D-Cycloserine augmentation of cognitive behavior therapy for pediatric OCD: Predictors and moderators of outcome

J Affect Disord. 2018 Dec 1;241:454-460. doi: 10.1016/j.jad.2018.07.042. Epub 2018 Jul 20.

Abstract

Background: Over half of children receiving cognitive behavioral therapy (CBT) for obsessive compulsive disorder (OCD) do not fully remit. To improve response rates and enhance extinction learning, d-cycloserine (DCS) has been examined as an augmenting agent of CBT. To direct children with OCD towards treatments with the highest likelihood of success, the current study evaluated the conditions under which DCS augmentation works best (i.e., moderators) and the baseline characteristics associated with outcome, irrespective of treatment type (i.e., predictors).

Methods: Data came from a two-site randomized controlled trial (N = 142) in which children received either DCS + CBT (n = 70) or placebo + CBT.

Results: No baseline variables moderated the effects of DCS augmentation on CBT outcome. However, several predictor variables were associated with a decreased likelihood of achieving remission status, including higher family accommodation scores, higher impairment scores, higher depression scores, and higher externalizing scores. Furthermore, better insight at pre-treatment was associated with more improvement longitudinally on a clinician-rated summary measure of illness severity.

Limitations: The current study did not examine all variables that had previously been shown to moderate or predict treatment outcome (e.g., family history of OCD or cognitive profile).

Conclusions: The absence of significant moderators suggests that baseline factors cannot yet be used to determine who benefits most from DCS. To maximize treatment benefits for children presenting with identified predictors of worse treatment outcome, clinicians might need to adapt existing CBT protocols and administer additional interventions that address patients' specific problem areas.

Trial registration: ClinicalTrials.gov NCT00864123.

Keywords: D-Cycloserine; cognitive behavioral therapy; moderators; pediatric obsessive-compulsive disorder; predictors.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Antimetabolites / therapeutic use*
  • Child
  • Cognitive Behavioral Therapy*
  • Combined Modality Therapy
  • Cycloserine / therapeutic use*
  • Female
  • Humans
  • Male
  • Obsessive-Compulsive Disorder / physiopathology
  • Obsessive-Compulsive Disorder / psychology
  • Obsessive-Compulsive Disorder / therapy*
  • Problem Solving
  • Treatment Outcome

Substances

  • Antimetabolites
  • Cycloserine

Associated data

  • ClinicalTrials.gov/NCT00864123