ) , and combined treatment ( P = .001 ) compared with placebo . Combined treatment also proved superior to CBT alone ( P = .008 ) and to sertraline alone ( P = .006 ) , which did not differ from each other . Site differences emerged for CBT and sertraline but not for combined treatment , suggesting that combined treatment is less susceptible to setting -specific variations . The rate of clinical remission for combined treatment was 53.6 % ( 95 % confidence interval [ CI ] , 36%-70 % ) ; for CBT alone , 39.3 % ( 95 % CI , 24%-58 % ) ; for sertraline alone , 21.4 % ( 95 % CI , 10%-40 % ) ; and for placebo , 3.6 % ( 95 % CI , 0%-19 % ) . The remission rate for combined treatment did not differ from that for CBT alone ( P = .42 ) but did differ from sertraline alone ( P = .03 ) and from placebo ( P<.001 ) . CBT alone did not differ from sertraline alone ( P = .24 ) but did differ from placebo ( P = .002 ) , whereas sertraline alone did not ( P = .10 ) . The 3 active treatments proved acceptable and well tolerated , with no evidence of treatment-emergent harm to self or to others .  CONCLUSION Children and adolescents with OCD should begin treatment with the combination of CBT plus a selective serotonin reuptake inhibitor or CBT alone BACKGROUND To examine the efficacy of sequential sertraline and cognitive-behavioral therapy ( CBT ) treatment relative to CBT with pill placebo over 18 weeks in children and adolescents with obsessive-compulsive disorder ( OCD ) . METHODS Forty-seven children and adolescents with OCD ( Range = 7 - 17 years ) were r and omized to 18-weeks of treatment in one of three arms : 1 ) sertraline at st and ard dosing + CBT ( RegSert + CBT ) ; 2 ) sertraline titrated slowly but achieving at least 8 weeks on the maximally tolerated daily dose + CBT ( SloSert + CBT ) ; or 3 ) pill placebo + CBT ( PBO + CBT ) . Assessment s were conducted at screening , baseline , weeks 1 - 9 , 13 , and 17 , and post-treatment . Raters and clinicians were blinded to sertraline ( but not CBT ) r and omization status . Primary outcomes included the Children 's Yale-Brown Obsessive-Compulsive Scale , and response and remission status . Secondary outcomes included the Child Obsessive Compulsive Impact Scale-Parent/Child , Children 's Depression Rating Scale-Revised , Multidimensional Anxiety Scale for Children , and Clinical -Global Impressions-Severity . RESULTS All groups exhibited large within-group effects across outcomes . There was no group by time interaction across all outcomes suggesting that group changes over time were comparable . CONCLUSIONS Among youth with OCD , there was no evidence that sequentially provided sertraline with CBT differed from those receiving placebo with CBT . CLINICAL TRIALSGOV IDENTIFIER NCT00382291 BACKGROUND Obsessive-compulsive disorder ( OCD ) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates . There are few prospect i ve long-term follow-up studies . AIMS To follow up young people with OCD to clarify persistence rates and relevant predictors , presence of other psychiatric disorders , functional impairment , service utilisation and perceived treatment needs . METHOD All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic , Maudsley Hospital , London , were included . Sixty-one per cent ( 142 of 222 ) of all contactable young people and parents completed computerised diagnostic interviews and question naires . RESULTS We found a persistence rate of OCD of 41 % ; 40 % of participants had a psychiatric diagnosis other than OCD at follow-up . The main predictor for persistent OCD was duration of illness at assessment . High levels of baseline psychopathology predicted other psychiatric disorders at follow-up . Functional impairment and quality of life were mildly to moderately affected . Approximately 50 % of participants were still receiving treatment and about 50 % felt a need for further treatment . CONCLUSIONS This study confirms that paediatric OCD can be a chronic condition that persists into adulthood . Early recognition and treatment might prevent chronicity . Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services OBJECTIVE To examine the influence of psychiatric comorbidity on response and relapse rates in children and adolescents treated with paroxetine for obsessive-compulsive disorder ( OCD ) . METHODS Patients responding following 16 weeks of treatment ( phase I ) were r and omized to continued paroxetine or to placebo for 16 additional weeks ( phase II ) . OCD response ( phase I ) and relapse ( phase II ) criteria were based on the Clinical Global Impression-Improvement Scale and the Children 's Yale-Brown Obsessive Compulsive Scale . The presence of OCD and other psychiatric disorders was ascertained using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview . RESULTS At entry , 193 of 335 ( 57.6 % ) patients had at least one psychiatric disorder in addition to OCD , and 102 of 335 ( 30.4 % ) had multiple other disorders . Although the response rate to paroxetine in the overall population was high ( 71 % ) , the response rates in patients with comorbid attention deficit