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1. Treatment Gains Are Sustainable in Pediatric Obsessive-Compulsive Disorder: Three-Year Follow-Up From the NordLOTS

Author

Katja A. Hybel, Davíð R.M.A. Højgaard, Sanne Skov Jensen, Tord Ivarsson, Bente Storm Mowatt Haugland, Nor Christian Torp, Robert Valderhaug, Gudmundur Skarphedinsson, Kitty Dahl, Karin Melin, Bernhard Weidle, Per Hove Thomsen, Judith Becker Nissen, and Ingela Skärsäter

Subjects
Obsessive-Compulsive Disorder, Pediatrics, medicine.medical_specialty, Adolescent, cognitive-behavioral therapy, medicine.medical_treatment, behavioral disciplines and activities, Pharmacotherapy, Obsessive compulsive, Sertraline, mental disorders, follow-up, Developmental and Educational Psychology, medicine, Humans, 0501 psychology and cognitive sciences, Child, Cognitive Behavioral Therapy, sertraline, business.industry, 05 social sciences, Significant difference, obsessive-compulsive disorder, Cognitive behavioral therapy, Clinical trial, Psychiatry and Mental health, Treatment Outcome, pediatric, Treatment study, business, After treatment, Follow-Up Studies, 050104 developmental & child psychology, medicine.drug
Abstract

Objective This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. Method This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. Results Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. Conclusion The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. Clinical trial registration information Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.

Published
2020

2. Obsessive-compulsive symptom dimensions: Association with comorbidity profiles and cognitive-behavioral therapy outcome in pediatric obsessive-compulsive disorder

Author

Tord Ivarsson, Gudmundur Skarphedinsson, Nor Christian Torp, Katja A. Hybel, Robert Valderhaug, Eric A. Storch, Judith Becker Nissen, Davíö R.M.A. Højgaard, Kitty Dahl, Karin Melin, Per Hove Thomsen, Bernhard Weidle, and Erik Lykke Mortensen

Subjects
Male, Obsessive-Compulsive Disorder, Adolescent, Sexual Behavior, medicine.medical_treatment, Comorbidity, Hoarding, Affect (psychology), behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, mental disorders, Odds Ratio, Humans, Medicine, 0501 psychology and cognitive sciences, Child, Association (psychology), Biological Psychiatry, Cognitive Behavioral Therapy, business.industry, 05 social sciences, Schedule for Affective Disorders and Schizophrenia, Odds ratio, Prognosis, medicine.disease, Outcome (probability), Latent class model, 030227 psychiatry, Cognitive behavioral therapy, Psychiatry and Mental health, Logistic Models, Treatment Outcome, Female, business, 050104 developmental & child psychology, Clinical psychology
Abstract

Our aims were to examine: (1) classes of comorbid disorders in a sample of children and adolescents with Obsessive-Compulsive Disorder (OCD), (2) how these classes relate to obsessive-compulsive symptom dimensions, and (3) the extent to which obsessive-compulsive symptom dimensions predict Cognitive-Behavioral Therapy (CBT) outcome. Participants (N = 269) were assessed with the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL) and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS). Latent Class Analysis (LCA) was used to identify comorbidity classes. Regression analyses were used to evaluate symptom dimensions as predictors of treatment outcome and their relation to comorbidity classes. Comorbidity was included in the treatment outcome analyses as it can affect outcome. Comorbidity was best categorized by a three-class model and each class was distinctively correlated with the OCD symptom dimensions. Higher scores on the symmetry/hoarding factor increased the chance of responding to CBT by an odds ratio of 1.56 (p = 0.020) when controlled for age, gender, and comorbidity class. The harm/sexual factor (p = 0.675) and contamination/cleaning factor (p = 0.122) did not predict CBT outcome. Three clinically relevant comorbidity subgroups in pediatric OCD were identified. Patients who exhibited higher levels of symmetry/hoarding dimension were more prone to respond to CBT.

Published
2018

5. Familial occurrence of tic disorder, anxiety and depression is associated with the clinical presentation of obsessive compulsive disorder (OCD) in children and adolescents

Author

Davíð R.M.A. Højgaard, Robert Valderhaug, Gudmundur Skarphedinsson, Bernhard Weidle, Karin Melin, Nor Christian Torp, Per Hove Thomsen, Tord Ivarsson, Fabian Lenhard, Judith Becker Nissen, and Kitty Dahl

Subjects
Proband, congenital, hereditary, and neonatal diseases and abnormalities, medicine.medical_specialty, Tic disorder, Tics, Adolescents, behavioral disciplines and activities, 03 medical and health sciences, 0302 clinical medicine, mental disorders, Obsessive-compulsive disorder, medicine, Family, Family history, Psychiatry, Children, Obsessive-compulsive disorder (OCD), Depression (differential diagnoses), Inheritance, medicine.disease, humanities, 030227 psychiatry, Psychiatry and Mental health, Clinical Psychology, Etiology, Anxiety, medicine.symptom, Psychology, 030217 neurology & neurosurgery, Clinical psychology
Abstract

Obsessive compulsive disorder (OCD) is a neuropsychiatric entity. The aim was to explore the association of familial OCD, tics, anxiety, and depression with the presentation of OCD in offspring. To our knowledge, this is the first study examining the association of other familial psychiatric disorders with OCD in offspring. A total of 198 families recruited to a Scandinavian multicenter treatment study participated. Characteristics of the child were assessed with standard measures. Family psychiatric disorders were assessed with two methods: a parent interview with open questions and a parent interview with specific questions concerning tics, depression, anxiety, and OCD. A family history of OCD was described in 6% of the probands. No differences were observed between children who had relatives with OCD and children without familial occurrence of OCD. Familial tic disorder was associated with comorbid tics, externalizing disorders, repeating compulsions, and hoarding in the child proband. Familial anxiety was associated with internalizing disorders and comorbid tics, whereas familial depression was associated with somatic obsessions and hoarding in the proband. Our study shows that familial occurrence of other psychiatric disorders is associated with differences in the clinical presentation. Identifying subtypes may have implications for our understanding of the etiology of OCD.

