CNS Drugs

, Volume 23, Issue 3, pp 241–252 | Cite as

Pharmacotherapy in Paediatric Obsessive-Compulsive Disorder

A Naturalistic, Retrospective Study
  • Gabriele Masi
  • Stefania Millepiedi
  • Giulio Perugi
  • Chiara Pfanner
  • Stefano Berloffa
  • Cinzia Pari
  • Maria Mucci
Original Research Article


Background: Pediatric obsessive-compulsive disorder (OCD) can cause substantial impairment in academic, social and family functioning. Even though cognitive-behavioural therapy (CBT) is an effective treatment, the pharmacological option has to be taken into consideration. Effectiveness of serotonin reuptake inhibitors (SRIs) has been supported by several double-blind, placebo-controlled studies.

Objective: To report the response to pharmacotherapy in children and adolescents with OCD naturalistically followed up and treated with SRIs.

Methods: From a consecutive series of 257 patients (174 males and 83 females; mean age 13.6 ± 2.7 years) diagnosed with OCD following a clinical interview according to DSM-IV criteria, 37 children improved significantly after psychotherapy and were excluded. The remaining 220 patients were included in the study.

Results: Eighty-nine patients (40.5%) were managed with SRI monotherapy and 131 with an SRI in combination with another medication. Compared with those who needed polypharmacy, patients managed with SRI mono-therapy were younger at the time of the first consultation, had less severe symptoms at baseline, and more frequently presented with co-occurring anxiety and depressive disorders, while patients receiving polypharmacy presented with higher rates of bipolar disorder, tic disorder and disruptive behaviour disorders. 135 patients (61.4%) achieved a positive clinical response and were considered responders. When differences between responders and nonresponders at the end of follow-up were considered, irrespective of the pharmacological treatment (monotherapy or polypharmacy), responders had less severe disease at baseline, were younger at the time of the first consultation, more frequently presented with the contamination/cleaning phenotype and less frequently presented with the hoarding phenotype. Treatment refractoriness was associated with higher rates of conduct disorder and bipolar disorder, and lower rates of generalized anxiety disorder and panic disorder. Forty-three children received therapy with an atypical anti-psychotic as an augmenting strategy, and 25 of these children (58.1%) became responders. Responders to augmentation were less severely impaired at baseline, while different subtypes of OCD were similar between responders and nonresponders, as were patterns of co-morbidity.

Conclusion: Our study suggests that putative variables associated with response to pharmacological treatment of paediatric OCD can be defined, and can help improve treatment strategies.


Bipolar Disorder Generalize Anxiety Disorder Sertraline Fluvoxamine Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this study. Dr Masi is a consultant for Eli Lilly, has received research grants from Eli Lilly, and has received honoraria as a speaker for Eli Lilly, sanofi-aventis, GlaxoSmithKline, Janssen Cilag and Pfizer. Dr Millepiedi has received research grants and honoraria as a speaker for Eli Lilly. Dr Perugi has received consultancy fees from Boehringer Ingelheim and Novartis Farma, and has received honoraria as a speaker for GlaxoSmithKline, Eli Lilly, Lundbeck, Pfizer, sanofi-aventis, AstraZeneca and Wyeth. Dr Pfanner has received research grants and honoraria as a speaker for Eli Lilly. Drs Berloffa, Pari and Mucci have no conflicts of interest that are directly relevant to the content of this study.


