Peds OCD

Question 1

Peds OCD stats:
prevalence
Remission by adulthood
Peak
Mean age
sex ration
genetic risk of sibling

Answer 1

prevalence: 1%
Remission by adulthood:substantial number
Peak: 2 peaks: preadol, and early adulthood
Mean age: 21 (10 in peds)
sex ration: 3:1 (male higher)
25% if ptn had childhood onset
12% if ptn had adult onset

Question 2

Talk about PANDAS

Answer 2

Pediatric autoimmune neuropsychiatric disorder associated with strep
GABHS
Small subset of OCD and Tourettes may be attributed to this
Cross reactivity between bacteria and basal ganglia
tics, OCD, hyperactivity, choreoathetoid movements

Most children will have positive ASO, mens nothing
doubling titer may mean something, but not necessarily need ABx
gold stanadard is positive culture
treat acute infection with antibiotics, not OCD
Do nt recommend plasma exchange: risky experimental stuff

Question 3

talk about CBT vs meds vs combo (POTs and GL)

Answer 3

POTS: Combo >= CBT>=sertraline>=placebo
depending on whether you used continuous or cut off scores on YBOCS

combination may have cummulative effect size : CBT (1)+ Sertraline (0.7)= combo (1.4)

GL:
mild-moderate: CBT
moderate to severe: combination

Also consider combination if: family hx, comorbidity, chaotic family, suboptimal CBT resources, if CBT fails

If OCD and tics: combination or CBT. Sertraline alone did not work

Question 4

Augmentation strategies for paediatric OCD

Answer 4

To an SSRI:
add AA (most common strategy, esp if tics, poor insight, PDD, mood instability) Risperdal and haldol studied
add clomipramine (luvox good combo, careful of 2d6 inhibitors)
add venafaxine or duloxetine (expert opinion)

Question 5

Tx of OCD and tics

Answer 5

not SSRI alone
combo or CBT
consider adding clondine, guanfacine (bt do EKG)
I think the presence of tics increases the response of OCD to augmentation by AA

Question 6

Tx of OCD and ADHD

Answer 6

treat OCD 1st as stimulants can worsen OCD

consider atomoxetine, clomipramine (NA)