Behavioral therapy in children and adolescents with obsessive-compulsive disorder: A pilot study
ABSTRACT Despite advances in pharmacotherapy for obsessive-compulsive disorder (OCD), medication treatments are not always effective. This pilot project examined the feasibility of a structured behavioral therapy program in the treatment of children and adolescents with OCD. Ten subjects with a primary diagnosis of OCD were invited to participate in the treatment program. Seven youngsters, 5 boys and 2 girls (age range 10.8-15.8, mean 13.0 years), participated and were treated for a mean of 14 sessions. These 7 subjects showed a broad range of OCD severity, as measured by the Children's Yale-Brown Obsessive Compulsive Scale (CYBOCS score range 12-29). Five subjects were also receiving antiobsessional medication (dose was not changed during the trial), and 2 subjects were treated without medication. All 7 youngsters showed a clinically significant reduction in the CYBOCS score at treatment endpoint (mean change 61%, range 30%-90%, effect size 2.04, p < 0.05), and the therapeutic gains were stable for at least 3 months after treatment. One of 5 children who had been receiving concurrent antiobsessional medication was able to tolerate a dose reduction following behavioral treatment. Two to three booster sessions within 6 months posttreatment were effective in preventing relapse in 4 of 6 subjects. The 3 children who declined behavioral treatment showed no improvement at 3-month and 6-month follow-up. Behavioral treatment appeared to be a useful adjunct to medication in children and adolescents with OCD. Further research could evaluate whether behavioral treatment would lower the dose requirements for children receiving antiobsessional medications. Randomized clinical trials are also needed to confirm the effectiveness of behavioral therapy alone or in combination with medication.
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ABSTRACT: Post-infectious autoimmunity and immune deficiency have been implicated in the pathogenesis of Tourette syndrome (TS). We asked here whether B cell immunity of patients with TS differs from healthy subjects. In two independent cross-sectional samples, we compared serum levels of IgG1, IgG2, IgG3, IgG4, IgM, IgA, and IgE in 21 patients with TS from Yale University (17 males, 4 females, 8-16 years) versus 21 healthy controls (13 males, 8 females, 7-17 years); and in 53 patients with TS from Groningen University (45 males, 8 females, 6-18 years) versus 53 healthy controls (22 males, 31 females, 6-18 years), respectively. We also investigated correlations between Ig concentrations and symptom severity. In 13 additional patients (9 males, 4 females, age range 9-14), we established Ig profiles at time points before, during, and after symptom exacerbations. IgG3 levels were significantly lower in Yale patients compared to healthy children (medians 0.28 versus 0.49 mg/ml, p=.04), while levels of IgG2, IgG4, and IgM in patients were lower at trend-level significance (p≤.10). Decreased IgG3 (medians 0.45 versus 0.52 mg/ml; p=.05) and IgM (medians 0.30 versus 0.38 mg/ml; p=.04) levels were replicated in the Groningen patients. Ig levels did not correlate with symptom severity. There was a trend-level elevation of IgG1 during symptom exacerbations (p=.09). These pilot data indicate that at least some patients with TS have decreased serum IgG3, and possibly also IgM levels, though only few subjects had fully expressed Ig immunodeficiency. Whether these changes are related to TS pathogenesis needs to be investigated.Brain Behavior and Immunity 03/2011; 25(3):532-8. DOI:10.1016/j.bbi.2010.12.003 · 6.13 Impact Factor
Article: Treating Anxiety Disorders in Youth.[Show abstract] [Hide abstract]
ABSTRACT: This chapter begins by placing anxiety within a normative context. Following this, the somatic, behavioral, cognitive, and emotion-related features of anxiety disorders in youth are described. Assessment issues are discussed, with special attention to normal developmental trajectories of anxiety. Recognizing the potential impact of family stress, pathology, and individual members' interpersonal/parenting styles, we explore the role of the family in the development and maintenance of a child's anxious experience. Finally, a descriptive review of the common principles and strategies of cognitive-behavioral therapy (CBT) is presented, and recent outcome research evaluating these procedures is provided. One treatment model for anxious youth is outlined in detail and illustrated by real-life session vignettes of cases seen at the Child and Adolescent Anxiety Disorders Clinic (CAADC) at Temple University. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Conference Paper: Education and awareness: keys to solving the marine debris problemOCEANS '88. 'A Partnership of Marine Interests'. Proceedings; 01/1988