Published
2016

8. The Nordic Long-Term OCD Treatment Study (NordLOTS): Treatment Outcomes and One-year Follow-up of Initial Cognitive Behavioral Therapy Responders

Author

Højgaard, Davíð R. M. A., Nor Christian Torp, Gudmundur Skarphedinsson, Tord Ivarsson, Kitty Dahl, Karin Melin, Judith Becker Nissen, Katja Anna Hybel, Robert Valderhaug, Bernhard Weidle, Erik Lykke Mortensen, Compton, Scott N., Fabian Lenhard, Tore Wentzel-Larsen, and Per Hove Thomsen

Abstract

Objective The purpose of the Nordic Long-Term OCD Treatment Study (NordLOTS) was toexamine the acute effectiveness of manualizedexposure-based Cognitive Behavioral Therapy (CBT) asan initial treatment for pediatric Obsessive-CompulsiveDisorder (OCD). Also, to investigate the effectivenessof sertraline (SRT) versus continued CBT in childrenand adolescents who did not respond to the initial courseof CBT. Finally, to describe the 1-year treatmentoutcome of the initial CBT responders. Method Thestudy included 269 participants, age 7-17, diagnosedwith OCD according to DSM-IV. In step I, all receivedCBT for 14 weekly sessions. In step II, 54 nonrespondersto CBT were randomized to SRT orcontinued CBT for 16 weeks. Treatment response wasin all cases defined as a Children’s Yale-BrownObsessive-Compulsive Scale (CY-BOCS) score of =15at post treatment. The 177 responders to CBT from stepI were assessed with the CY-BOCS at 6- and 12-monthfollow-up. Results In step I, 241 participants (89.6%)completed all 14 weeks of treatment with a treatmentresponse of 72.6% (95% CI: 66.7%-77.9%) and a meansymptom reduction on the CY-BOCS of 52.9% (SD =30.9). In step II, 21 of 28 participants (75 %) completedcontinued CBT, and 15 of 22 participants (69.2 %)completed SRT treatment. The response rate was 50.0 %in the CBT group and 45.4 % in the SRT group.Comparison of the CY-BOCS total score did not reveala significant difference between the treatment types (p =0.351). At 1-year follow-up of step I CBT responders(n=177), a total of 155 (87.6%) were available forassessment, with 142 (91.6%) still rated as responders.On average, the CY-BOCS total scores dropped by 1.72points during the first year after terminating step I CBT(p = 0.001). Conclusion This study found that CBT canbe applied effectively in community mental healthclinics and that that CBT non-responders are equallylikely to benefit from either continued CBT or treatmentwith SSRI. CBT for pediatric OCD is shown to havedurable effects for those who respond to an initial courseof CBT.

Published
2018

9. Effectiveness of cognitive behavior treatment for pediatric obsessive-compulsive disorder: Acute outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS)

Author

Tord Ivarsson, Nor Christian Torp, Martin E. Franklin, Robert Valderhaug, Kitty Dahl, Katja A. Hybel, Tore Wentzel-Larsen, Bernhard Weidle, Karin Melin, Per Hove Thomsen, Fabian Lenhard, Gudmundur Skarphedinsson, and Judith Becker Nissen

Subjects
Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Cognitive-behavioral therapy, Exposure and response prevention, Adolescent, Denmark, medicine.medical_treatment, Cognitive behavioural therapy, Experimental and Cognitive Psychology, Child and adolescent, medicine, Humans, Outpatient clinic, Longitudinal Studies, Treatment outcome, Child, Psychiatry, Sweden, OCD, Cognitive Behavioral Therapy, Norway, Cognition, Mental health, Clinical trial, Cognitive behavioral therapy, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, Treatment study, Physical therapy, Family Therapy, Female, Psychology
Abstract

OBJECTIVE: The purpose of this study was to examine the acute effectiveness of manualized exposure-based CBT with a family-based treatment, as an initial treatment for pediatric OCD delivered in regular community child and adolescents outpatient clinics. The report summarizes outcome of the first treatment step in the NordLOTS, which was conducted in Denmark, Sweden and Norway.METHOD: 269 participants, age 7-17, with OCD, received treatment for 14 weekly sessions. Treatment response was defined as CY-BOCS score of ≤15 at post treatment.RESULTS: 241 participants (89.6%) completed all 14 weeks of treatment. Treatment response among the completers was 72.6% (95% CI 66.7%-77.9%). Mixed effects model revealed a statistically significant effect of time F(1,479) = 130.434. Mean symptom reduction on the CY-BOCS was 52.9% (SD = 30.9). The estimated within-group effect size between baseline and post treatment was 1.58 (95% CI: 1.37-1.80).CONCLUSION: This study found that manualized CBT can be applied effectively in community mental health clinics. These findings underscore the feasibility of implementing exposure-based CBT for pediatric OCD in a regular child and adolescent mental health setting.CLINICAL TRIALS REGISTRATION INFORMATION: This study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).

Published
2015

11. One-Year Outcome for Responders of Cognitive-Behavioral Therapy for Pediatric Obsessive-Compulsive Disorder

Author

Davíð R.M.A. Højgaard, Sanne Skov Jensen, Robert Valderhaug, Tord Ivarsson, Erik Lykke Mortensen, Kitty Dahl, Karin Melin, Bernhard Weidle, Per Hove Thomsen, Scott N. Compton, Nor Christian Torp, Fabian Lenhard, Katja A. Hybel, Judith Becker Nissen, and Gudmundur Skarphedinsson

Subjects
Male, medicine.medical_specialty, Treatment response, Pediatrics, Obsessive-Compulsive Disorder, cognitive-behavioral therapy, Adolescent, medicine.medical_treatment, Treatment outcome, 03 medical and health sciences, 0302 clinical medicine, Obsessive compulsive, Acute care, Outcome Assessment, Health Care, Developmental and Educational Psychology, medicine, follow-up, Humans, 0501 psychology and cognitive sciences, Psychiatry, Child, treatment, Cognitive Behavioral Therapy, 05 social sciences, 030227 psychiatry, Large sample, Clinical trial, Cognitive behavioral therapy, obsessive-compulsive disorder, Psychiatry and Mental health, pediatric, Treatment study, Female, Psychology, 050104 developmental & child psychology, Follow-Up Studies
Abstract

Objective This study describes 1-year treatment outcomes from a large sample of cognitive-behavioral therapy (CBT) responders, investigates age as a possible moderator of these treatment outcomes, and evaluates clinical relapse at the 1-year follow-up. Method This study is the planned follow-up to the Nordic Long-term OCD [obsessive-compulsive disorder] Treatment Study (NordLOTS), which included 177 children and adolescents who were rated as treatment responders following CBT for OCD. Participants were assessed with the Children’s Yale−Brown Obsessive-Compulsive Scale (CY-BOCS) at 6- and 12-month follow-up. Treatment response and remission were defined as CY-BOCS total scores ≤15 and ≤10, respectively. Linear mixed-effects models were used to analyze all outcomes. Results At 1 year, a total of 155 children and adolescents (87.6%) were available for follow-up assessment, with 142 of these (91.6%) rated below a total score of ≤15 on the CY-BOCS. At 1-year follow-up, 121 (78.1%) were in remission. On average, CY-BOCS total scores dropped by 1.72 points during the first year after terminating treatment (p = .001). A total of 28 participants (15.8%) relapsed (CY-BOCS ≥ 16) at either the 6- or 12-month assessment; only 2 patients required additional CBT. Conclusion Results suggest that manualized CBT in a community setting for pediatric OCD has durable effects for those who respond to an initial course of treatment; children and adolescents who respond to such treatment can be expected to maintain their treatment gains for at least 1 year following acute care. Clinical trial registration information– Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com ; ISRCTN66385119.

Published
2017

12. Is it time to rethink standard dosage of exposure-based cognitive behavioral therapy for pediatric obsessive-compulsive disorder?

