Factors That Predict Treatment Outcomes, Remission in Pediatric OCD

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No significant moderators were identified for treatment outcome, suggesting that baseline characteristics cannot be used to predict the effect of adjunct d-cycloserine on children with OCD.
No significant moderators were identified for treatment outcome, suggesting that baseline characteristics cannot be used to predict the effect of adjunct d-cycloserine on children with OCD.

A study published in the Journal of Affective Disorders assessed the efficacy of d-cycloserine with cognitive behavioral therapy (CBT) for the treatment of pediatric obsessive-compulsive disorder (OCD). No significant moderators were identified for treatment outcome, suggesting that baseline characteristics cannot be used to predict the effect of adjunct d-cycloserine on children with OCD.  

Researchers extracted data from a controlled trial in which children (7-17 years of age) were randomly assigned to receive either d-cycloserine with CBT (n=70) or placebo with CBT (n=72). Outcome measures included improvements on the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) and on the Clinical Global Impressions Scale-Severity. Researchers also assessed various baseline factors, including sociodemographic characteristics, family accommodation of the child's OCD, anxiety and depression symptoms, level of impairment caused by OCD, and the presence of externalizing behaviors.  

No baseline variables were found to moderate the effects of d-cycloserine augmentation on CBT outcome. As such, it remains unclear which patient demographics may most benefit from adjunct d-cycloserine. However, researchers identified several factors associated with a lower likelihood of achieving remission across both treatment modes, including higher family accommodation scores (odds ratio [OR], 0.94; 95% CI, 0.91-0.98), higher impairment scores (OR, .95, 95% CI, 0.92-0.99), higher depression scores (OR, 0.96; 95% CI, 0.92-0.99), and higher externalizing scores (OR, 0.93; 95% CI, 0.88-0.98). Additionally, worse scores on the CY-BOCS at baseline were associated with higher levels of impairment, higher levels of depression and anxiety, higher family accommodation (all P <.001), and higher externalizing behavior scores (P =.024). Higher Clinical Global Impressions Scale-Severity scores at baseline were correlated with a previous history of depression (P <.05), higher impairment and depression scores (both P <.001), and more severe externalizing symptoms (P =.022). Endorsement of the “insight” item on the CY-BOCS at baseline was associated with linear improvements over time (P =.03).

These results identify several predictive factors for remission in children with OCD and may be useful for clinicians in tailoring their treatment approach, although the impact of adjunctive d-cycloserine requires further investigation.

See full study for a list of disclosures.

Reference

Wilhelm S, Berman N, Small BJ, Porth R, Storch EA, Geller D. D-cycloserine augmentation of cognitive behavioral therapy for pediatric OCD: predictors and moderators of outcome [published online July 20, 2018]. J Affect Disord. doi: 10.1016/j.jad.2018.07.042

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