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OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN & ADOLESCENTS,…
OBSESSIVE-COMPULSIVE DISORDER IN CHILDREN & ADOLESCENTS
INTRODUCTION
:unlock: Obsessive compulsive Disorder (OCD), as described in the provided document, is a psychiatric condition that affects children and adolescents. :
:unlock: Characteristics Feature:
:check: Persistent and unwanted intrusions into the child's mind, such as thoughts, images, or urges
(Obsession)
:check: Repetitive behaviors or mental acts
(Compulsion)
:check: Typically performed to alleviate the distress caused by the obsession.
:unlock: The disorder can have a significant impact on the child's daily life, leading to functional impairment in various settings, including home, school, and social environments.
:unlock: OCD is associated not only with immediate distress but also with a chronic course that can persist into adulthood, often accompanied by other psychiatric comorbidities.
DIAGNOSTIC CRITERIA FOR OCD
Either obsessions or compulsions or both present on most days for a period of 2 weeks.
Obsessions and compulsions share the following features:
Patient is aware that these originate from their own
mind.
They are repetitive, unpleasant and distressing to the patient. At least one is perceived as excessive or unreasonable (
egodystonic
)
At least one is resisted unsuccessfully, even though others may be present that the sufferer no longer resists
Thought of carrying out the obsession or compulsion is not intrinsically pleasurable
The symptoms must be disabling. Even young children will have some insight into the senselessness of the thoughts and behaviours.
ASSESSMENT & DIAGNOSIS
A six-question screening instrument,
the Short OCD Screener (SOCS)
, recommended by the National Institute for Health and Clinical Excellence, has been found to have a high sensitivity in detecting OCD.
Further assessment is required for individuals who screen positive, including taking a detailed history of obsessions and compulsions, a developmental history, and a separate interview with the young person.
TREATMENT
COMBINATION OF CBT & MEDICATION
:red_flag: Superior outcomes
COGNITIVE BEHAVIOR THERAPY
Incorporating exposure with response prevention (E/RP) and selective serotonin reuptake inhibitors (SSRIs).
Consists of 12-20 weekly sessions
The main therapeutic strategy being E/RP, where the individual gradually confronts feared situations and refrains from carrying out compulsions to neutralize anxiety.
MEDICATION
SSRIs such as fluoxetine, sertraline, paroxetine, fluvoxamine, and citalopram have been shown to be effective in reducing symptoms
:warning: CBT is recommended as the first-line treatment in mild to moderate cases of pediatric OCD, while medication should be considered in more severe cases or when young people fail to respond to CBT.
TREATMENT-RESISTANT OCD
:checkered_flag: Refers to cases where individuals with OCD do not respond to standard treatments such as CBT or SSRIs, or where they make gains but are left with clinically significant residual symptoms.
:checkered_flag: In cases where children with OCD fail to respond to a course of CBT and an initial SSRI administered for at least 12 weeks at the maximum tolerated dose, additional trials of at least one other SSRI or the tricyclic drug clomipramine may be considered.
:warning: Most attention has been given to the impact of comorbidity on treatment response
FUTURE DIRECTIONS
Focused on addressing the challenges of disseminating evidence-based cognitive behavior therapy (CBT) to young people with OCD.
Efforts are being made to develop novel approaches to increase the availability and access to CBT, including methods such as CBT delivered via telephone or web-camera, as well as internet-based CBT with minimal therapist input.
Family therapy specifically aimed at targeting family dynamics has been shown to be an effective adjunct to CBT in families presenting with difficulties.
Neuropsychological models
OCD arises due to alterations in the brain's frontostriatal circuitry, particularly involving the orbitofrontal cortex.
This area of the brain is thought to mediate the persistent thoughts associated with OCD, leading to the development of compulsions as a means to neutralize the perceived threats or harm.
Social isolation, physical abuse and negative emotionality were specific predictors of an adult OCD diagnosis.