Author

Robert Valderhaug, Marianne Aalberg, Bernhard Weidle, Tord Ivarsson, Nor Christian Torp, Gudmundur Skarphedinsson, Per Hove Thomsen, Judith Becker Nissen, Karin Melin, and Kitty Dahl

Subjects
Male, Obsessive-Compulsive Disorder, Treatment response, Adolescent, medicine.medical_treatment, Cognitive-behavior therapy, 03 medical and health sciences, 0302 clinical medicine, Obsessive compulsive, Humans, Medicine, Prospective Studies, Child, Biological Psychiatry, Retrospective Studies, Characteristics of early responds, Univariate analysis, Cognitive Behavioral Therapy, business.industry, Cognition, Combined Modality Therapy, Response to treatment, Pediatric OCD, 030227 psychiatry, Cognitive behavioral therapy, Psychiatry and Mental health, Young age, Treatment Outcome, Baseline characteristics, Health Resources, Female, business, 030217 neurology & neurosurgery, Clinical psychology
Abstract

Objective Identifying factors associated with early treatment response is important, because it can help allocate limited resources in psychiatric care more appropriately. This study examined baseline characteristics of participants with early response to exposure-based cognitive behavior therapy (CBT) for pediatric obsessive-compulsive disorder (OCD). Method 269 participants with OCD, aged 7–17 years, were enrolled in a 14-weeks CBT program. We identified participants with early response to treatment, (CY-BOCS total score of ≤15), by the seventh session. Results At week 7, 248 (92.2%) participants were assessed, 38.3% (95% CI 32.4–44.5%, n = 95) were identified as treatment responders. Univariate analyses showed that six baseline characteristics were significantly associated with early treatment response: young age, lower levels of symptom severity, functional impairment, internalizing- and externalizing problems, depressive symptoms, and family accommodation. Conclusions These results suggested that treatment plans for younger children with moderate OCD symptoms and no major comorbid disorder should include briefer and less resource demanding treatment formats than the commonly recommended and applied standard doses of 15 CBT sessions.

Published
2019

14. School Psychologists' Views and Management of Obsessive-Compulsive Disorder in Children and Adolescents

Author

Robert Valderhaug, Jason Gallant, Gary R. Geffken, and Eric A. Storch

Subjects
medicine.medical_specialty, Evidence-based practice, Cognitive restructuring, education, School psychology, Professional development, Psychodynamics, behavioral disciplines and activities, Mental health, Treatment success, Obsessive compulsive, mental disorders, Developmental and Educational Psychology, medicine, Psychiatry, Psychology, Clinical psychology
Abstract

Over the past decade, an increasing body of research has been conducted on evidence-based psychological and psychiatric treatment for pediatric obsessive-compulsive disorder (OCD). Despite this improved understanding, however, these treatments are not being performed. This study descriptively examined the practices and views of school psychologists on the management of pediatric OCD. Two hundred twenty-seven clinicians responded to a survey adapted from previous work by Valderhaug, Gotestam, and Larsson. Results suggested that school psychologists preferred cognitive-behavioral, medical, and family/systemic orientations relative to psychodynamic and humanistic approaches. Although respondents reported an adherence to evidence-based treatment, only 7% reported using behavioral exposure. Many respondents reported only moderate treatment success and expressed an overwhelming need for further training in both the assessment and treatment of pediatric OCD. Our results suggest that school psychologists are not adequately trained to assess and provide evidence-based treatment of pediatric OCD.

Published
2007

15. An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive–compulsive disorder administered in regular outpatient clinics

Author

Robert Valderhaug, John Piacentini, Bo Larsson, and K. Gunnar Götestam

Subjects
Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Adolescent, Community Mental Health Centers, medicine.medical_treatment, Psychological intervention, Psychology, Child, Experimental and Cognitive Psychology, Norwegian, behavioral disciplines and activities, Manuals as Topic, Outpatients, mental disorders, medicine, Humans, Outpatient clinic, Child, Psychiatry, Psychiatric Status Rating Scales, Analysis of Variance, Cognitive Behavioral Therapy, medicine.disease, language.human_language, Clinical trial, Psychiatry and Mental health, Clinical Psychology, Treatment Outcome, El Niño, language, Cognitive therapy, Clinical Global Impression, Female, Psychology, Anxiety disorder, Clinical psychology
Abstract

The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive–compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. Methods A total of 28 youngsters, aged 8–17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale–Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. Results Twenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. Conclusion The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.

Published
2007

16. Evaluation of the factor structure of the Child Obsessive-Compulsive Impact Scale - Revised (COIS-R) in Scandinavia with confirmatory factor analysis

Author

Robert Valderhaug, Per Hove Thomsen, Karin Melin, David R.M.A. Højgaard, Tore Wentzel-Larsen, Gudmundur Skarphedinsson, and Tord Ivarsson

Subjects
Activities of daily living, Children and adolescents, Psychometrics, Sample (statistics), Norwegian, language.human_language, Confirmatory factor analysis, Developmental psychology, Danish, Psychiatry and Mental health, Clinical Psychology, Functional impairment, Obsessive compulsive, Scale (social sciences), language, Obsessive-compulsive disorder, Psychology
Abstract

Research on functional impairment in obsessive–compulsive disorder (OCD) based on standardized measurement lags behind compared to its prominence in diagnostic classification systems. Our aim was to evaluate the psychometric properties of the Child Obsessive Compulsive Impact Scale – Revised (COIS-R), which is a measure of OCD-related functional impairment. The sample consisted of 396 Danish, Swedish, and Norwegian youth diagnosed with OCD according to the Diagnostic and Statistical Manual of Mental Disorders (4th edition) (48.9% boys; mean age 12.9, SD=2.7). We used confirmatory factor analysis to evaluate the initial four-factor structure of the parent-reported measure (Daily Living Skills, School, Social, Family/Activities) and the three-factor structure of the child-reported measure (School, Social, Activities). We used the robust weighted least squares mean- and variance-adjusted estimator as applied in the MPLUS program (version 7.2). The parent-report format showed acceptable fit and the structure was equivalent across gender, age, and country. The child-report format showed poor fit and equivalent results across gender, age, and country. These findings indicate that the fit for the COIS-R original factor structure was acceptable for the parent-report but not for the child-report. The measure would benefit from revisions such as split sample procedure factor analyses with a large cross-cultural sample.

