Treatment of Obsessive Compulsive Disorder in Children
Condition: Obsessive-Compulsive Disorder
MeSH terms: Compulsive Personality Disorder; Obsessive-Compulsive Disorder
Intervention: Serotonin reuptake inhibitors management; Cognitive behavioral therapy by a psychologist; Instructional cognitive behavioral therapy by a psychiatrist
Intervention description: Participants are maintained on their optimized dose of SRI for OCD symptoms (see "Other Names" section for specific drugs and dosage ranges). If the participant has been treated with an SRI for at least 9 weeks AND has been at a stable dose for the past 3 weeks (e.g., the dose response curve is flat indicating no further improvement in OCD symptoms) OR the participant did not tolerate a dose increase to the next higher dose OR the participant has been at the maximum allowable dose for 3 weeks, then the participant is considered optimized and will be maintained on that dose. During trial, all participants will be maintained on their SRI dose during acute treatment at a constant dose unless side effects warrant downward adjustment of the SRI.; CBT consists of 14 visits over 12 weeks involving: (1) psychoeducation, (2), cognitive training, (3) mapping OCD, and (4) exposure and ritual prevention (EX/RP). The intervention was adapted from March and Mulle (1998) treatment protocol for pediatric OCD.; The psychiatrist who manages medication will also provide instructions in the CBT procedures that have been found to help reduce OCD symptoms, namely EX/RP. MM+I-CBT was constructed as a single-doctor "best practice" treatment with three primary goals: (1) inclusion of the main psychoeducational and EX/RP components of the full CBT protocol; (2) feasibility of training psychiatrists to perform the CBT component of MM+I-CBT; (3) integration with protocol medication management visits; and (4) feasibility of implementation with the constraints of a busy practice oriented primarily toward pharmacotherapy.
Intervention MeSH terms: Fluvoxamine; Citalopram; Fluoxetine; Paroxetine; Venlafaxine Hydrochloride; Sertraline; Clomipramine; Escitalopram; Selective Serotonin Reuptake Inhibitors; Serotonin
Phase: Phase 3
Study type: Interventional
Primary purpose: Treatment
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Enrollment: 124.0
Sex: All
Minimum age: 7 Years
Maximum age: 17 Years
Healthy volunteers: No
Keywords: Child; Adolescent

Summary:

      This study will determine whether cognitive behavioral therapy delivered by either
      psychologists or psychiatrists can improve the effectiveness of serotonin reuptake inhibitor
      treatment in children with obsessive compulsive disorder.
    

Eligibility criteria:

        Inclusion Criteria:

          -  DSM-IV Diagnosis of obsessive compulsive disorder

          -  CYBOCS total score greater than 16

        Exclusion Criteria:

          -  Other primary or co-primary psychiatric disorder

          -  Pervasive developmental disorder or disorders, including Asperger's Syndrome

          -  Thought disorder

          -  Prior failed trial of cognitive-behavioral therapy

          -  Has pediatric autoimmune neuropsychiatric disorders associated with streptococcus
             (PANDAS) or maintenance antibiotic for obsessive-compulsive disorder

          -  Mental retardation

          -  Pregnancy