Frequency and correlates of suicidal ideation in pediatric obsessive-compulsive disorder.

This study examined the frequency and sociodemographic and clinical correlates of suicidal ideation in a sample of children and adolescents with obsessive-compulsive disorder (OCD). Fifty-four youth with OCD and their parent(s) were administered the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime, Children's Yale-Brown Obsessive Compulsive Scale, and Children's Depression Rating Scale-Revised. Children completed the Suicidal Ideation Questionnaire-Junior (SIQ-JR), Child Obsessive Compulsive Impact Scale-Child, and Multidimensional Anxiety Scale for Children; parents completed the Child Obsessive Compulsive Impact Scale-Parent, Swanson, Nolan, and Pelham-IV Parent Scale, and Young Mania Rating Scale-Parent Version. Seven youth endorsed clinically significant levels of suicidal ideation on the SIQ-JR. Suicidal ideation was significantly related to clinician-rated depressive symptoms, age, child-rated impairment and anxiety symptoms, and symmetry, sexuality/religiosity and miscellaneous symptom dimensions. There was no significant association between suicidal ideation and obsessive-compulsive symptom severity, comorbidity patterns, or several parent-rated indices (e.g., impairment, impulsivity). These results provide initial information regarding the frequency and correlates of suicidal ideation in treatment-seeking youth with OCD. Clinical implications are discussed, as well as directions for future research.

Insight in adults with obsessive-compulsive disorder.

The present study examined the clinical correlates of insight among adults with obsessive-compulsive disorder (OCD). One hundred and thirty treatment-seeking adults with a primary diagnosis of OCD, aged 18 to 68 years (mean 31.4 years) participated. Measures of clinical severity, obsessive-compulsive symptom dimensions, anxiety symptoms, depressive symptoms, and ability to resist and control OCD symptoms were obtained. Results indicated that poor insight was positively related to greater OCD symptom severity and poorer ability to resist and control OCD symptoms; this pattern of associations held when insight was examined continuously and categorically (i.e., high versus low insight). Insight was generally not associated with other clinical characteristics, except for a relationship with mental neutralizing behaviors. Insight did not mediate the relationship between the ability to resist and control OCD symptoms and obsessive-compulsive symptom severity. Overall, this study provides further information into the nature and role of insight in adults with OCD.

Phenomenology and correlates of insight in pediatric obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is marked by the presence of obsessions and/or compulsions that cause significant interference in an individual's life. Insight regarding symptoms in youth with OCD may affect accurate assessment, acceptance and motivation for treatment, tolerance of negative valence states (i.e., fear) and treatment outcome, so assessment of this construct and associated clinical characteristics is important. Accordingly, the current study sought to expand the literature on symptom insight by examining multi-informant ratings of insight from children, parents, and clinicians simultaneously and its relationship to varied clinical characteristics. One-hundred and ten treatment-seeking youth with a primary diagnosis of OCD, aged 6-17, participated in the study along with a parent/guardian. The nature of symptom conviction, fixity of ideas, and perceptions about the cause of the problems were important indicators in assessing child insight and resulted in a comprehensive, psychometrically-sound measure of insight. Insight was generally not strongly associated with clinical characteristics. Poor insight was moderately associated with less resistance of obsessive-compulsive symptoms, increased externalizing symptoms, and ordering symptoms. Overall, this study contributes further information into the nature and correlates of insight in youth with OCD, and provides a psychometrically sound approach for its assessment.

Relations between emotional and social functioning in children with anxiety disorders.

The current study investigated concurrent relations between emotional and social functioning in youth with anxiety disorders using a multi-reporter (i.e., children, parents, teachers) assessment strategy. Ninety youth (M age = 8.98 years, SD = 1.68) with a primary diagnosis of generalized anxiety disorder, social phobia, and/or separation anxiety disorder, and a parent participated. Regression analyses indicated that positive affect and emotion regulation coping were related to adaptive measures of social functioning, whereas positive affect, negative affect, reluctance to share emotional experiences with peers, and lability/negativity were related to maladaptive measures of social functioning in the expected directions. For youth high in lability/negativity and low in emotion regulation coping, the relationship between diagnostic severity and social problems was exacerbated. This research contributes to our understanding of the interplay of social and emotional variables and suggests that efforts to facilitate child emotional functioning may improve social functioning for anxious youth, or vice versa.

Feasibility of exercise training for the short-term treatment of generalized anxiety disorder: a randomized controlled trial.

