Disorders - Obsessive Compulsive Disorder
Jalal, B., Bruhl, A., O'Callaghan, C., Piercy, T., Cardinal, R. N., Ramachandran, V. S., Sahakian, B. J.
One type of obsessive-compulsive disorder (OCD) is characterized by contamination fears and compulsive cleansing. Few effective treatments are available for this debilitating condition. Compulsive symptoms, such as excessive washing, are believed to be mediated by cognitive inflexibility-arguably the most striking cognitive impairment in OCD. In this study, we investigated the effects of two novel smartphone interventions on cognitive flexibility and OCD symptoms in healthy individuals with OCD-like contamination fears. In the first intervention, participants watched a brief video recording of themselves engaging in handwashing on a smartphone, four times a day, for a total of one week (N=31). The second intervention was similar except that participants watched themselves repeatedly touching a disgust-inducing object (N=31). In a third (control) "intervention", participants watched themselves performing sequential hand movements (N=31). As hypothesized, the two smartphone interventions, unlike the control, improved cognitive flexibility; as assessed on the Intradimensional-Extradimensional Set Shifting task (a sensitive marker of cognitive flexibility). The two interventions, unlike the control, also improved OCD symptoms (measured with the Obsessive-Compulsive Inventory-Revised and Yale-Brown Obsessive-Compulsive Scale). Finally, we found high levels of adherence to the interventions. These findings have significant clinical implications for OCD.
Scientific Reports, 8(1) : 14923
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Other Psychological Interventions, Technology, interventions delivered using technology (e.g. online, SMS)
Conley, Sara L., Wu, Kevin D.
Background and objectives: Dysfunctional interpretations of intrusive thoughts are implicated in the etiology and maintenance of Obsessive-Compulsive Disorder (OCD). Cognitive Bias Modification training for interpretations (CBM-I) has successfully modified dysfunctional interpretations in the context of several disorders, including OCD. However, research regarding CBM-I's impact on symptom reduction and behavior is mixed, which limits its clinical application. Further, support for the specific efficacy of CBM-I in individuals with contamination concerns is limited. The current study aimed to modify dysfunctional interpretations in individuals with contamination concerns, and examine the effect of the modification on both interpretation bias and performance on a behavioral approach task (BAT). Methods: Participants (N = 74) completed a word-sentence association task by indicating whether a threatening or benign word was related to an ambiguous scenario. The active condition received feedback designed to reduce maladaptive interpretations; the control condition received random feedback. Results: Findings revealed that the active-but not the control-condition showed a significant decrease in interpretation bias for threat cues. Analyses of behavioral effects indicated that when ceiling effects were accounted for, the active condition completed more BAT steps than the control condition (p = 0.06; d = 0.45). Limitations: The current study is preliminary and requires replication with a clinical sample. Conclusions: Completion of the CBM-I was beneficial for reducing dysfunctional interpretations relevant to naturally-occurring contamination concerns and, importantly, this reduction may help those individuals approach feared situations. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Behavior Therapy and Experimental Psychiatry, 59 : 56-64
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Attention/cognitive bias modification
Wilson, A. C., Aldao, A., Cheavens, J.
Objectives: A large body of work suggests that cognitive reappraisal is an effective strategy for modifying emotional intensity. In addition, its habitual use has been linked to adaptive psychological functioning, operationalized as low levels of symptoms of psychopathology. However, little is known about the impact of cognitive reappraisal on behavioral aspects of mental disorders. For example, the experience of fear is often accompanied by the behavioral urge to avoid the feared stimuli. Although there is evidence to suggest that cognitive reappraisal reduces fear in the moment, there is less information about the impact on behavioral correlates. Method: To that end, we recruited 90 participants who experienced substantial contamination concerns (i.e., obsessive-compulsive disorder symptoms) and asked them to participate in exposure tasks that consisted of gradually coming into contact with contaminated objects (i.e., approach behavior). We randomly assigned participants to one of three conditions: (1) reappraise the emotion-eliciting stimulus, (2) reappraise their emotional response, or (3) no specific emotion regulation instructions. Results: Reappraising the stimulus, but not reappraising the emotional response, led to significantly greater behavioral approach (p = .02) than the no-instruction condition during exposure. There were no significant differences in subjective state anxiety between any of the conditions. Conclusion: These findings suggest that certain types of reappraisal may lead to greater approach behavior during exposure even in the absence of subjective emotional changes. More broadly, they underscore the importance of examining the role of emotion regulation strategies (including different types of reappraisal) on the behavioral aspects of mental disorders. (PsycINFO Database Record (c) 2018 APA, all rights reserved)
Journal of Clinical Psychology, 74(9) : 1583-1593
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: At risk (indicated or selected prevention)
-
Treatment and intervention: Psychological Interventions (any)
, Exposure therapy, Exposure and response prevention, Other Psychological Interventions
Abuwalla, Z., Clark, M. D., Burke, B., Tannenbaum, V., Patel, S., Mitacek, R., Gladstone, T., Van-Voorhees, B.
