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J Am Acad Child Adolesc Psychiatry. 2019 Feb 14. pii: S0890-8567(19)30108-X. doi: 10.1016/j.jaac.2019.01.010. [Epub ahead of print]

Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS.

Author information

1
Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden. Electronic address: karin.a.melin@vgregion.se.
2
Faculty of Psychology, University of Iceland, Reykjavik.
3
Aarhus University Hospital, Aarhus, Denmark.
4
Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway; St. Olav's University Hospital, Trondheim, Norway.
5
Division of Mental Health and Addiction, Vestre Viken Hospital, Drammen, Norway.
6
Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway; Hospital of Aalesund, Aalesund, Norway.
7
Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.
8
School of Health and Social Sciences, Halmstad University, Halmstad, Sweden.
9
Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway.
10
Institute of Neuroscience and Physiology, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology, Trondheim, Norway.

Abstract

OBJECTIVE:

This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes.

METHOD:

This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes.

RESULTS:

Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions.

CONCLUSION:

The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment.

CLINICAL TRIAL REGISTRATION INFORMATION:

Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.

KEYWORDS:

cognitive-behavioral therapy; follow-up; obsessive-compulsive disorder; pediatric; sertraline

PMID:
30768383
DOI:
10.1016/j.jaac.2019.01.010

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