BACKGROUND: Exercise training may be especially helpful for patients with generalized anxiety disorder (GAD). We conducted a randomized controlled trial to quantify the effects of 6 weeks of resistance (RET) or aerobic exercise training (AET) on remission and worry symptoms among sedentary patients with GAD. METHODS: Thirty sedentary women aged 18-37 years, diagnosed by clinicians blinded to treatment allocation with a primary DSM-IV diagnosis of GAD and not engaged in any treatment other than pharmacotherapy, were randomly allocated to RET, AET, or a wait list (WL). RET involved 2 weekly sessions of lower-body weightlifting. AET involved 2 weekly sessions of leg cycling matched with RET for body region, positive work, time actively engaged in exercise, and load progression. Remission was measured by the number needed to treat (NNT). Worry symptoms were measured by the Penn State Worry Questionnaire. RESULTS: There were no adverse events. Remission rates were 60%, 40%, and 30% for RET, AET, and WL, respectively. The NNT was 3 (95% CI 2 to 56) for RET and 10 (95% CI -7 to 3) for AET. A significant condition-by-time interaction was found for worry symptoms. A follow-up contrast showed significant reductions in worry symptoms for combined exercise conditions versus the WL. CONCLUSIONS: Exercise training, including RET, is a feasible, low-risk treatment that can potentially reduce worry symptoms among GAD patients and may be an effective adjuvant, short-term treatment or augmentation for GAD. Preliminary findings warrant further investigation.

Cognitive behavioral therapy plus motivational interviewing improves outcome for pediatric obsessive-compulsive disorder: a preliminary study.

Lack of motivation may negatively impact cognitive behavioral therapy (CBT) response for pediatric patients with obsessive-compulsive disorder (OCD). Motivational interviewing is a method for interacting with patients in order to decrease their ambivalence and support their self-efficacy in their efforts at behavior change. The authors present a preliminary randomized trial (N = 16) to evaluate the effectiveness of adding motivational interviewing (MI) as an adjunct to CBT. Patients aged 6 to 17 years who were participating in intensive family-based CBT for OCD were randomized to receive either CBT plus MI or CBT plus extra psychoeducation (PE) sessions. After four sessions, the mean Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score for the CBT plus MI group was significantly lower than for the CBT plus psychoeducation group, t(14) = 2.51, p < .03, Cohen's d = 1.34. In addition, the degree of reduction in CY-BOCS scores was significantly greater, t(14) = 2.14, p = .05, Cohen's d = 1.02, for the CBT plus MI group (mean Delta = 16.75, SD = 9.66) than for the CBT plus psychoeducation group (mean Delta = 8.13, SD = 6.01). This effect decreased over time, and scores at posttreatment were not significantly different. However, participants in the MI group completed treatment on average three sessions earlier than those in the psychoeducation group, providing support for the utility of MI in facilitating rapid improvement and minimizing the burden of treatment for families.

Further psychometric analysis of the Florida Obsessive-Compulsive Inventory.

This study examined the psychometric properties of the Florida Obsessive-Compulsive Inventory (FOCI [Storch, E. A., Stigge-Kaufman, D., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., et al. (2007). Florida Obsessive-Compulsive Scale: development, reliability, and validity. Journal of Clinical Psychology, 63, 851-859]). Participants were 89 adults with OCD presenting for treatment at a specialty clinic. A trained clinician administered the Yale-Brown Obsessive Compulsive Scale and patients completed the FOCI, Obsessive-Compulsive Inventory-Revised, Beck Depression Inventory-Second Edition, and State Trait Anxiety Inventory at baseline and following 14 weekly or daily cognitive behavioral therapy sessions. The internal consistency of FOCI Symptom Checklist and Severity Scale were good, and the concurrent and divergent validity of the FOCI Symptom Checklist and Severity Scale was supported through its associations with clinician-rated OCD symptom severity, and self-reported OCD, depressive, and anxiety measures. In addition, sensitivity to cognitive-behavioral treatment effects was shown as the Severity Scale scores were significantly lower following treatment compared to baseline. These findings not only replicate Storch et al. [Storch, E. A., Stigge-Kaufman, D., Bagner, D., Merlo, L. J., Shapira, N. A., Geffken, G. R., et al. (2007). Florida Obsessive-Compulsive Scale: development, reliability, and validity. Journal of Clinical Psychology, 63, 851-859] but also add unique construct validity data in support of the psychometrics of the FOCI.