Introduction This rapid review identifies and summarizes the effectiveness of preventative telemental health interventions. It investigates studies conducted between 2010 and 2016 that improve mood and anxiety with long-term follow-up. Methods A literature search of three major databases was performed by four reviewers. After citation tracing, 3604 studies were discovered, and twenty of these met the inclusion criteria. Data from the papers were abstracted, assessed for quality, and effect sizes were calculated. Results Salient information was discussed using the Behavioural Vaccine Model of mental illness prevention. This included key concepts such as efficacy, duration of benefits, sociocultural relevance, professional guidance, peer-to-peer support, adherence, delivery and safety. Conclusion This review suggests there are clear prolonged benefits to using technology in youth mental illness prevention. Although this is a rapidly growing area of investigation in countries around the globe, there is still a dearth of research with long-term follow-up. Future studies should aim to boost engagement by increasing motivational guidance in order to recruit at-risk youth of all demographics into these promising intervention programs. Copyright © 2017
Internet Interventions, 11 : 20-29
- Year: 2018
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Universal prevention
, At risk (indicated or selected prevention)
-
Treatment and intervention: Service Delivery & Improvement, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Skills training, Attention/cognitive bias modification
, Technology, interventions delivered using technology (e.g. online, SMS)
Mechler, K., Hage, A., Schweinfurth, N., Glennon, J. C., Dijkhuizen, R. M., Murphy, D., Durston, S., et al., TACTICS Consortium
Objective: Research has implicated glutamatergic projections between the various frontal subregions in the pathogenesis of compulsivity and impulsivity. Reducing striatal glutamate release, or antagonising the action of glutamate at its receptors, may therefore represent viable treatment strategies. Several glutamatergic agents with regulatory approval for other indications are available and may be of potential benefit in the treatment of compulsivity/impulsivity in psychiatric disorders in paediatric patients. Method(s): This review was performed according to PRISMA guidelines and evaluates available scientific literature concerning the use of glutamatergic agents in these patients, in order to determine their reported effectiveness/efficacy and tolerability/safety. Result(s): Out of a total of 1,426 publications, 21 trials examining six glutamatergic substances in patients with obsessive-compulsive disorder, autism spectrum disorders, and attention deficit/hyperactivity disorder were included. Conclusion(s): Trial designs as well as results were heterogeneous and thus comparability was limited. Available data support the hypothesis that glutamatergic agents are of potential value in the treatment of compulsivity/impulsivity in children and adolescents. Based on the data reviewed, memantine and N-acetylcysteine suggest the best risk-benefit profile for future trials. Riluzole should primarily be further investigated in adults. Clinical research of this nature is a key element of the TACTICS Consortium project funded by the European Union (FP7). Copyright © 2017 Hogrefe.
Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 46(3) : 246-263
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Turner, C., O'Gorman, B., Nair, A., OKearney, R.