hyperactivity disorder , tic disorder , or oppositional defiant disorder ( 56 % , 53 % , and 39 % , respectively ) were significantly less than in patients with OCD only ( 75 % ) ( intent-to-treat population , last observation carried forward analysis , p < 0.05 ) . Psychiatric comorbidity was associated with a greater rate of relapse in the total patient population ( 46 % for one or more comorbid disorders [ p = 0.04 ] and 56 % for two or more comorbid disorders [ p < 0.05 ] vs. 32 % for no comorbidity ) . CONCLUSIONS The results of these post hoc analyses show that comorbid illness adversely impacted response to pharmacotherapy with paroxetine in pediatric OCD and significantly increased risk of relapse following withdrawal from treatment . Continued paroxetine treatment reduced the relapse rates in all groups compared with placebo , including those with comorbid illness . Because pediatric OCD is frequently comorbid with other psychiatric disorders , results of r and omized , controlled pediatric OCD trials that use multiple exclusion criteria may not generalize to more naturalistic OCD sample OBJECTIVE To examine whether  adverse perinatal experiences of  children  are associated with obsessive compulsive disorder ( OCD ) in youth . METHODS Subjects were 130 children and adolescents with OCD recruited from a family genetic study of pediatric OCD and 49 matched controls from a contemporaneous family case-control study of attention-deficit/hyperactivity disorder ( ADHD ) . Subjects were comprehensively assessed in multiple domains of function . A systematic history of pregnancy , delivery , and infancy complications was obtained . RESULTS Compared to normal controls , children with OCD had mothers with significantly higher rates of illness during pregnancy requiring medical care ( chi(2 ) + /- 8.61 , p + /- 0.003 ) and more birth difficulties ( induced labor , forceps delivery , nuchal cord , or prolonged labor ) ( chi(2 ) + /- 7.51 , p + /- 0.006 ) . Among the OCD-affected children , we found several significant associations between adverse perinatal experiences and earlier age at onset , increased OCD severity , and increased risk for comorbid ADHD , chronic tic disorder , anxiety disorder , and major depressive disorder . CONCLUSION Although exploratory , our analyses found that children with OCD had higher rates of several adverse perinatal experiences compared with controls . Among OCD-affected children , comorbid psychopathology was predicted by specific perinatal risk factors . Prospect i ve studies of perinatal adverse events that minimize potential recall bias and type I errors are needed UNLABELLED The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy ( CBT ) for childhood obsessive-compulsive disorder ( OCD ) administered within three regular , i.e. , non-academic , Norwegian outpatient child psychiatric clinics . METHODS A total of 28 youngsters , aged 8 - 17 with primary OCD entered the study . Assessment at intake included Norwegian versions of the K-SADS-PL , Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , and a measure of OCD-specific functional impairment ( Child OCD Impact Scale ( COIS ) ) . Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision . Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS , the Clinical Global Impression ( CGI ) and the CGI-Improvement scales , and the COIS . RESULTS Twenty-four youngsters ( 86 % ) completed treatment and were available for the follow-up assessment s. Significant improvements were found on all outcome measures after treatment , including a mean symptom reduction on the CY-BOCS of 60.6 % , increasing to 68.8 % at the 6-month follow-up . Estimates of within-group effect sizes showed strong effects of treatment . CONCLUSION The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric setting s with outcomes in accordance with previous findings from highly specialised university clinics OBJECTIVE To evaluate the safety and effectiveness of sertraline in the long-term treatment of pediatric obsessive-compulsive disorder ( OCD ) . METHOD Children ( 6 - 12 years ; n= 72 ) and adolescents ( 13 - 18 years ; n = 65 ) with DSM-III-R-defined OCD who had completed a 12-week , double-blind , placebo-controlled sertraline study were given open-label sertraline 50 to 200 mg/day in this 52-week extension study . Concomitant psychotherapy was allowed during the extension study Outcome was evaluated by the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , National Institute of Mental Health Global Obsessive-Compulsive Scale , and Clinical Global Impression Severity ( CGI-S ) and Improvement ( CGI-I ) scores . RESULTS Significant improvement ( p < .0001 ) was demonstrated on all four outcome parameters on an intent-to-treat analysis for the overall study population ( n = 132 ) , as well as the child and the adolescent sample s. At endpoint , 72 % of children and 61 % of adolescents met response criteria ( > 25 % decrease in CY-BOCS and a CGI-I score of 1 or 2 ) . Significant ( p < .05 ) improvements were also demonstrated from the extension study baseline to endpoint on all outcome