Published
2015

17. Symptom patterns in children and adolescents with obsessive–compulsive disorder (OCD)

Author

Robert Valderhaug and Tord Ivarsson

Subjects
Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Adolescent, Experimental and Cognitive Psychology, Treatment research, behavioral disciplines and activities, mental disorders, medicine, Cluster Analysis, Humans, Child, Psychiatry, Obsessive-compulsive disorder (OCD), Heterogeneous disorder, Psychiatric Status Rating Scales, Prognosis, medicine.disease, humanities, Psychiatry and Mental health, Clinical Psychology, El Niño, Homogeneous, Psychiatric status rating scales, Female, Adolescent development, Psychology, Anxiety disorder, Clinical psychology
Abstract

Objective: Obsessive–compulsive disorder (OCD) defined at the diagnostic level encompasses divergent symptoms. The present study examines symptom patterns in OCD in children and adolescents in order to search for the presence of diagnostic heterogeneity. Subjects and methods: Two hundred and thirteen outpatients with primary OCD participated. The patients’ and primary caretakers’ responses on the Children's Yale-Brown Obsessive–Compulsive Scale were used to generate severity ratings for 61 OCD symptoms, and cluster analysed them. Results: A five cluster solution was judged to be the most clinically and theoretically relevant model. The clusters were named: (1) “Mental Rituals, Touching & Ordering”, (2) “Contamination & Cleaning”, (3) “Superstitions”, (4) “Obsessions/Checking & Confessing” and (5) “Somatic Concerns”. The symptom patterns of the groups differed, and three groups were particularly homogeneous. In addition, there were differences in severity, number of symptoms and age. Conclusions: OCD in children and adolescents is a heterogeneous disorder and discrepancies vis-a-vis adult studies indicate that childhood OCD may have developmentally specific traits. The sub-groups obtained are likely to have implications for the assessment of OCD symptoms in children, their prognosis and outcome in treatment research.

Published
2006

18. Functional impairment in clinical samples of Norwegian and Swedish children and adolescents with obsessive-compulsive disorder

Author

Tord Ivarsson and Robert Valderhaug

Subjects
Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Adolescent, Comorbidity, Norwegian, behavioral disciplines and activities, Surveys and Questionnaires, mental disorders, Developmental and Educational Psychology, medicine, Child and adolescent psychiatry, Humans, Outpatient clinic, Child, Psychiatry, Sweden, Norway, Mental Disorders, Social environment, General Medicine, medicine.disease, humanities, language.human_language, Diagnostic and Statistical Manual of Mental Disorders, Psychiatry and Mental health, El Niño, Pediatrics, Perinatology and Child Health, language, Female, Psychology, Psychosocial, Anxiety disorder, Tourette Syndrome
Abstract

The aims of the present study were to examine OCD-related impairments in clinical cases of childhood OCD and to replicate and extend previous research on OCD-related impairments. Sixty-eight patients aged 8–17 years recruited from four child psychiatric outpatient clinics in Norway and Sweden with a confirmed DSM-IV diagnosis of OCD were included in the study. All patients and their parents were interviewed for diagnosis and comorbidity (KSADS),OCD symptoms and severity (CY-BOCS), and global impairment (CGAS). OCD-specific impairments were assessed by means of the Child OCD Impact Scale (COIS), a 58 item questionnaire with parallel parent and child versions. Overall, the majority of patients suffered from substantial impairments. The impact of OCD symptoms was found to be most severe at home, but impairments were also prominent in situations related to school and social settings. Our study supports findings of previous research suggesting multiple impacts of OCD symptoms on children’s psychosocial functioning. We conclude that impairment issues should be further addressed in future research to establish a better empirical basis for the understanding of different aspects of OCD-related impairment.

Published
2005

19. Clinicians’ views on management of obsessive–compulsive disorders in children and adolescents

Author

K. Gunnar Götestam, Robert Valderhaug, and Bo Larsson

Subjects
Male, Obsessive-Compulsive Disorder, medicine.medical_specialty, Adolescent, Cognitive Behavioral Therapy, Attitude of Health Personnel, MEDLINE, Cognition, Psychodynamics, behavioral disciplines and activities, Frequent use, Psychiatry and Mental health, Obsessive-compulsive disorders, Surveys and Questionnaires, Scale (social sciences), mental disorders, Child and adolescent psychiatry, medicine, Humans, Female, Child, Psychiatry, Psychology, Clinical skills, Clinical psychology
Abstract

Research on obsessive-compulsive disorder (OCD) in children and adolescents has led to important developments with clinical implications as regards assessment and treatment. These developments have resulted in new guidelines and recommendations as to what is regarded to be an adequate treatment of the disorder. The objective of the present study was to examine if these developments have led to changes in the views on clinical management of childhood OCD among child psychiatry personnel in Norway. A national survey was conducted by means of a questionnaire addressing preferences and practices among clinicians in their assessment and management of OCD, the clinicians self-reported experienced treatment success, and need to develop clinical skills on assessing and treating childhood OCD. Seventy-nine clinicians (58.5%) responded. The results showed that cognitive/behavioural, family and medication approaches were preferred over psychodynamic and humanistic approaches in the management of OCD. The preferred cognitive/behavioural approach seems to be more cognitive than behavioural, and only one-third of clinicians reported frequent use of anxiety-provoking methods in treatment of childhood OCD. Clinicians that self-rated the Clinical Global Improvement Scale on their last treated OCD case indicated moderate treatment success. Because of low numbers of OCD cases in the clinics, the majority of clinicians are rated as inexperienced in the management of the disorder and results show a need for adequate training opportunities. It is concluded that clinicians have accommodated to recommended standards in the management of childhood OCD, but some results are contradictory and do not justify conclusive statements. The study needs to be supplemented by research focusing on more specific elements of the preferred treatments, thus narrowing the scope of the present study.

Published
2004

20. 6.117 COGNITIVE-BEHAVIOR TREATMENT FOR CHILD AND ADOLESCENT OBSESSIVE-COMPULSIVE DISORDER: ONE YEAR OUTCOMES FROM THE NORDIC LONG-TERM OBSESSIVE-COMPULSIVE DISORDER TREATMENT STUDY (NORDLOTS)

Author

Gudmundur Skarphedinsson, Tord Ivarsson, Nor Christian Torp, Fabian Lenhard, Katja A. Hybel, Per Hove Thomsen, Davíð R.M.A. Højgaard, Robert Valderhaug, Sanne Skov Jensen, Scott N. Compton, Erik Lykke Mortensen, Kitty Dahl, Karin A. Melin, Bernhard Weidle, and Judith Becker Nissen

Subjects
Child and adolescent, Psychiatry and Mental health, medicine.medical_specialty, Obsessive compulsive, Treatment study, Developmental and Educational Psychology, medicine, Cognition, Psychiatry, Psychology, Term (time)
Published
2016

21. 6.114 LONG-TERM EFFECTIVENESS OF TREATMENTS FOR COGNITIVE-BEHAVIORAL THERAPY RESISTANT YOUTH WITH OBSESSIVE-COMPULSIVE DISORDER INITIALLY RANDOMIZED TO CONTINUED COGNITIVE-BEHAVIORAL THERAPY OR SERTRALINE

Author

Tord Ivarsson, Davíð R.M.A. Højgaard, Katja A. Hybel, Nor Christian Torp, Robert Valderhaug, Judtih B. Nissen, Karin A. Melin, Kitty Dahl, Gudmundur Skarphedinsson, Per Hove Thomsen, and Bernhard Weidle

Subjects
medicine.medical_specialty, Sertraline, Psychotherapist, business.industry, medicine.medical_treatment, Term (time), Cognitive behavioral therapy, Psychiatry and Mental health, Obsessive compulsive, Developmental and Educational Psychology, medicine, Psychiatry, business, medicine.drug
Published
2016