We report a systematic review of moderators of CBT efficacy for pediatric OCD relative to other treatments. CENTRAL, MEDLINE, EMBASE, CINAHL, and PsycINFO were searched for RCTs reporting on effect moderation for CBT outcomes. Five studies (N = 365) examined 17 variables with three significant moderators identified. Compared to pill-placebo, CBT monotherapy was not effective for children with a family history of OCD but was for those without a family history. For children with a family history, CBT plus sertraline efficacy was attenuated but remained significant. For children with tics, CBT but not sertraline remained superior to pill-placebo. For non-responders to initial treatment with CBT, continuing CBT was inferior to commencing sertraline for those with tics but was not different for those without tics. A supplementary review identified older age, symptom and impairment severity, co-morbidity and family accommodation as consistent predictors of a poorer outcome to CBT. Current evidence for moderation effects is post-hoc, from single RCTs, has small Ns and requires replication. The review identifies family history of OCD and the presence of tics as factors requiring further examination in properly conducted trials and about which clinicians need to show care in their treatment recommendations. Copyright © 2017 Elsevier B.V.
Psychiatry Research, 261 : 50-60
- Year: 2018
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Peris, T. S., Rozenman, M. S., Sugar, C. A., McCracken, J. T., Piacentini, J.
Objective Although evidence-based treatments for pediatric obsessive-compulsive disorder (OCD) exist, many youth fail to respond, and interventions tailored to the needs of specific subsets of patients are lacking. This study examines the efficacy of a family intervention module designed for cases of OCD complicated by poor family functioning. Method Participants were 62 youngsters aged 8 to 17 years (mean age = 12.71 years; 57% male; 65% white) with a primary diagnosis of OCD and at least 2 indicators of poor family functioning. They were randomized to receive 12 sessions of individual child cognitive-behavioral therapy (CBT) plus weekly parent psychoeducation and session review (standard treatment [ST]) or the same 12 child sessions plus 6 sessions of family therapy aimed at improving OCD-related emotion regulation and problem solving (positive family interaction therapy [PFIT]). Blinded raters evaluated outcomes and tracked responders to 3-month follow-up. Results Compared to ST, PFIT demonstrated better overall response rates on the Clinician Global Impression-Improvement scale (CGI-I; 68% versus 40%, p =.03, phi = 0.28) and rates of remission (58% PFIT versus 27% ST, p =.01, phi = 0.32). PFIT also produced significantly greater reductions in functional impairment, symptom accommodation, and family conflict, and improvements in family cohesion. As expected, these shifts in family functioning constitute an important treatment mechanism, with changes in accommodation mediating treatment response. Conclusion PFIT is efficacious for reducing OCD symptom severity and impairment and for improving family functioning. Findings are discussed in terms of personalized medicine and mechanisms of change in pediatric OCD treatment. Clinical trial registration information-Family Focused Treatment of Pediatric Obsessive Compulsive Disorder; http://clinicaltrials.gov/; NCT01409642. Copyright © 2017 American Academy of Child and Adolescent Psychiatry
Journal of the American Academy of Child and Adolescent Psychiatry, 56(12) : 1034-1042.e1
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, Family therapy, Psychoeducation
Vattimo, E., Barros, V., Batistuzzo, M., Requena, G., Sato, J., Fatori, D., Shavitt, R., Miguel, E., Hoexter, M.
