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Key Features

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Essentials of Diagnosis
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  • Recurrent obsessive thoughts, impulses, or images that are experienced as intrusive at times

  • Repetitive compulsive behaviors or mental acts are performed to prevent or reduce distress stemming from obsessive thoughts

  • Obsessions and compulsions cause marked distress, are time-consuming, and interfere with normal routines

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General Considerations
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Obsessive-compulsive disorder (OCD) is related to anxiety disorders, but tends to cluster genetically with other compulsive disorders such as compulsive skin picking, and hoarding. Onset often occurs during childhood, and untreated OCD can have a lifelong course. Males have an earlier age of onset, with childhood cases usually occurring before the age of 10 years. OCD often leads to avoidance of situations that trigger obsessions, and for children and adolescents, this can interfere with development.

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Clinical Findings

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  • Obsessions that lead to OCD are defined as recurrent, persistent, intrusive thoughts, urges, or images that cause significant distress

  • The individual tries to avoid, suppress, or ignore the obsessions or to mitigate them through action or thought

  • Obsessions and compulsions of OCD consume more than an hour per day

  • In addition to compulsive symptoms, youth who are experiencing obsessions may also experience panic, depressive, irritable, and suicidal symptoms

  • Sudden onset of symptoms should alert pediatricians to screen for Group A streptococcal infections, as pediatric autoimmune disorders associated with these infections have been implicated in the development of OCD for some children

  • Caretakers can often identify children who have compulsions, but obsessions can be difficult to recognize because they are experienced internally

  • Youth who recognize that obsessions and compulsions are strange may not spontaneously reveal symptoms unless specifically asked

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Diagnosis

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  • Clinical

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Treatment

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  • Psychoeducation is an important first step to help put symptoms in perspective and outline treatment progression

  • Cognitive-behavioral therapy; should be combined with medications in severe cases

  • Fluvoxamine and sertraline have FDA approval for the treatment of pediatric OCD

  • Severe cases have been treated with gamma knife brain surgery interrupting the circuit involved in OCD

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Outcome

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Prognosis
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  • Cognitive-behavioral therapy plus medication is most effective for patients who do not respond to either treatment alone

  • Early recognition and treatment are important because early age of onset and greater impairment are predictors of poor prognosis

  • Hoarding is particularly difficulty to treat

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References

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Franklin  ME  et al: Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the pediatric OCD Treatment Study II (POTS II) randomized controlled trial. JAMA 2011;306(11):1224–1232
[PubMed: 21934055]
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Gilbert  AR, Maalouf  FT: Pediatric obsessive-compulsive disorder: management priorities in primary care. Curr Opin Pediatr 2008 Oct;20(5):544–550
[PubMed: 18781117] .
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Reinblatt  SP, Walkup  JT: Psychopharmacologic treatment of pediatric anxiety disorders. Child Adolesc Psychiatr Clin N Am 2005 Oct;14(4):877–908
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