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


METHODS
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.
Department of Psychiatry, University of Florida, Gainesville, FL 32610, USA. estorch@psychiatry.ufl.edu
Eric A
EA
Storch
Lisa J
LJ
Merlo
Michael J
MJ
Larson
Wendi E
WE
Marien
Gary R
GR
Geffken
Marni L
ML
Jacob
Wayne K
WK
Goodman
Tanya K
TK
Murphy
D000293:Adolescent; D002648:Child; D015928:Cognitive Behavioral Therapy; D003863:Depression / Q000523:psychology; D005260:Female; D006801:Humans; D007389:Internal-External Control; D016015:Logistic Models; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000523:psychology* / Q000628:therapy*; D010290:Parents / Q000523:psychology; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000523:psychology; D017211:Treatment Failure
D017367:Selective Serotonin Reuptake Inhibitors