Background: Magnetic resonance imaging investigations in psychiatry have produced a sizable amount of data, contributing to a better understanding of the neurobiological correlates of psychiatric illnesses. As a result, there is strong evidence of the role of the cortico-basal ganglia-thalamocortical (CBGTC) circuitry in the pathophysiology of obsessive-compulsive disorder (OCD). These specific brain regions have also been suggested as possible morphometric biomarkers of treatment response in adults undergoing cognitive-behavior therapy (CBT) or pharmacological treatment (antidepressants). Morphometric measurements of CBGTC structures were also shown to correlate to treatment response in children, as our group has previously demonstrated. The large amount of data produced by neuroimaging studies requires, however, improvements of statistical analysis techniques. The aims of this study were to compare the power of simple linear regression (SLR) and support vector regression (SVR) as prediction techniques of treatment response using structural neuroimaging parameters. Methods: A total of 29 children with OCD underwent magnetic resonance imaging (MRI). Gray Matter (GM) volume and cortical thickness of CBGTC structures were selected a priori for analysis using FreeSurfer Software. After MRI acquisition, patients were enrolled in a randomized clinical trial receiving either fluoxetine (n=12) or CBT (n=17) during 14 weeks. Baseline and post-treatment symptom severity was assessed using Yale Brown Obsessive- Compulsive Scale (Y-BOCS). Morphometric data from CBGTC structures were, then, used to predict clinical response (Y-BOCS changes) in a SLR model. Predictive power of the SLR model was then compared to SVR (with default and tuned parameters) through Root-Mean-Square Error calculations. Results: Larger GM volume of left caudate (r2= 0,175; p=0.024), right lateral orbitofrontal cortex (OFC) (r2= 0,161; p=0.031) and right medial OFC (r2= 0,143; p=0.043) correlated with percentage improvement in Y-BOCS considering both groups. Thicker right lateral OFC was also correlated with Y-BOCS improvement (r2= 0,181; p=0,021), markedly in patients that underwent CBT (r2= 0,39; p=0,007). SVR was more accurate to predict treatment response in all cases and tuned parameters failed to improve even further the technique was used only for the left caudate. Conclusions: This investigation presents a comparison of conventional and novel techniques to analyze neuroimaging data as predictors of treatment response in pediatric patients with OCD. Our results raise the possibility that machine learning methods, particularly support vector regression, may be useful to improve the predictive power of such neuroimaging studies.
Neuropsychopharmacology, 43 (Supplement 1) : S479
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
Wilhelm, S., Berman, N., Small, B. J., Storch, E. A., Porth, R., Geller, D.
Background: Previous research suggests that cognitive behavioral therapy (CBT) is an efficacious treatment for pediatric OCD. However, up to 60% of children with OCD receiving CBT do not fully remit. Researchers have attempted to augment CBT with D-cycloserine (DCS), an N-methyl-D-aspartate (NMDA) partial agonist that has been shown to enhance extinction learning, with mixed results. While results of the largest trial to date (5R01MH093402-02) suggest that DCS did not improve outcomes for pediatric OCD patients, it may be that baseline factors moderate a patients' response to DCS. The present study aimed to identify the predictors and moderators of DCS of CBT, or baseline characteristics that are associated with outcomes and the conditions in which DCS augmentation worked best. Identifying these factors would allow clinicians to better direct pediatric patients with OCD to the most appropriate treatment option. Methods: Two hundred and six children and adolescents were enrolled at either Massachusetts General Hospital (MGH) in Boston, MA or University of South Florida (USF) in St. Petersburg, FL. One hundred and forty-two patients with an OCD diagnosis per DSM-IV-TR criteria as determined by the Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version (KSADS-PL) (M = 12.79, SD = 2.99; range 7- 17-years-old) were randomized to either DCS + CBT (n = 70) or placebo + CBT (n = 72; for full consort diagram, please refer to Storch et al., 2016). Eligible children received 10 sessions of cognitive behavioral treatment, with two sessions per week for the first two weeks. Participants were randomized in a double-blind approach to either CBT augmented with DCS or CBT and placebo before the fourth CBT session. They then received either DCS or a placebo pill one hour prior to exposure sessions. We adopted an exploratory approach, as prior research on the predictors of CBT for pediatric OCD is conflicting. We looked at the extent to which demographics (age, gender, race, ethnicity), OCD-specific features (symptom severity, family accommodation, impairment), comorbidity (number of comorbidities, a comorbid anxiety, depression, or tic disorder, anxiety symptom severity, depression symptom severity, and externalizing behavior symptom severity), and treatmentrelated factors (treatment alliance at randomization) predicted treatment response. We also looked at how demographic (age and gender) and comorbidity (previous or current history of depression, anxiety and tics) variables interact with DCS augmentation to moderate outcome. All procedures performed in studies involving human participants were in accordance with the ethical standards of the Institutional Review Boards at the USF and MGH. Written parental informed consent and child assent were obtained from all individual subjects participating in the study. Results: Moderator analyses examined the extent to which age, gender, current history and previous history of depression, anxiety and tics predicted treatment outcomes. Although there were significant improvements in all outcome measures (Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) and CGI-Severity), the treatment group by time by moderator term was not statistically significant for any of the outcome/moderator pairs. We next examined the predictors of response across treatment groups, looking at changes in CY-BOCS total, CY-BOCS obsessions and compulsions, and CGI-Severity. However, we found that none of the predictors were related to longitudinal changes. Conclusions: The results of the present study suggest that there are no factors that moderate DCS augmentation of CBT and that no baseline variables predict outcomes, as pediatric patients with OCD with varying initial symptom severity and baseline characteristics improved during CBT. This finding indicates that CBT is an effective treatment option for pediatric patients with OCD regardless of baseline characteristics and moderators, and that baseline characteristics cannot determine whether DCS augmentation is appropriate. However, because not all pediatric patients with OCD respond equally well to CBT, future research should look at the interactions between other baseline variables, such as positive family history of OCD, oppositional behavior, and poor treatment expectancy.