Preliminary evidence of biased attentional mechanisms and reward processing in adults with obsessive-compulsive disorder.

Individuals with obsessive-compulsive-disorder (OCD) may have difficulties in using feedback from rewarding and punishing experiences to optimally guide future decisions. The current aim was to examine how adults with OCD use associative learning feedback to direct attention toward learned stimuli when the action-outcome contingency for those stimuli has changed. Participants first learned to select high-probability (over low-probability) rewarding stimuli and low-probability (over high-probability) loss stimuli. Participants then saw these stimuli as the second of two targets in a task where available attentional resources were limited. Recognition of learned stimuli during limited attention was driven by previously learned stimulus-response associations instead of an attentional benefit toward the most favorable action-outcome associations (reward-associated stimuli), as demonstrated in prior research with non-OCD adults. The current evidence supports the hypothesis that individuals with OCD have difficulties shifting from learned stimulus-response associations when the response-outcome contingencies change.

Obsessive-compulsive disorder in youth with and without a chronic tic disorder.

The goal of this study was to discriminate subtypes of pediatric obsessive-compulsive disorder (OCD) among youth with and without a comorbid tic disorder. Seventy-four youth (M(age)=9.7+/-2.3 years) with a principal diagnosis of OCD, with (n=46) or without (n=28) a comorbid tic disorder, were assessed with a semi-structured diagnostic interview and the Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS). The CY-BOCS Symptom Checklist was used to categorize obsessions and compulsions. Group differences were analyzed by t tests, chi(2), and discriminant function analyses. Results suggested that subjects without tics had significantly more contamination obsessions, sexual obsessions, and counting compulsions than youth with comorbid tics. Generally speaking, however, youth with and without tics had similar symptom presentations. These data suggest that pediatric OCD patients with and without comorbid tics may have some aspects of symptom presentation that differ, but generally have more OCD symptoms in common than different. Implications of these findings on clinical presentation and treatment efficacy are highlighted.

Insight in pediatric obsessive-compulsive disorder: associations with clinical presentation.

Insight has emerged as a significant treatment outcome predictor in adult obsessive-compulsive disorder (OCD), with some suggesting that OCD with poor insight represents a distinct clinical subtype. Despite its clinical relevance, limited data exist on insight in pediatric OCD patients. The present study investigated the relation between poor insight and clinical characteristics among children and adolescents with OCD (N=78, ages 6-20 years). Forty-five percent of the sample (n=35) was considered to have low levels of insight into their symptoms, as determined by clinician rating on item 11 of the Children's Yale-Brown Obsessive-Compulsive Scale. Pearson product-moment correlations showed a significant, inverse relation between insight and OCD severity. Relative to the high insight group, parents of patients with low insight reported higher levels of OCD-related impairment and family accommodation. These findings suggest that OCD with poor insight may represent a distinct clinical feature that may require more intensive and multimodal treatment approaches.

Sleep-related problems in pediatric obsessive-compulsive disorder.

Although attention has been given to presence of sleep related problems (SRPs) in children with psychiatric conditions, little has been reported on SRPs in youth with obsessive-compulsive disorder (OCD). Sixty-six children and adolescents with OCD were administered the Children's Yale Brown Obsessive-Compulsive Scale and completed the Children's Depression Inventory and Multidimensional Anxiety Scale. Their parents completed the Child Behavior Checklist and Children's Obsessive-Compulsive Impact Scale. A subset of youth (n=41) completed a trial of cognitive-behavioral therapy. Frequency of eight specific SRPs was examined in relation to age, gender, OCD symptom severity, child-rated symptoms of depression and anxiety, parent-proxy ratings of internalizing and externalizing problems, and functional impairment. Ninety-two percent of youth experienced at least one SRP, with 27.3% reporting five or more SRPs. Total SRPs were positively associated with OCD symptom severity, child-rated anxiety, and parent-proxy ratings of internalizing problems. Total and several specific SRPs were reduced following cognitive-behavioral treatment. These results suggest that SRPs are relatively common in youth with OCD, are associated with symptom severity, and warrant attention during assessment and treatment.

Emotion-Focused Cognitive-Behavioral Therapy for Youth with Anxiety Disorders: A Randomized Trial.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

D-cycloserine does not enhance exposure-response prevention therapy in obsessive-compulsive disorder.

