title: Difficult-to-treat pediatric obsessive-compulsive disorder: feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy.
abstract: BACKGROUND
  This study examined the feasibility and preliminary effectiveness of d-cycloserine (DCS)-augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult-to-treat Obsessive Compulsive Disorder, in a double-blind randomized controlled pilot trial (RCT).
  
  
  METHODS
  Seventeen children and adolescents (aged 8-18 years) with a primary diagnosis of OCD, which was deemed difficult-to-treat, were randomly assigned to either nine sessions of CBT including five sessions of DCS-augmented exposure and response prevention (ERP) [ERP + DCS] or nine sessions of CBT including five sessions of placebo-augmented ERP [ERP + PBO]. Weight-dependent DCS or placebo doses (25 or 50 mg) were taken 1 hour before ERP sessions.
  
  
  RESULTS
  At posttreatment, both groups showed significant improvements with 94% of the entire sample classified as responders. However, a greater improvement in the ERP + DCS relative to the ERP + PBO condition was observed at 1-month follow-up on clinician-rated obsessional severity and diagnostic severity, and parent ratings of OCD severity. There were no changes across time or condition from 1- to 3-month follow-up.
  
  
  CONCLUSIONS
  In this preliminary study, DCS-augmented ERP produced significant improvements in OCD severity from posttreatment to 1-month follow-up, relative to a placebo control condition, in severe and difficult-to-treat pediatric OCD. The significant effect on obsessional severity suggests that DCS augmentation might be associated with enhanced modification of obsessional thoughts during ERP, and warrants further investigation.
authors.affiliation: Griffith Health Institute, Griffith University, Queensland, Australia. l.farrell@griffith.edu.au
authors.forename: Lara J
authors.initials: LJ
authors.lastname: Farrell
authors.forename: Allison M
authors.initials: AM
authors.lastname: Waters
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Boschen
authors.forename: Laetitia
authors.initials: L
authors.lastname: Hattingh
authors.forename: Harry
authors.initials: H
authors.lastname: McConnell
authors.forename: Ella L
authors.initials: EL
authors.lastname: Milliner
authors.forename: Nigel
authors.initials: N
authors.lastname: Collings
authors.forename: Melanie
authors.initials: M
authors.lastname: Zimmer-Gembeck
authors.forename: Doug
authors.initials: D
authors.lastname: Shelton
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Ollendick
authors.forename: Chris
authors.initials: C
authors.lastname: Testa
authors.forename: Eric A
authors.initials: EA
authors.lastname: Storch
mesh_terms: D000293:Adolescent; D000963:Antimetabolites / Q000627:therapeutic use*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D003523:Cycloserine / Q000627:therapeutic use*; D004311:Double-Blind Method; D005108:Extinction, Psychological; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007171:Implosive Therapy / Q000379:methods*; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D010865:Pilot Projects; D016194:Receptors, N-Methyl-D-Aspartate / Q000819:agonists*; D016896:Treatment Outcome
chemical_list: D000963:Antimetabolites; D016194:Receptors, N-Methyl-D-Aspartate; D003523:Cycloserine
keywords: CBT; d-cycloserine; obsessive-compulsive disorder; pediatric