Neuropsychopharmacology, 43 (Supplement 1) : S350-S351
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Psychological Interventions (any)
, Cognitive & behavioural therapies (CBT)
, D-cycloserine (DCS)
Locher, C., Koechlin, H., Zion, S. R., Werner, C., Pine, D. S., Kirsch, I., Kessler, R. C., Kossowsky, J.
IMPORTANCE: Depressive disorders (DDs), anxiety disorders (ADs), obsessive-compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) are common mental disorders in children and adolescents. OBJECTIVE: To examine the relative efficacy and safety of selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and placebo for the treatment of DD, AD, OCD, and PTSD in children and adolescents. DATA SOURCES: PubMed, EMBASE, PsycINFO, Web of Science, and Cochrane Database from inception through August 7, 2016. STUDY SELECTION: Published and unpublished randomized clinical trials of SSRIs or SNRIs in youths with DD, AD, OCD, or PTSD were included. Trials using other antidepressants (eg, tricyclic antidepressants, monoamine oxidase inhibitors) were excluded. DATA EXTRACTION AND SYNTHESIS: Effect sizes, calculated as standardized mean differences (Hedges g) and risk ratios (RRs) for adverse events, were assessed in a random-effects model. MAIN OUTCOMES AND MEASURES: Primary outcomes, as defined by authors on preintervention and postintervention data, mean change data, and adverse event data, were extracted independently by multiple observers following PRISMA guidelines. RESULTS: Thirty-six trials were eligible, including 6778 participants (3484 [51.4%] female; mean [SD] age, 12.9 [5.1] years); 17 studies for DD, 10 for AD, 8 for OCD, and 1 for PTSD. Analysis showed that SSRIs and SNRIs were significantly more beneficial compared with placebo, yielding a small effect size (g = 0.32; 95% CI, 0.25-0.40; P < .001). Anxiety disorder (g = 0.56; 95% CI, 0.40-0.72; P < .001) showed significantly larger between-group effect sizes than DD (g = 0.20; 95% CI, 0.13-0.27; P < .001). This difference was driven primarily by the placebo response: patients with DD exhibited significantly larger placebo responses (g = 1.57; 95% CI, 1.36-1.78; P < .001) compared with those with AD (g = 1.03; 95% CI, 0.84-1.21; P < .001). The SSRIs produced a relatively large effect size for ADs (g = 0.71; 95% CI, 0.45-0.97; P < .001). Compared with participants receiving placebo, patients receiving an antidepressant reported significantly more treatment-emergent adverse events (RR, 1.07; 95% CI, 1.01-1.12; P = .01 or RR, 1.49; 95% CI, 1.22-1.82; P < .001, depending on the reporting method), severe adverse events (RR, 1.76; 95% CI, 1.34-2.32; P < .001), and study discontinuation due to adverse events (RR, 1.79; 95% CI, 1.38-2.32; P < .001). CONCLUSIONS AND RELEVANCE: Compared with placebo, SSRIs and SNRIs are more beneficial than placebo in children and adolescents; however, the benefit is small and disorder specific, yielding a larger drug-placebo difference for AD than for other conditions. Response to placebo is large, especially in DD. Severe adverse events are significantly more common with SSRIs and SNRIs than placebo. Copyright © 2017 American Medical Association. All rights reserved.