Obsessive-compulsive disorder is a common, chronic, and oftentimes disabling disorder. The only established first-line treatments for obsessive-compulsive disorder are exposure and response prevention therapy and the serotonin reuptake inhibitors. Many patients do not experience complete symptom resolution with either modality and require augmentation approaches. Recent animal and clinical data suggest that D-cycloserine, a partial agonist that acts at the strychnine-insensitive glycine-recognition site of the N-methyl-D-aspartate receptor complex, may enhance extinction learning that occurs in exposure-based psychotherapies. Given this, this study examined if D-cycloserine (250 mg) enhances the overall efficacy and rate of change of exposure and response prevention therapy for adult obsessive-compulsive disorder. Participants were 24 adults meeting Diagnostic and Statistical Manual of Mental Disorders-IV criteria for obsessive-compulsive disorder. The study design was a randomized, double-blinded, placebo-controlled augmentation trial examining exposure and response prevention therapy+D-cycloserine versus exposure and response prevention therapy+placebo. All patients received 12 weekly sessions of exposure and response prevention treatment. The first session involved building a ritual hierarchy and providing psychoeducation about obsessive-compulsive disorder. The second session involved a practice exposure. Sessions 3-12 involved exposure and response prevention exercises. D-cycloserine or placebo (250 mg) was taken 4 h before every session. No significant group differences were found across outcome variables. The rate of improvement did not differ between groups. The present results fail to support the use of D-cycloserine with exposure and response prevention therapy for adult obsessive-compulsive disorder. As this study is the first to explore this question and a number of methodological issues must be considered when interpreting the findings, the conclusions that may be drawn from our results are limited.

Associations between miscellaneous symptoms and symptom dimensions: an examination of pediatric obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) in children and adults is a heterogeneous disorder associated with significant psychosocial impairment. Although factor analytic studies have identified symptom dimensions, these analyses do not capture the varied miscellaneous symptoms that fail to load on a specific dimension despite being functionally related. The present study sought to extend the findings of previous research in adults to a sample of youth with OCD (n=131). Logistic regression analyses were used to examine the predictive value of each of the four symptom factors (contamination symptoms, obsessions and checking, symmetry and ordering, and hoarding) to the miscellaneous OCD symptoms. The vast majority of miscellaneous symptoms (17 of the 18 symptoms) were associated with one or more symptoms factors (i.e., contamination symptoms, obsessions and checking, symmetry, and ordering). Hoarding was not related to any miscellaneous symptom. In addition to improving our understanding about the clinical presentation of pediatric OCD, findings also have important assessment (e.g., understanding which miscellaneous symptoms relate to certain dimensions) and treatment implications (e.g., hierarchy development).

Still lonely: Social adjustment of youth with and without social anxiety disorder following cognitive behavioral therapy.

Social experiences are an integral part of normative development for youth and social functioning difficulties are related to poor outcomes. Youth with anxiety disorders, and particularly social anxiety disorder, experience difficulties across many aspects of social functioning that may place them at risk for maladjustment. The goal of this paper was to compare social experiences of youth across anxiety diagnoses and examine whether treatment is helpful in improving social functioning. Ninety-two children (age 7-12 years; 58% male; 87.0% White) with a primary diagnosis of generalized anxiety disorder, separation anxiety disorder, and/or social anxiety disorder participated in cognitive behavioral therapy. At both pre- and post-treatment, children with social anxiety disorder self-reported greater loneliness than youth without social anxiety disorder, though levels of peer victimization and receipt of prosocial behavior were similar across groups. Parents reported greater social problems for youth with social anxiety disorder compared to those without social anxiety disorder. All youth experienced improved social functioning following treatment per child- and parent-reports. The results call for an increased focus on the social experiences of youth with anxiety disorders, and particularly loneliness, for children with social anxiety disorder. The results document ways that evidenced-based practice can improve social functioning for youth with anxiety disorders.

A model-based cluster analysis of social experiences in clinically anxious youth: links to emotional functioning.