22. 51.3 THE NORDIC LONG-TERM OBSESSIVE-COMPULSIVE DISORDER TREATMENT STUDY: EFFECTIVENESS OF A STEPPED-CARE TREATMENT

Author

Katja A. Hybel, Nor Christian Torp, Kitty Dahl, Tord Ivarsson, Scott N. Compton, Karin A. Melin, Martin E. Franklin, Robert Valderhaug, Fabian Lenhard, Gudmundur Skarphedinsson, Bernhard Weidle, Per Hove Thomsen, Judtih B. Nissen, and Tore Wentzel-Larsen

Subjects
050103 clinical psychology, medicine.medical_specialty, business.industry, 05 social sciences, 030227 psychiatry, Term (time), 03 medical and health sciences, Psychiatry and Mental health, 0302 clinical medicine, Obsessive compulsive, Treatment study, Developmental and Educational Psychology, Medicine, 0501 psychology and cognitive sciences, Stepped care, business, Psychiatry
Published
2016

23. Child and Adolescent OCD Symptom Patterns: A Factor Analytic Study

Author

Højgaard, Davíð R. M. A., Erik Lykke Mortensen, Tord Ivarsson, Robert Valderhaug, Katja Anna Hybel, Gudmundur Skarphedinsson, Kitty Dahl, Bernhard Weidle, Nor Christian Torp, Grados, Marco A., Adam Lewin, Karin Melin, Storch, Eric A., Else de Haan, Tanya Murphy, Judith Becker Nissen, and Per Hove Thomsen

Abstract

Objectives: To investigate OCD symptom structurein children and adolescents in order to identify OCDsubtypes.A few studies have tried to identify symptom basedsubtypes of OCD in Children and Adolescents, andfound it to contain 4-5 factors. There are severalreasons for the different number of factors foundsuch as different methods and limited sample sizes.Therefore, this study based on a large sample will bea valuable addition to the previous studies.Methods: Exploratory factor analysis will be appliedto the Children’s Yale-Brown Obsessive-CompulsiveScale (CY-BOCS) symptom checklist items in orderto reveal any latent factor structure. The relationbetween specific factors and co-morbid disorders willbe examined. Data for 696 children and adolescentswith OCD is already collected and the final sample isexpected to be around 850 subjects, collected from24 different research units in Europe and USA. Thisstudy is a part of the Nordic Long-Term OCDTreatment Study (NordLOTS).Results: Work in progress. Preliminary results will beavailable at the time of presentation.Discussion: Our study is unique in that it includesindividual CY-BOCS checklist items and it is thuspossible that our results will refine or go beyond the“classical” factors in the original publication. Theimportance of our findings for studies on OCDgenetics and pathogenesis of symptoms will bediscussed.

Published
2014

24. The Nordic long-term OCD treatment study (NordLOTS): rationale, design, and methods

Author

Kitty Dahl, Bernhard Weidle, Robert Valderhaug, Katja A. Hybel, Gudmundur Skarphedinsson, Karin Melin, Inger Englyst, Tord Ivarsson, Petra Lindheim von Bahr, Judith Becker Nissen, Nor Christian Torp, Karin Christensen, and Per Hove Thomsen

Subjects
medicine.medical_specialty, MEDLINE, Cognitive behavioural therapy, Outcome (game theory), behavioral disciplines and activities, Multisite study, Forensic psychiatry, mental disorders, Obsessive-compulsive disorder, medicine, Child and adolescent psychiatry, Pediatrics, Perinatology, and Child Health, Treatment outcome, Sertraline, business.industry, Research, Study design, Term (time), Stepped care design, Psychiatry and Mental health, Pediatrics, Perinatology and Child Health, Physical therapy, Aripiprazole, Child and adolescents, business, medicine.drug, Clinical psychology
Abstract

BACKGROUND: This paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response. METHODS: Step 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline. CONCLUSIONS: This multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders. © 2013 Thomsen et al.; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

Published
2013

25. The rationale and some features of the Nordic long-term OCD treatment study (NordLOTS) in childhood and adolescence

Author

Robert Valderhaug, Nor Christian Torp, Judith Becker Nissen, Tord Ivarsson, Karin Christensen, Inger Englyst, Bernhard Weidle, Per Hove Thomsen, Kitty Dahl, and Karin Melin

Subjects
Family therapy, Psychodynamic psychotherapy, medicine.medical_specialty, business.industry, Prevalence, behavioral disciplines and activities, humanities, Young adolescents, Treatment study, mental disorders, Medicine, Life-span and Life-course Studies, business, Psychiatry, Social Sciences (miscellaneous)
Abstract

OCD is a more prevalent disorder than was once thought at a point prevalence from 0.6–1.5% in older children and young adolescents (Heyman et al. 2001) often running a chronic course as found in a meta-analysis of available outcome studies (Stewart et al. 2004). While a third of those who still were ill did fairly well, the other 2/3 had significant impairment and suffering. However, the patients had received very different therapies ranging from those known to be ineffective, such as psychodynamic psychotherapy, ‘‘classical’’ family therapy or drugs as benzodiazepines to therapies that had included CBT and/or serotonine active drugs at some point. The range of outcome did not differ as much as one would have hoped, given the range of treatments (see also Nissen and Thomsen 2008). Those who had had an inadequate first treatment tended to do worse. More than 50% of adults with OCD report onset in childhood/adolescence (Rasmussen and Eisen 1992), and we really do not know to what extent adults with OCD had been in treatment as children, nor if they had, to what extent it helped. The question of chronic pediatric OCD is not a trivial one, children with OCD grow up and many adults with OCD had childhood onset (Rasmussen and Eisen 1992). Adult OCD is the 10:th most common cause of disability from illness, including somatic illness (Lopez 1996, cited in Haynes et al. 2006).