parameters in those patients who received sertraline during the 12-week , double-blind acute study . Long-term sertraline treatment was well tolerated , and there were no discontinuations due to changes in vital signs , laboratory values , or electrocardiograms . CONCLUSION Sertraline ( 50 - 200 mg/day ) was effective and generally well tolerated in the treatment of childhood and adolescent OCD for up to 52 weeks . Improvement was seen with continued treatment BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments BACKGROUND Despite its high chronicity , few studies have evaluated the effectiveness of long-term treatment for pediatric obsessive-compulsive disorder ( OCD ) . The goal of the current analysis is to evaluate remission among children and adolescents with OCD treated with sertraline  for 12 months . METHODS Children ( 6 - 12 years old , n = 72 ) and adolescents ( 13 - 18 years old , n = 65 ) with Diagnostic and Statistical Manual of Mental Disorders ( third edition , revised ) OCD , who had completed a 12-week , double-blind , placebo-controlled sertraline study , were administered open-label sertraline  50 - 200 mg for 52 weeks . Full remission was defined by a Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) score of 8 or less , and partial remission was defined as a CY-BOCS score of 15 or less . RESULTS Using an last observation carried forward analysis , 47 % of patients achieved a full remission , and an additional 25 % achieved a partial remission . Among study completers , full remission was achieved by 55 % of patients and partial remission by 31 % . Two thirds of patients with severe OCD at baseline ( CY-BOCS of 26 or greater ) achieved full or partial remission . Children were more likely to achieve a full remission than adolescents . CONCLUSION Sertraline is effective in the treatment of childhood and adolescent OCD , with initial acute response converting to remission and improved functional status in a substantial proportion of patients . More research is needed to develop pharmacologic and psychotherapeutic strategies that facilitate the achievement of full remission in the remaining patients suffering from this chronic and disabling illness OBJECTIVE To evaluate the relative efficacy of ( 1 ) individual cognitive-behavioral family-based therapy ( CBFT ) ; ( 2 ) group CBFT ; and ( 3 ) a waitlist control group in the treatment of childhood obsessive-compulsive disorder ( OCD ) . METHOD This study , conducted at a university clinic in Brisbane , Australia , involved 77 children and adolescents with OCD who were r and omized to individual CBFT , group CBFT , or a 4- to 6-week waitlist control condition .  Children were assessed before and after treatment and at 3 months and 6 months following the completion of treatment using diagnostic interviews , symptom severity interviews , and self-report measures . Parental distress , family functioning , sibling distress , and levels of accommodation to OCD dem and s were also assessed . Active treatment involved a manualized 14-week cognitive-behavioral protocol , with parental and sibling components . RESULTS By an evaluable patient analysis , statistically and clinical ly significant pretreatment-to-posttreatment change occurred in OCD diagnostic status and severity across both individual and group CBFT , with no significant differences in improvement ratings between these conditions . There were no significant changes across measures for the waitlist condition . Treatment gains were maintained up to 6 months of follow-up . CONCLUSIONS Contrary to previous findings and expectations , group CBFT is as effective in reducing OCD symptoms for children and adolescents as individual treatment . Findings support the efficacy and durability of CBFT in treating childhood OCD UNLABELLED Previous studies of serotonin transporter protein ( 5HTPR ) indexed in platelets by 3H-imipramine demonstrate reduction in children with comorbid obsessive-compulsive disorder ( OCD ) and Tourette 's syndrome ( TS ) . OBJECTIVE To use the 5HTPR selective lig and 3H-paroxetine and homogeneous diagnostic groups to reevaluate these findings . METHOD Platelet Kinetic binding parameters were evaluated using st and ard techniques from medication-free child and adolescent patients with OCD ( n = 18 ) , with TS ( n = 10 ) , and normal controls ( n = 19 ) . RESULTS Baseline binding capacity ( Bmax ) was significantly reduced in patients with OCD ( 1,342 + /- 952 fmol/mg ; protein p < .01 ) compared with normal controls ( 2,486 + /- 1309 fmol/mg ) and TS patients ( 2,420 + /- 1,069 fmol/mg ; p < .05 ) . Among OCD patients who were subsequently treated on an open-label basis with selective serotonin reuptake inhibitor ( SSRI ) , Bmax values at baseline differentiated between responders ( 1,718 + /- 1,041 fmol/mg ) and nonresponders ( 802 + /- 713 fmol/mg protein ; p < .05 ) . Response to SSRI was greatest in patients with a positive family history of OCD . Among responders ( n = 10 ) , baseline Yale-Brown Obsessive Compulsive Scale and Bmax were positively correlated ( r = .76 , p = .01 ) , as was Clinical Global Impression ( r = .67 , p = .03 ) . CONCLUSIONS Platelet 5HTPR capacity ( Bmax ) is reduced in children and adolescents with OCD , but not in those with TS . 