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

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

Author information

1
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States. Electronic address: swilhelm@mgh.harvard.edu.
2
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114, United States.
3
School of Aging Studies, University of South Florida, Tampa, FL, United States.
4
School of Aging Studies, University of South Florida, Tampa, FL, United States; Menninger Department of Psychiatry & Behavioral Sciences, Baylor College of Medicine, United States.

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

PMID:
30149332
PMCID:
PMC6129428
[Available on 2019-12-01]
DOI:
10.1016/j.jad.2018.07.042
[Indexed for MEDLINE]

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