title: Assessment and management of treatment-refractory obsessive-compulsive disorder in children.
abstract: OBJECTIVE
  To review the assessment and treatment of treatment-refractory pediatric obsessive-compulsive disorder (OCD).
  
  
  METHODS
  A PubMed search was conducted to identify controlled trials in pediatric OCD. In addition, practice guidelines for the treatment of adults and children were further reviewed for references in treatment-refractory OCD across the lifespan.
  
  
  RESULTS
  Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) were found to be effective treatments for pediatric OCD. Evidence suggests that CBT is also effective even in pediatric patients with refractory OCD symptoms. Antipsychotic augmentation, raising SSRI dosage, and several glutamate-modulating agents have some evidence of efficacy in adults with treatment-refractory OCD but have not been studied in pediatric populations.
  
  
  CONCLUSIONS
  Several pharmacological treatment options exist for children with refractory OCD symptoms. However, little evidence-based data exist to guide treatment for our most challenging pediatric OCD patients. Further research is needed to evaluate the efficacy/side effect profile of commonly used interventions in treatment-refractory pediatric OCD.
authors: Yale Child Study Center, Yale University, New Haven, CT. Electronic address: michael.bloch@yale.edu.
authors: Michael H
authors: MH
authors: Bloch
authors: University of South Florida, Tampa, and Rogers Behavioral Health System, Tampa Bay, FL.
authors: Eric A
authors: EA
authors: Storch
mesh_terms: D014150:Antipsychotic Agents / Q000008:administration & dosage*; D002648:Child; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D006801:Humans; D015201:Meta-Analysis as Topic; D009771:Obsessive-Compulsive Disorder / Q000628:therapy*; D016032:Randomized Controlled Trials as Topic; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage*; D016896:Treatment Outcome
chemical_list: D014150:Antipsychotic Agents; D017367:Selective Serotonin Reuptake Inhibitors
keywords: antipsychotic agents; cognitive-behavioral therapy; obsessive-compulsive disorder; serotonin uptake inhibitors; systematic review