Childhood obsessive-compulsive disorder
Division of Child and Adolescent Psychiatry, Baystate Health System, Springfield, MA. Pediatrics in Review
(Impact Factor: 0.82).
01/2013; 34(1):19-28. DOI: 10.1542/pir.34-1-19
Strong research evidence indicates that children and adolescents who have OCD have recurrent experiences of disturbing intrusive thoughts and intensely driven repetitive behaviors associated with high levels of distress and significant functional impairment. (4)(8) (12) • Although OCD, in general, is associated with a high rate of co-occurring psychiatric illnesses, such as other anxiety disorders and mood disorders, research evidence has shown that the childhood-onset form of OCD is more likely to be associated with co-occurring tic disorders and disruptive behavior disorders, in comparison with the adult-onset form. (4) • A neurobiologic model for the pathophysiology of OCD is supported by a substantial body of research evidence of dysregulation of frontal corticostriatalthalamic circuits associated with OCD symptoms. (13) (14)(15) • Although there is some research evidence of the existence of a poststreptococcal, autoimmune etiology for some patients who have OCD, (16)(23) currently there is a lack of expert consensus regarding the validity of this syndrome (PANDAS) and the use of immunomodulatory or antibiotic treatment currently is not supported by research evidence. (24)(25) • Numerous clinical trials have demonstrated the effectiveness of CBT in the treatment of childhood OCD, (26) and the use of this psychotherapy alone (without psychiatric medication) is considered an acceptable initial treatment approach for patients who have OCD of mild-to-moderate severity. (41) • According to expert consensus, psychopharmacologic medication often is necessary in the treatment of children who have OCD. (40) The efficacy of serotonergic medications, including SSRIs and clomipramine, has been demonstrated and replicated in randomized controlled trials. (30)(32)(33)(34)(35)(36).
Available from: Roger L. Albin
- "OCD often begins during childhood, with a mean age at onset of $20 years (Narayanaswamy et al., 2012), though a median onset age at onset of 10 has been reported (Sarvet, 2013). OCD is believed to affect 1–3% of the population, both in children and adults (Sarvet, 2013). Like TS, OCD has a strong genetic component, though specific genes have yet to be identified (Pauls, 2008). "
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ABSTRACT: This chapter focuses on neurodevelopmental diseases that are tightly linked to abnormal function of the striatum and connected structures. We begin with an overview of three representative diseases in which striatal dysfunction plays a key role-Tourette syndrome and obsessive-compulsive disorder, Rett's syndrome, and primary dystonia. These diseases highlight distinct etiologies that disrupt striatal integrity and function during development, and showcase the varied clinical manifestations of striatal dysfunction. We then review striatal organization and function, including evidence for striatal roles in online motor control/action selection, reinforcement learning, habit formation, and action sequencing. A key barrier to progress has been the relative lack of animal models of these diseases, though recently there has been considerable progress. We review these efforts, including their relative merits providing insight into disease pathogenesis, disease symptomatology, and basal ganglia function.
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