JAMA Psychiatry, 74(10) : 1011-1020
- Year: 2017
- Problem: Anxiety Disorders (any), Obsessive Compulsive Disorder, Post Traumatic Stress Disorder, Depressive Disorders
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Selective serotonin reuptake inhibitors (SSRIs), Serotonin-norepinephrine reuptake inhibitors (SNRIs), Antidepressants (any)
Marinova, Z., Chuang, D. M., Fineberg, N.
OBJECTIVE: Obsessive-compulsive disorder (OCD) is a mental disease commonly associated with severe distress and impairment of social functioning. Serotonin reuptake inhibitors and/or cognitive behavioural therapy are the therapy of choice, however up to 40% of patients do not respond to treatment. Glutamatergic signalling has also been implicated in OCD. The aim of the current study was to review the clinical evidence for therapeutic utility of glutamate-modulating drugs as an augmentation or monotherapy in OCD patients.
METHODS: We conducted a search of the MEDLINE database for clinical studies evaluating the effect of glutamate-modulating drugs in OCD.
RESULTS: Memantine is the compound most consistently showing a positive effect as an augmentation therapy in OCD. Anti-convulsant drugs (lamotrigine, topiramate) and riluzole may also provide therapeutic benefit to some OCD patients. Finally, ketamine may be of interest due to its potential for a rapid onset of action.
CONCLUSION: Further randomized placebo-controlled trials in larger study populations are necessary in order to draw definitive conclusions on the utility of glutamate-modulating drugs in OCD. Furthermore, genetic and epigenetic factors, clinical symptoms and subtypes predicting treatment response to glutamate-modulating drugs need to be investigated systematically.
Current Neuropharmacology, 15(7) : 977-995
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Systematic reviews
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions
Murphy, T. K., Brennan, E. M., Johnco, C., Parker-Athill, E. C., Miladinovic, B., Storch, E. A., Lewin, A. B.
OBJECTIVES: Sudden and severe onset of obsessive-compulsive disorder (OCD) may present secondary to infectious and/or immune-mediated triggers. We assessed the preliminary efficacy, tolerability, and safety of azithromycin compared with placebo in the treatment of OCD and associated symptoms in children with pediatric acute-onset neuropsychiatric syndrome (PANS). METHODS: Thirty-one youth aged 4-14 years (M=8.26+/-2.78 years, 62.5% male) were randomized to receive either placebo or azithromycin for 4 weeks (10mg/kg up to 500mg per day). Both groups were administered twice daily probiotics. The primary outcome, obsessive-compulsive symptom severity, was assessed using the OCD Clinical Global Impressions Severity (CGI-S OCD) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). RESULTS: Participants in the azithromycin group (n=17) showed significantly greater reductions in OCD severity on the CGI-S OCD than the placebo group (n=14) posttreatment (p=0.003), although there were no significant differences on the CY-BOCS. Significantly more participants in the azithromycin condition met treatment responder criteria on the CGI-I OCD at the end of week 4 (41.2%, n=7) in comparison to the placebo group (7.1%, n=1; p=0.045). Tic severity moderated treatment response, with greater tic severity being associated with enhanced treatment response on the CGI-S OCD. Azithromycin was well tolerated with minimal adverse effects and no study dropouts due to side effects. However, the azithromycin group showed a trend toward significantly greater electrocardiography QTc (p=0.060) at the end of week 4, and significantly more reports of loose or abnormal stools (p=0.009). CONCLUSION: This double blind pilot study suggests that azithromycin may be helpful in treating youth meeting the PANS diagnosis, especially those with elevated levels of both OCD and tic symptoms. Azithromycin was well tolerated, but the potential for cardiac risks suggests that additional monitoring may be needed to ensure safety.
Journal of Child and Adolescent Psychopharmacology, 27(7) : 640-651
- Year: 2017
- Problem: Obsessive Compulsive Disorder
- Type: Randomised controlled trials
-
Stage: Disorder established (diagnosed disorder)
-
Treatment and intervention: Biological Interventions (any)
, Other biological interventions