5HTPR may be an indirect measure of basal serotonergic tone OBJECTIVE It is now well documented that fluoxetine is a viable treatment option for patients with obsessive-compulsive disorder ( OCD ) , and there is a small body of evidence indicating that monoamine oxidase inhibitors may be effective in at least a subset of patients . The authors conducted a 10-week placebo-controlled trial of these two agents in patients who met DSM-III-R criteria for OCD . METHOD Sixty-four subjects were r and omly assigned to receive placebo , phenelzine ( 60 mg/day ) , or fluoxetine ( 80 mg/day ) . These doses were achieved by the end of week 3 of the active phase of the study . Outcomes were assessed with st and ardized instruments to measure OCD , mood , and anxiety . RESULTS Fifty-four patients completed the study . There was a significant difference among the three treatments on one OCD scale , with fluoxetine-treated patients improving significantly more than those in the placebo or phenelzine group . A subgroup of OCD patients with symmetry obsessions  did respond to phenelzine . CONCLUSIONS This study provides no evidence to support the use of phenelzine in OCD except possibly for those patients with symmetry or other atypical obsessions . There was also no support for the hypothesis that patients with high levels of anxiety would respond preferentially to phenelzine OBJECTIVE To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-compulsive disorder ( OCD ) with a double-blind , placebo-controlled , multicenter study . METHOD Subjects , aged 8 to 17 years , meeting DSM-III-R criteria for OCD were recruited from July 1991 to August 1994 . After a 7- to 14-day single-blind , placebo washout/screening period , subjects were r and omly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks . Subjects who had not responded after 6 weeks could discontinue the double-blind phase of the study and enter a long-term , open-label trial of fluvoxamine . Analyses used an intent-to-treat sample with a last-observation-carried-forward method . RESULTS Mean Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) scores with fluvoxamine were significantly ( p < .05 ) different from those with placebo at weeks 1 , 2 , 3 , 4 , 6 , and 10 . Significant ( p < .05 ) differences between fluvoxamine and placebo were observed for all secondary outcome measures at all visits . Based on a 25 % reduction of CY-BOCS scores , 42 % of subjects taking fluvoxamine were responders compared with 26 % taking placebo . Forty-six ( 19 fluvoxamine , 27 placebo ) of 120 r and omized subjects discontinued early . Adverse events with a placebo-adjusted rate greater than 10 % were insomnia and asthenia . CONCLUSIONS Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors ( SSRIs ) for the treatment of obsessive-compulsive disorder ( OCD ) . In the present study , we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD , diagnosed according to DSM-IIIR . A total of 55 patients entered this 8-week , double-blind controlled study . Efficacy for both drugs was comparable . The primary efficacy criterion , the Y-BOCS Total score , did not show any significant differences between treatment arms . Response rate was higher with clomipramine , using a 25 % decrease in Y-BOCS Total score as response threshold , but there were no significant differences between treatment arms using a 35 % threshold . Overall safety and tolerability were good for both drugs , being slightly better for fluoxetine Cognitive behaviour therapy ( CBT ) for young people with obsessive compulsive disorder ( OCD ) has become the treatment of first choice . However , the literature is largely based on studies emphasising exposure and response prevention . In this study , we report on a r and omised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions . A r and omised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD . Assessors were blind to treatment allocation . 21 consecutive patients with OCD aged between 9 and 18 years were recruited . The group who received treatment improved more than a comparison group who waited for 3 months . The second group was treated subsequently using the same protocol and made similar gains . In conclusion , CBT can be delivered effectively to young people with OCD in typical outpatient setting Expert guidelines recommend cognitive-behavior therapy ( CBT ) as a first-line treatment in pediatric obsessive – compulsive disorder ( OCD ) and the addition of selective serotonin reuptake inhibitors when CBT is not effective . However , the recommendations for CBT non-responders are not supported by empirical data . Our objective was to investigate the effectiveness of sertraline ( SRT ) versus continued CBT in children and adolescents that did not respond to an initial course of CBT . R and omized controlled trial conducted in five sites in Denmark , Sweden and Norway , 54 children and adolescents , age 7–17 years , with DSM-IV primary OCD were r and omized to SRT or continued CBT for 16 weeks . These participants had been classified as non-responders to CBT following 14 weekly sessions . Primary outcomes were the CY-BOCS total score and clinical response ( CY-BOCS < 16 ) . The study was a part of the Nordic Long-Term OCD Treatment Study ( NordLOTS ) . Intent-to-treat sample included 50 participants , mean age 14.0 ( SD = 2.7 ) and 48 % ( n = 24 ) males . Twenty-one of 28 participants ( 75 % ) completed continued CBT and 15 of 22 participants ( 69.2 % ) completed SRT . Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments ( p = .351 ) , the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group . The multivariate χ2 test suggested that there were no statistically significant differences between groups ( p = .727 ) . Within-group effect sizes were large and significant across both treatments . These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial . However , there was no significant between-group differences in SRT or continued CBT at post-treatment It has been suggested that the clinical efficacy of chronic treatment with selective serotonin reuptake inhibitors ( SSRIs ) such as fluoxetine and perhaps all antidepressants is due to their ability to enhance serotonergic activity . The effects of chronic treatment with fluoxetine or tricyclic antidepressants on the L-5-hydroxytryptophan ( 200 mg , L-5-HTP ; PO)–induced increases in plasma cortisol and prolactin ( PRL ) concentrations were studied in patients with major depression or obsessive compulsive disorder ( OCD ) . Administration of L-5-HTP increased plasma cortisol and PRL levels in medicated and unmedicated patients with major depression or OCD . The  L-5-HTP – induced cortisol and PRL responses were significantly higher in fluoxetine-treated than in tricyclic-treated or unmedicated major depressed patients . The latter two groups did not differ significantly in their cortisol or PRL responses to L-5-HTP . The L-5-HTP – induced increases in cortisol and PRL in fluoxetine-treated patients with major depression or OCD were not significantly different . The results suggest that fluoxetine , but not tricyclic antidepressants , potentiates 5-HT receptor – mediated stimulation of cortisol and PRL secretion in humans , consistent with available evidence that fluoxetine treatment , but not tricyclic antidepressants , increases central serotonergic activity in patients with MD or OCD by a presynaptic mechanism The purpose of this study was to evaluate the comparative efficacy and tolerability of sertraline and fluoxetine in the treatment of obsessivecompulsive disorder ( OCD ) . Out patients meeting DSM-IV criteria for OCD , with a Yale-Brown Obsessive-Compulsive ( Y-BOCS ) total score ≥ 17 , an NIMH Global Obsessive-Compulsive ( NIMH-OC ) scale score ≥ 7 , and a CGI-Severity score ≥ 4 were r and omized to 24 weeks of double-blind treatment with sertraline ( N = 77 ) or fluoxetine ( N = 73 ) . Primary efficacy measures consisted of the Y-BOCS , the NIMH-OC scale , and the CGI-Severity ( CGI-S ) and Improvement ( CGI-I ) scales . Equivalent and significant ( p < 0.001 ) improvement was found at week 24 in Y-BOCS and NIMH-OC scale scores  for sertraline and fluoxetine . After 12 weeks , 49.2 % of patients on sertraline were rated on the CGI-S scale as being mildly ill or not ill compared to 24.6 % on fluoxetine ( p < 0.01 ) . A Cox analysis found patients on sertraline to have a statistically nonsignificant 42 % greater likelihood of achieving a response by week 12 ( CGI-I , much or very much improved ; 95 % CI , 0.85 , 2.38;p = 0.18 ) . Sertraline treatment also result ed in a higher proportion of remissions  than fluoxetine ( defined as a CGI-I ≤ 2 and a Y-BOCS score ≤ 11 ) , both at week 12 ( 20 % vs. 8 % ; χ2 , 3.95;df 1;p = 0.047 ) and week 24 ( 36 % vs. 22 % ; χ2 , 3.18;df , 1;p = 0.075 ) . Both medications were welltolerated and demonstrated significant efficacy in the treatment of out patients with moderate to severe OCD with the subjects treated with sertraline showing a greater likelihood of remission as well as an earlier improvement on some but not all efficacy
Conclusions and implication s of key findings : Fluoxetine is associated with a significantly greater reduction in OCD severity , as measured by the CY-BOCS , NIMH-OC and CGI-S , in children and adolescents .
Additionally , it is well tolerated in children and adolescents .
The acceptability is comparable to that of the placebo-treated group .
Background : Obsessive-compulsive disorder ( OCD ) is a common psychiatric illness in children and adolescents .
Previous evidence suggests that fluoxetine is effective in the treatment of OCD in children and adolescents .
However , those studies had small sample sizes .
As a result , a systematic review , which is a more powerful method to calculate the true effect size , can be applied to examine the efficacy , acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents .
Objectives : The aims of this study were to review the efficacy , acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents .