Paediatric obsessive-compulsive disorder and depression: clinical correlates and response to cognitive-behavioural therapy.
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1 Paediatric obsessive-compulsive disorder and depression: clinical correlates and response to cognitive-behavioural therapy Hannah Brown Amita Jassi, Kathryn Lester & Georgina Krebs
2 Paediatric OCD and CBT OCD is a chronic and debilitating condition CBT largely efficacious Meta: Abramowitz et al., but significant minority fail to respond/remit.
3 Paediatric OCD and depression OCD Subtypes OCD severity females OCD Adults 25 40% Children 13 73% Depression quality of life family history earlier OCD onset functional impairment
4 Comorbid depression and CBT Comorbid depression may impede response to CBT for OCD OCD Depression Adults: Greater post-treatment OCD 1 Response/Remission rates 2 Children: fewer studies
5 Remission Depressed Not depressed Pre-treatment Post-treatment
6 Current Study 1. Examine prevalence and clinical features of concurrent depression in paediatric OCD 2. Examine the impact of concurrent depression on CBT outcomes in paediatric OCD
7 Sample NHS National & Specialist OCD clinic, Maudsley Hospital Child And Adolescent Mental Health Service ( NHS AMHS) 295 children; mean age = 15 (7 18 years) 112 (38%) received CBT CBT: OCD-specific, protocol driven CBT; exposure with response prevention (ERP) 14 weekly sessions
8 Pre-treatment Demographic information Age, Sex Clinical information Previous treatment (CBT, SRI) Family history Age of OCD onset Functional impairment (school, hospitalisation) OCD symptoms Clinician (CYBOCS) Child-report (CHOCI) Parent-report (CHOCI) Depression Symptoms (BDI-y) Diagnosis (DAWBA CBT Measures Post-Treatment OCD symptoms Clinician(CYBOCS) Child-report (ChOCI) Parent-report (ChOCI) Depression Symptoms (BDI) Global functioning CGAS
9 % patients % patients Prevalence average mild moderate extreme Depressive symptom severity Not depressed 26 Depressed
10 Clinical features Depressive disorders (n = 127) Depressive symptoms (n = 261) Not depressed Depressed r (n = 94) (n= 33) Gender; female, n (%) * 58 (40.8) 25 (62.5) -- Age (years), mean (SD) (2.55) (2.34).12 Age at onset (years), mean (SD) (3.14) (3.32).05 Family history of affective disorder, n (%) 45 (48.9) 11 (34.4) -- Family history of OCD, n (%) 15 (16.3) 6 (18.8) -- Previous CBT, n (%) 58 (41.4) 16 (41.0) -- Current SSRI medication, n (%) 50 (36.8) 17 (43.6) -- Global functioning (CGAS), mean (SD) * * Psychiatric admission * 12 (12.9) 11 (34.4) -- School non-attendance* 15 (22.7) 15 (50.0) -- OCD severity, mean (SD) Clinician (CY-BOCS)* (6.45) (5.18).42* Parent (ChOCI)* (8.91) (9.26).29* Child (ChOCI)* (8.55) (6.65).48* OCD dimensions (CY-BOCS), mean (SD) Symmetry 1.77 (1.49) 1.97 (1.33).18* Forbidden thoughts 4.62 (3.65) 5.74 (4.32).34* Checking 3.80 (3.33) 4.30 (3.45).23* Hoarding.68 (.88).91 (1.01).23*
11 Change over CBT Baseline Posttreatment t OCD severity Clinician (6.43) (8.06) * Parent (9.36) (11.32) * Child (8.66) (11.32) * Depression (13.43) (15.08) 5.04 *
12 Impact on CBT 40 Depressive Symptoms 40 Depressive Disorders Average Mild Moderate Not depressed Depressed 25 Extreme remission 15 remission Pre-treatment Post-treatment 0 Pre-treatment Post-treatment
13 Impact on CBT Depressive Symptoms Depressive Disorders Model 1 Model 2 Model 3 Model 4 Age Sex Prior CBT SSRIs.38 *.28 *.47 *.33 * Depression.19 * *.13 OCD severity * * R F (df) 7.03(5,91) * * 11.85(6,90) ** 6.30(5,55) ** 8.87(6,54) **
14 Discussion Depression is common, especially in females Depression associated with: OCD symptom severity functioning Psychiatric hospitalisation School attendance Depression decreases across CBT Depression did not attenuate CBT response when accounting for baseline differences in OCD
15 Strengths/Limitations Strengths Largest paediatric study of depression on CBT for OCD Diagnostic and dimensional measures of depression First to look at specific areas of functional impairment Limitations Variation in treatment protocol No structured diagnostic interview for depression Relation between depression and OCD unclear Small sample size for some analyses
16 Conclusions Depression... frequently co-occurs with paediatric OCD is associated with more severe OCD and functional impairment does not attenuate response to CBT Clinicians should... treat as usual be aware that depression is a marker for complex OCD
17 Any questions? Acknowledgements:
18 Disclosures: No conflicts of interest
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