Published
2010

26. Symposia

Author

Christoph Correll, Stanley P. Kutcher, John McClellan, Jan Buitelaar, Elizabeth Pappadopulos, Aribert Rothenberger, Fritz Mattejat, Stephen Scott, John Weisz, Eberhard Schulz, Wilhelm Felder, Christian Fleischhaker, R. Böhme, B. Sixt, Rutger Jan van der Gaag, Laurence Y. Katz, Brian J. Cox, Shiny Gunasekara, Alec L. Miller, Nathaniel Laor, Peter Riedesser, Ernesto Caffo, James Leckman, Massimo Ammaniti, Giampaolo Nicolais, Mario Speranza, Hans Steiner, Laura Delizonna, Astrid Schallauer, Margo Thienemann, Alexander C. McFarlane, Miranda van Hooff, Michael Sawyer, Carlo Cianchetti, Naoufel Gaddour, Mokni Sana, Mechri Anouar, Letaief Mondher, Gaha Lotfi, Fabian Härtling, Robert Bittner, Corinna Haenschel, Marcus Cap, Tanja Goncharova, David E. J. Linden, Ralf Dittmann, Anneliese Maestele, Claudia Mehler, Eberhard Meyer, Jack A. Jenner, Leonie Boeing, Val Murray, Anthony Pelosi, Robert McCabe, Douglas Blackwood, Robert Wrate, S. Pellerano, M. Pintor, G. L. Mellis, T. Piroddi, Alan Flisher, Monique Nesa, Rosanna Rooney, Clare Roberts, Robert Kane, Sven Silburn, Lisbeth Pike, Helge Staby Deaton, Stuart Lustig, Michelle Funk, Anne Rickards, Dinah Reddihough, Roslyn Wright-Rossi, Jacqui Simpson, Dieter David Seuthe, H. Vielhaber, Kinderklinik Dritter Orden, H. Backmund, M. Gerlinghoff, Mary Schwab-Stone, Ine Jespers, Robert Vermeiren, Vladislav Ruchkin, Marek Blatny, Michal Hrdlicka, Tomas Urbanek, Martin Jelinek, Veronika Balastikova, Philippe Jeammet, Alain Frottin, Andjelka Filipovic, Eric Albert, Dora Musetti Schelotto, Mladen Knezevic, Milivoj Jovancevic, Jonathan Hill, Maria Lawlor, Christian Kienbacher, Carolin Prause, Margit Stöckl, Gertrude Bogyi, Max H. Friedrich, Michael Klein, Katrin Kürschner, Lynne Murray, Victoria Leidecker, Helen Sharp, Ilona Luoma, Pälvi Kaukonen, Tuula Tamminen, Barry Nurcombe, Graham Martin, Brett McDermott, Franz Resch, Benno Graf Schimmelman, Jane Edwards, Patrick D. McGorry, Martin Lambert, Philippe Conus, Ulrich Preuss, Dieter Bürgin, Monika Strauss, Peter Parzer, Georg Spiel, C. von Korff, H.-A. Ballin, R. Gößler, M. Günter, G. Sange, Heiner Meng, Eginhard Koch, Klaus Minde, Mary True, L. Pisani, F. Oumar, J. Padilla, Jean-François Bouville, Wendy Vogel, Klaus Schmeck, Kirstin Goth, Diane Purper-Ouakil, Véronique Dessons, Catherine Doyen, Fernando Perez-Diaz, Marie-Christine Mouren-Simeoni, Andreas Karwautz, Gudrun Wagner, Klaus Schwienbacher, Maria Haidvogl, Gerald Nobis, Janet Linda Treasure, David Andrew Collier, Romuald Brunner, A. Hueg, Johann Haffner, Marc Schmid, Lutz Goldbeck, Jakob Nützel, Volkmar Höfling, Karin Schermelleh-Engel, Helfried Moosbrugger, Josep Tomàs, Josep Cornellà, Alex Llusent, Anna Bielsa, Myron Belfer, Brian Robertson, Custodia Mandlhate, Birama Seck, Barbara Zwirs, Huib Burger, Tom Schulpen, A. Karem Salman Al-Obedy, Oleh Romanchuk, Irena Namyslowska, Björn S. Reigstad, Kirsti Margrethe Jorgensen, Walter Matthys, John Lochman, Marjo Zonnevylle-Bender, Nicolle van de Wiel, Angela Wagner, Christine Jennen-Steinmetz, Christopher Goepel, Irene van Bokhoven, Stephanie van Goozen, L. Patt Franciosi, Leode Graaf Acquoy, Anne Tischlinger, B. Pharm, Knut Halyard Bronder, Kari Schleimer, Joachim Walter, Boia Ephraime, Tatjana Dmitrieva, Alvaro Seligman Silva, Katja Becker, Hans-Christoph Steinhausen, C. Winkler Metzke, Erikson F. Furtado, Manfred Laucht, Oliver Bilke, Petra Zimmermann, Hans-Ulrich Wittchen, Roselind Lieb, Helga Hannesdottir, Thorarinn Tyrfingsson, Manfred Döpfner, Kurt Hahlweg, Annett Kuschel, Heike Bertram, Nina Heinrichs, Inez Freund-Braier, Gabriele Brix, Christopher Hautmann, Julia Pluck, Alfons Crijnen, Pol van Lier, Patricia Vuijk, Reiner Frank, Inger Helene Vandvik, Rainer Schäfert, Jeanne van Weel, Jan Schieveld, Jörg M. Fegert, William Friedrich, Smadar Celestin-Westreich, Leon Patrice Celestin, Ingrid Ponjaert-Kristoffersen, Keizo Nagao, M. Kisida, E. Shindo, Helmer Baying Larsen, Karin Helweg-Larsen, Ramón Lindauer, Jan Booij, Miranda Olff, Gerard den Heeten, Berthold Gersons, Frits Boer, Eric Schoentjes, Sarah Bal, Michael Schulte-Markwort, Tytti Solantaus, Sini Toikka, Maarit Alasuutari, Barbara Steck, Andrea Grether, M. Ehrensperger, Felix Amsler, L. Kappos, Rina Saha, Bela Paschen, Christiane Baldus, Miriam Haagen, Martina Pott, Georg Romer, Yoshiro Ono, H. Homma, Y. Ishida, H. Ide, M. Okamoto, S. Kameoka, Hiroshi Nakayama, A. Yamamoto, Nahit Motavalli Mukaddes, Sam Tyano, Tamar Mozes, R. Caplan, Savita Malhotra, Maria Giuseppina Ledda, Al Fratta, S. Mannino, Simona Corona, A. Zuddas, Macarena Marin Olalla, Ruth Garcia, Bernardo Perez Ramirez, Ross Campion, Peter Hindley, Nitin Gupta, Anish Bhattacharaya, Mehak Kapoor, G. van de Willge, Silke Klemm, S. Smesny, M. Stockebrand, S. Grunwald, Femmie Juffer, Marinus H. van Ijzendoorn, Marian J. Bakermans-Kranenburg, Ute Ziegenhain, B. Derksen, R. Dreisörner, Daniel Gutschner, Martin Maldonado-Duran, Manuel Ferndndez-Criado, Felicia Heidenreich, Marie Rose Moro, Charles Millhuff, Kirby Pope, Frank Theisen, Hubertus Himmerich, T. Kraus, A. Schuld, T. Pollmächter, Alan Apter, D. Gothelf, A. Brand-Gothelf, Gidi Ratzoni, L. Kikinzon, A. Weizman, Yuval Bloch, Michael Haberhausen, Daniel Müller, John Fayyad, Altino Bessa Marques Filho, Adolfo Bezerra de Menezes, John Campo, Sheree Shafer, Jennifer Strohm, Amanda Lucas, David Shaeffer, Harold Altman, Christine Gelachek, Naoyasu Motomura, Yozo Takino, Masahiro Iwakiri, Patrick Pössel, Simone Seemann, Martin Hautzinger, Theodore Mutale, Christian Haase, Majid Ali Abidi, Shehla Raheem, Leyla Faw, Aaron Hogue, Howard Liddle, Kirsten Catthoor, Joost Hutsebaut, Donald Jasinski, Douglas Faries, Rodney Moore, Annette Streeck-Fischer, Renate Sannwald, Gottfried Maria Barth, Christoph Schwarz, Monika Staigle, Manh-Hiep Pham, Dario Balanzin, Joelle Materi, Pia Eresund, Alexander Mokhovikov, Sandra Stankovic, Kerim Munir, Nese Erol, Füsun Çuhadarodlu Çetin, Angela Hassiotis, Martine Flament, Michael Scholz, Maud Rix, Franziska Nestler, Annegret Selisko, Nathalie Godart, Fabienne Perdereau, Zoé Rein, Florence Curt, Jane Akister, Pei-Chin Peggy Lee, Sho-Man Susan Tsai, Lai-Shiun Ho, Su-Chun Wu, Jacques Miermont, Joel Swenson, Mardjane Teherani, Bruno Falissard, Jean Cottraux, Julia Plück, Robert Oades, Mirjam Simons-Sprong, P. F. Schothorst, J. T. Swaab-Barneveld, Stephanie Juran, Matthias Weisbrod, Eric Chen, Bernd Röpcke, Smiljka Popovic-Deusic, Luise Poustka, Nele Wild-Wall, Mechthilde Papousek, Mirelle Keren, Ruth Feldman, S. Maestro, A. Chilosi, C. Pecini, L. Pfanner, Laurence Greenhill, K. Jahnsen, L. T. W. Jong-van den Berg, J. M. Zito, Kelly Posner, Anne Skrobala, Pablo Goldberg, Lisa Kotler, Robert Findling, Regina Bussing, Kapil Sayal, Geoffrey Mitchell, Michael Huss, Barbara Högl, Renate Grimmlinger, Karl Christoph Käppler, Maycoln M. L. Teodoro, Sylvia Hiromi Oswald, Janine M. Dagnoni, M. I. Pinheiro, C. T. Heleno, R. Rothe-Neves, V. G. Haase, A. Del Prette, Marimilia Rodrigues Lambertucci, J. L. Rodrigues, P. M. Freitas, C. A. P. Lourenco, H. C. W. Carvalho, J. Baumeister, M. Weisenhorn, S. Stadelmann, S. H. Oswald, H. Ruder, Ciro Ruggerini, Stefania Vicini, Enrico Pupulin, Antonio Guidi, Kaija Puura, Mirjami Mäntymaa, Kai von Klitzing, Orna Rosvald, Hans-Ludwig Kröber, A. Stöver, R. Proske, Rainer Semmelbeck, Marc Walther, Matthias Schmelzle, Monika Egli-Alge, Richard Beckett, Constanze Gerhold, Lieselotte Turkmen-Barta, Colette Chiland, Heino Meyer-Bahlburg, Domenico Di Ceglie, Ulrike Lehmkuhl, Orlando Uccellini, Mario Bertolini, Francesca Neri, Delia Albanese, Raffaella Bertola, Maartje Snoek, Martien Kas, Ulrike Margarete Elisabeth Schulze, Silke Calame, Ferdinand Keller, Stephanie Santel, Kerstin Krauel, Michael Rotte, Thomas F. Münte, Annemarie van Elburg, Fritz Poustka, Sven Bölte, Sabine Feineis-Matthews, Sven Boite, D. Hubl, D. Prvulovic, T. Dierks, Sabine Klauck, Irma Moilanen, M. Mattila, J. Laurila, K. Jussila, A. Pyper, S. L. Linna, Hanna Ebeling, D. Pauls, Pirjo Korpilahti, Soile Loukusa, Eira Jansson-Verkasalo, Johannes Hebebrand, Beate Herpertz-Dahlmann, Anke Hinney, Anne-Kathrin Wermter, Susann Friedel, Frank Geller, Helmut Schafer, Fernando Fernandez-Aranda, Joanna Holliday, Kristian Holtkamp, C. Mika, M. Heer, Rudolf Uher, Nicole Barbarich, Shannan E. Henry, Ursula Bailer, Guido Frank, Walter H. Kaye, Elisabet Wentz, J. Hubert Lacey, Glenn Waller, Maria Rastam, Jeremy Turk, Christopher Gillberg, Frank C. Verhulst, Marieke Zwaanswijk, Peter Verhaak, Jozien Bensing, Jan van der Ende, Frank Verhulst, Andre Sourander, Paivi Santalahti, Tamsin Ford, Robert Goodman, Howard Meltzer, Inge Seiffge-Krenke, Richard Fritsch, Marika Cutler, E. James Anthony, Per-Anders Rydelius, Rolf Castell, Milica Pejovic-Milovancevic, Miroslav Pavlovic, Noa Kalman, Muli Linder, Ido Luria, Yechiel Levkovitz, Kosuke Yamazaki, Pedro Caldeira da Silva, Grata Santos, Filipa Martins, Yen-Nan Chiu, Wen-Jer Tsai, Shur-Fen Gau, Chang-Chang Tseng, Shu-Chen Su, Jan Croonenberghs, Lucas Brouw, Annick Wauters, Nicole Bruning, Zina Manjaly, Gereon Fink, Olivera Aleksic, Nenad Rudic, Lucres Jansen, Christine C. Gispen-De Wied, Bertine Lahuis, Hanna Swaab, Jolijn Pietersen, Carolien Gevers, Inge Kamp-Becker, Isabell Germerott, Patricia Howlin, null Gaudière, Barbara Forresi, G. Lepri, Soumaila Laval, Andreas Wiefel, Z. Biringen, Karl Titze, K. Lenz, C. Seither, B. Witte, Marguerite Dunitz-Scheer, Markus Wilken, Alexandra Krasnovsky, Peter Scheer, Maria Cordeiro, Filippo Muratori, B. Felloni, A. Cesari, Linda Helmig, Peter Fonagy, Chris Moody, Jim Fultz, René Glanzmann, Nathalie Lutz-Latil, Agnes van Wyl, Dainius Puras, Amaia Hervds, John Tsiantis, T. Dragonas, H. Davis, V. Ispanovic, A. Paradisiotou, Mimoza Shanini, Lynne Jones, A. Uka, A. Rrustemi, Anne-Liis von Knorring, Dirk Deboutte, Souraya Dorhmi, Mohamed Agoub, Driss Moussaoui, Omar Battas, Inger Halvorsen, Anne Andersen, Sonja Heyerdahl, Denise Baillot, Michele La Roche, Claudia Furino, Annick Buchholtz, Gary