Social difficulties are commonly associated with anxiety disorders in youth, yet are not well specified in the literature. The aim of this study was to identify patterns of social experiences in clinically anxious children and examine the associations with indices of emotional functioning. A model-based cluster analysis was conducted on parent-, teacher-, and child-reports of social experiences with 64 children, ages 7-12 years (M = 8.86 years, SD = 1.59 years; 60.3% boys; 85.7% Caucasian) with a primary diagnosis of separation anxiety disorder, social phobia, and/or generalized anxiety disorder. Follow-up analyses examined cluster differences on indices of emotional functioning. Findings yielded three clusters of social experiences that were unrelated to diagnosis: (1) Unaware Children (elevated scores on parent- and teacher-reports of social difficulties but relatively low scores on child-reports, n = 12), (2) Average Functioning (relatively average scores across all informants, n = 44), and (3) Victimized and Lonely (elevated child-reports of overt and relational victimization and loneliness and relatively low scores on parent- and teacher-reports of social difficulties, n = 8). Youth in the Unaware Children cluster were rated as more emotionally dysregulated by teachers and had a greater number of diagnoses than youth in the Average Functioning group. In contrast, the Victimized and Lonely group self-reported greater frequency of negative affect and reluctance to share emotional experiences than the Average Functioning cluster. Overall, this study demonstrates that social maladjustment in clinically anxious children can manifest in a variety of ways and assessment should include multiple informants and methods.

Pediatric obsessive-compulsive disorder: a review for nursing professionals.

TOPIC: Pediatric obsessive-compulsive disorder (OCD). PURPOSE: OCD is a neuropsychiatric disorder characterized by the presence of obsessions and/or compulsions. Given that most children with OCD will initially be seen by nursing professionals in environments such as pediatrician offices, hospitals, and schools, increasing awareness of this disorder among nurses will likely facilitate early detection, accurate diagnosis, and appropriate treatment. SOURCES: Psyc-INFO, PubMed, Google Scholar. CONCLUSION: This article provides an overview of pediatric OCD, including information about clinical presentation, suspected etiology, epidemiology, assessment, and evidence-based treatment options.

Family emotion expressivity, emotion regulation, and the link to psychopathology: examination across race.

Research has established links between parental emotion socialization behaviours and youth emotional and psychological outcomes; however, no study has simultaneously compared these relations for White, Black, and Asian individuals. In this study, emerging adults identifying as White (n= 61), Black (n= 51), or Asian (n= 56) retrospectively reported on parents' emotion socialization behaviours during childhood, existing emotion regulation (ER) skills, and current psychopathology symptoms. Asian participants reported fewer positive displays of emotions in their families during childhood than White and Black participants. Despite this difference, low expression of positive emotions in families during childhood did not relate to negative outcomes for Asian participants but was linked for White and Black participants. Overall, Asian participants reported more difficulties with ER than Black or White participants, and relations between ER difficulties and psychopathology varied by racial group. The findings emphasize the need to consider race when conducting research on emotion functioning with families and highlight emotion dysregulation as a potential treatment target for White, Black, and Asian individuals.

Emotional, behavioral, and cognitive factors that differentiate obsessive-compulsive disorder and other anxiety disorders in youth.

Abstract The current study examined specific emotional, behavioral, and cognitive variables that may distinguish obsessive-compulsive disorder (OCD) from generalized anxiety disorder (GAD), social phobia (SoP), and separation anxiety disorder (SAD) in youth. Youth with OCD (n=26) and other anxiety disorders (ADs; n=31), aged 7-12 years (56.1% males), and their parents participated. The study compared the two anxious groups on levels of emotional, behavioral, and cognitive functioning, as well as impairment associated with the disorder. Results indicated that in comparison to youth with GAD, SoP, or SAD, youth with OCD were found to have poorer emotion regulation skills, as well as greater oppositionality, cognitive problems/inattention, and parent impairment associated with the disorder. The findings suggest that there are unique characteristics of OCD that may differentiate this disorder from other ADs in youth. Potential clinical implications and directions for future research are discussed.

Associations between miscellaneous symptoms and symptom dimensions in adults with obsessive-compulsive disorder.

Obsessive-compulsive disorder (OCD) is a debilitating psychiatric condition with a heterogeneous array of obsessions and compulsions. Although factor analytic studies have identified symptom dimensions comprising the clinical presentation of OCD, many frequently reported miscellaneous symptoms are not considered in factor analytic studies because they do not fit conceptually within a particular symptom category, despite being functionally related. In the present study, we examined the associations between miscellaneous symptoms and OCD symptom dimensions in a sample of 111 adults with OCD. Overall, most miscellaneous symptoms were associated with one or more symptom dimensions in previously identified four- (14 of the 22 symptoms) and five-factor models (12 of the 22 symptoms). In both models, Contamination/Cleaning was the only dimension not related to any miscellaneous symptom. The present results provide information about which miscellaneous symptoms may be related to particular symptom dimensions, which will assist in clinical evaluations and help planning behavioral psychotherapy (e.g., hierarchy development).