  1. 1.
    Barrett P, Healy-Farrell L, March JS. Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: a controlled trial. J Am Acad Child Adolesc Psychiatry 2004; 43: 46–62PubMedCrossRefGoogle Scholar
  2. 2.
    Pediatric OCD Treatment Study (POTS) Team. Cognitive-behavior therapy, sertraline, and their combination in children and adolescents with obsessive-compulsive disorder: Pediatric OCD Treatment Study (POTS) randomized controlled trial. J Am Med Assn 2004; 292: 1969–76CrossRefGoogle Scholar
  3. 3.
    De Veaugh-Geiss J, Moroz G, Biederman J, et al. Clomipramine hydrocloride in childhood and adolescent obsessive-compulsive disorder: a multicenter trial. J Am Acad Child Adolesc Psychiatry 1992; 31: 45–9CrossRefGoogle Scholar
  4. 4.
    Flament MF, Rapoport JL, Berg CJ, et al. Clomipramine treatment of childhood obsessive-compulsive disorder: a double-blind controlled study. Arch Gen Psychiatry 1985; 42: 977–83PubMedCrossRefGoogle Scholar
  5. 5.
    March JS, Biederman J, Wolchow R, et al. Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial. J Am Med Assn 1998; 280: 1752–6CrossRefGoogle Scholar
  6. 6.
    Riddle MA, Reeve EA, Yaryura-Tobias JA, et al. Fluvox-amine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled multicenter trial. J Am Acad Child Adolesc Psychiatry 2001; 40: 222–9PubMedCrossRefGoogle Scholar
  7. 7.
    Geller DA, Hoog SL, Heiligenstein JH, et al. Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 2001; 40: 773–9PubMedCrossRefGoogle Scholar
  8. 8.
    Geller DA, Wagner KD, Emslie G, et al. Paroxetine treatment in children and adolescents with obsessive-compulsive disorder: a randomized, multicenter, double-blind, placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 2004; 43: 1387–96PubMedCrossRefGoogle Scholar
  9. 9.
    Geller DA, Biederman J, Stewart SE, et al. Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. Am J Psychiatry 2003; 160: 1919–28PubMedCrossRefGoogle Scholar
  10. 10.
    McDougle CJ. Update on pharmacologic management of OCD: agents and augmentation. J Clin Psychiatry 1997; 12(58Suppl.):7–11Google Scholar
  11. 11.
    Grados M, Riddle MA. Do all obsessive-compulsive disorder subtypes respond to medication? Int Rev Psychiatry 2008; 20: 189–93PubMedCrossRefGoogle Scholar
  12. 12.
    Masi G, Millepiedi S, Mucci M, et al. A naturalistic study of referred children and adolescents with obsessive-compulsive disorder. J Am Acad Child Adol Psychiatry 2005; 44: 673–81CrossRefGoogle Scholar
  13. 13.
    American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994Google Scholar
  14. 14.
    Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 1997; 36: 980–8PubMedCrossRefGoogle Scholar
  15. 15.
    Guy W. ECDEU assessment manual for psychopharmacology. Rockville (MD): National Institute of Mental Health, 1976Google Scholar
  16. 16.
    Shaffer D, Gould M, Brasic J, et al. Children’s Global Assessment Scale (CGAS). Arch Gen Psychiatry 1983; 40:1228–31PubMedCrossRefGoogle Scholar
  17. 17.
    Goodman WK, Price LH, Rasmussen LH, et al. The Yale-Brown Obsessive Compulsive Scale: I. Development, use and reliability. Arch Gen Psychiatry 1989; 46: 1006–11PubMedCrossRefGoogle Scholar
  18. 18.
    Masi G, Millepiedi S, Mucci M, et al. Comorbidity of obsessive-compulsive disorder and ADHD in referred children and adolescents. Compr Psychiatry 2006; 47: 42–7PubMedCrossRefGoogle Scholar
  19. 19.
    Masi G, Perugi G, Millepiedi S, et al. Bipolar comorbidity in pediatric obsessive-compulsive disorder: clinical and treatment implications. J Child Adolesc Psychopharmacol 2007; 17: 475–86PubMedCrossRefGoogle Scholar
  20. 20.
    Leckman JF, Grice DE, Boardman J, et al. Symptoms of obsessive-compulsive disorder. Am J Psychiatry 1997; 154: 911–7PubMedGoogle Scholar
  21. 21.
    Delorme R, Bille A, Betancur C, et al. Exploratory analysis of obsessive compulsive symptom dimensions in children and adolescents: a prospective follow-up study. BMC Psychiatry 2006; 6: 1PubMedCrossRefGoogle Scholar
  22. 22.
    Stewart SE, Rosario MC, Brown TA, et al. Principal component analysis of obsessive-compulsive disorder symptoms in children and adolescents. Biol Psychiatry 2007; 61: 285–91PubMedCrossRefGoogle Scholar
  23. 23.
    Scahill L, Riddle MA, McSwiggin-Hardin M, et al. Children’s Yale-Brown Obsessive Compulsive Scale: reliability and validity. J Am Acad Child Adolesc Psychiatry 1997; 36: 844–52PubMedCrossRefGoogle Scholar
  24. 24.
    Storch EA, Murphy TK, Geffken GR, et al. Psychometric evaluation of the Children’s Yale-Brown Obsessive-Compulsive Scale. Psychiatry Res 2004; 129: 91–8PubMedCrossRefGoogle Scholar
  25. 25.
    Masi G, Perugi G, Toni C, et al. Obsessive-compulsive bipolar comorbidity: focus on children and adolescents. J Affect Disord 2004; 78: 175–83PubMedCrossRefGoogle Scholar
  26. 26.
    March JS, Franklin ME, Leonard H, et al. Tics moderate the treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biol Psychiatry 2007; 61: 344–7PubMedCrossRefGoogle Scholar
  27. 27.
    Geller DA, Biederman J, Stewart SE, et al. Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? J Child Adolesc Psychopharmacol 2003; 1(13 Suppl.): S19–29CrossRefGoogle Scholar
  28. 28.
    Black DW, Monahan P, Gable J, et al. Hoarding and treatment response in 38 non-depressed subjects with obsessive-compulsive-disorder. J Clin Psychiatry 1998; 59: 420–5PubMedCrossRefGoogle Scholar
  29. 29.
    Mataix-Cols D, Rauch SL, Manzo PA, et al. Use of factor-analyzed symptom dimensions to predict outcome with serotonin reuptake inhibitors and placebo in the treatment of obsessive-compulsive disorder. Am J Psychiatry 1999; 156: 1409–16PubMedGoogle Scholar
  30. 30.
    Wheaton M, Timpano KR, LaSalle-Ricci VH, et al. Characterizing the hoarding phenotype in individuals with OCD: associations with comorbidity, severity and gender. J Anxiety Disord 2008; 22(2): 243–52PubMedCrossRefGoogle Scholar
  31. 31.
    Winsberg ME, Cassic KS, Koran IM. Hoarding in obsessive-compulsive disorder: a report of 20 cases. J Clin Psychiatry 1999; 60: 591–7PubMedCrossRefGoogle Scholar

Copyright information

© Adis Data Information BV 2009

Authors and Affiliations

  • Gabriele Masi
    • 1
  • Stefania Millepiedi
    • 1
  • Giulio Perugi
    • 2
    • 3
  • Chiara Pfanner
    • 1
  • Stefano Berloffa
    • 1
  • Cinzia Pari
    • 1
  • Maria Mucci
    • 1
  1. 1.IRCCS Stella MarisScientific Institute of Child Neurology and PsychiatryCalambrone, PisaItaly
  2. 2.Department of Psychiatry, Neurobiology, Pharmacology and Biotechnologies, Psychiatry SectionUniversity of PisaPisaItaly
  3. 3.Institute of Behavioral Sciences “G. De Lisio”Carrara, PisaItaly

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