Clinical features associated with treatment-resistant pediatric obsessive-compulsive disorder

Compr Psychiatry. 2008 Jan-Feb;49(1):35-42. doi: 10.1016/j.comppsych.2007.06.009. Epub 2007 Aug 21.

Abstract

Objective: The objective of the study was to identify clinical and sociodemographic characteristics that may differentiate youth with obsessive-compulsive disorder (OCD) who are resistant to treatment vs those who have a favorable response.

Method: Participants included 60 outpatients, aged 7-17 years, who were determined to have previously received an adequate trial of a first-line treatment (ie, serotonin reuptake inhibitors, cognitive behavioral therapy). Patients who were treatment-resistant were compared with responders on a number of factors, including severity and nature of OCD symptoms, levels of internalizing and externalizing symptoms, family accommodation of OCD symptoms, and functional impairment.

Results: The treatment-resistant group endorsed significantly more obsessions and compulsions, greater levels of internalizing symptoms, higher parental stress related to accommodation, and greater functional impairment than treatment responders. However, relative to treatment-resistant patients, treatment responders reported higher levels of depressive symptoms, perhaps indicating that they were more distressed by their OCD symptoms, as well as greater insight into their symptoms.

Conclusions: This study indicates that youth with more severe symptoms of OCD, higher related parental stress, and greater functional impairment tend to be more resistant to first-line treatments, and that perhaps they may require more intensive or family-based interventions. Treatment responders report more depressive symptoms and insight into their OCD, which may suggest a greater readiness for treatment. Further research likely would help to identify which types of treatment would be most beneficial for individual youth.

MeSH terms

  • Adolescent
  • Child
  • Cognitive Behavioral Therapy
  • Depression / psychology
  • Female
  • Humans
  • Internal-External Control
  • Logistic Models
  • Male
  • Obsessive-Compulsive Disorder / psychology*
  • Obsessive-Compulsive Disorder / therapy*
  • Parents / psychology
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Severity of Illness Index
  • Stress, Psychological / psychology
  • Treatment Failure

Substances

  • Serotonin Uptake Inhibitors