Goldfield, Katherine Henderson, Ulrich Hagenah, Varinja Blume, Marlene Flacke-Redanz, Beate Herpertz Dahlmann, Angelique A. Sallas, Hubertus Adam, null Mozambique, Aferdita Goci-Uka, Susanne Schlüter-Müller, Umesh Bawa, Fakhri Khalik, Nima Forouher, Miyuki Sadamatsu, null Nanba, Nobumasa Kato, Kiyoto Kasai, Eiji Nanba, Martin H. Schmidt, Günter Esser, Herman van Engeland, Sophie Willemsen-Swinkels, Claudine Dietz, Anne Claire Beernink, Oliver Vidojevic, Ivona Milacic, Rael Strous, Roni Hegesh, Simion Kertzman, Z. Ben-Nahum, Moshe Kotler, Emma van Daalen, Mijke Zeegers, Hilleke Hulshoff Pol, Charles Williams, Jessica Sank, Martha Paulk, George Schwarz, Paul Wharton, Marija Raleva, Kamka Paketchieva, Angelina Filipovska, Carole Müller Nix, Margarita Forcada Guex, Abdel-Mohsen Daigham, Marit S. Indredavik, Torstein Vik, Siri Kulseng, Ann-Mari Brubakk, Marion Cuddy, Katharine Riley, Brigitte Vollmer, John Wyatt, Robin Murray, Mika Soininen, E. Juulia Paavonen, Mika Fjällberg, Juha Salmi, Almgvist Fredrik, Eeva T. Aronen, Olaf Reis, Stephanie P. Bohne, Susanne Kraenz, Dong-Hyun Ahn, Tae-Ho Kim, Jun-Ho Choi, Yun-Young Kim, Ivan Begovac, Milena Skocic, Vlasta Rudan, Oleg Filipovic, Tomasz Wolanczyk, Anita Brynska, Stanislaw Wojtowicz, Salvador Celia, Cisca Aerts, Elisabeth Cleve, Hellmut Hartmann, Hans-Jürgen Kühle, Fridjof Heidorn, Solveigh Zeyer, Joaquin Fuentes, Andrés Martin, Denis G. Sukhodolsky, Riittakerttu Kaltiala-Heino, Matti Rimpelä, Henrik Andershed, Deborah O’Donnell, Michelle Pearce, Dieter Burgin, Andreas Becker, Nicola Hagenberg, Matthias Berking, Veit Roessner, Ketil Hanssen-Bauer, Odd Aalen, Jürgen Junglas, Yoon-Seok Huh, Yun Young Kim, Kyung-Ja Oh, Kai Wang, Michael Tarren-Sweeney, D. M. Leiblum, Renate Kühl, Cornelia Nötzel, Ernst Pfeiffer, Klaus Lenz, Agneta Rosling, Marianne Poller, Donna Cross, Simone Klabin, Diana Kaplan, Lars Mickel, Gerd Lehmkuhl, Regina Möckel, Shani Leor, Leor Frisch, Amos Frisch, Abraham Weizman, Andrey Zanozin, Sylvie Jamart, Jean-Yves Hayez, Agnes Leor, Maria Elisabeth Ahle, Galit Ben Amitay, Irene Kosov, Ahuva Reiss, Moses Tamar, Hans Smedje, Hiie Allik, Jean Steyaert, Dries Castermans, John Creemers, Koenraad Devriendt Marta Kaczynska-Haladyj, Maria Claustre Jané Ballabriga, Joaquima Judez, Empar Pelaez, Pilar Sole, Lidia Rodriguez, Saskia Palmen, Chantal Kemner, Hugo Schnack, Rene Kahn, Anna Fabrizi, Levi Gabriel, Marcos Mercadante, Sergiode Paula Ramos, Maria Concecao Rosario-Campos, Michael Rutter, Stephan Collishaw, Barbara Maughan, Andrew Pickles, Julie Messer, Avshalom Caspi, Terrie Moffitt, Jana Kreppner, Anne Inger H. Borge, Suniya Luthar, Stephanie Hamarman, C. Ulger, J. Fossella, M. Brimacombe, J. Dermody, Mark Stein, L. D. Waldman, C. Sarampote, A. Robb, E. H. Cook, Aiveen Kirley, N. Lowe, Z. Hawi, C. Mullins, G. Daly, I. Waldman, M. McCarro, null O’Donell, Emma van der Meulen, S. C. Bakker, D. L. Pauls, R. J. Sinke, Guilherme Polanczyk, C. Zeni, J. P. Genro, Tatiana Roman, Mara Hutz, Christa Schaff, Patrick Haemmerle, Harald Sontag, Agnes Vetro, Julia Gadoros, Gotthard Roosen-Runge, Jocelyn Hattab, Peter Hummel, Orna Braun-Lewensohn, Daniel Schechter, Charles Zeanah, Michael Myers, Michael Liebowitz, Mark Davies, Wei-Tsuen Soong, Deborah James, Nick Sofroniou, Marine Gegelashvili, Umesh Parikh, John M. Kane, Anil K. Malhotra, Manoj Shah, Richard R. Pleak, Ronen Hizami, David Michelson, Marina Danckaerts, Alessandro Zuddas, Shuyu Zhang, Philip Hazell, P. Zeiner, M. Johnson, Frank Häßler, Prasad Suyash, Edmund Sonuga-Barke, Lynne Poole, Sarah Mares, Jon Jureidini, Zachary Steel, Louise Newman, Torsten Lucas, Stephanie Paulus, Martin Aßhauer, Birgit Miller, Gunilla Jarkman Björn, Christina Bodén, Per Gustafsson, Viola Povse Ivkic, Lazar Tenjovic, Radosavljev Jelena, Smiljka Popovic Deusic, Philip Graham, Henrikje Klasen, Jacinta Tan, Tony Hope, Anne Stewart, Raymond Fitzpatrick, Michael Kölch, Angeles Diaz-Caneja, Sonia Johnson, Ines Dippold, Katja Wiethoffi Ferdinand Keller, Sue Bailey, Nathan Whittle, Klaus Hennighausen, Gregor Kohls, Verena Maas, Tanja Rinker, Swantje Zachau, Gabriele Christmann, Anna Jaremkiewicz, Michael Schecker, Waldemar von Suchodoletz, Ruth Uwer, Ronald Albrecht, Lisa Glass, Valéria Csépe, Ferenc Honbology, Anett Rago, Eva Mészdros, Richard G. Schwartz, Valerie L. Shafer, Jonathan Green, C. Jacobs, L. Kroll, J. Briskman, G. Dunn, J. Beecham, B. Tobias, L. Baird, Terje Ogden, Michael Fitzgerald, Mark Bellgrove, Michael Gill, Ian H. Robertson, Paul McArdle, Amanda Burke, K. Michael Hong, Christina Hoven, Danuta Wasserman, Katharina Braun, Jórg Bock, Carina Helmecke, Michael Gruß, Gerd Poeggel, Charles Marsden, S. Muchimapura, M.-C. Pardon, M. Bianchi, Joram Feldon, Daniela Rüedi-Bettschen, Andrea C. Dettling, Christopher R. Pryce, Hans-Willi Clement, O. Sommer, A. Pschibul, C. Rombach, M. Gerlach, Claudia Mehler-Wex, S. Zeiske, E. Grünblatt, G. Gille, D. Rausch, Manfred Gerlach, Amira Seif El-Din, Nadia Kadri, Houda Hjiej Andaloussi, Khadija Chihabeddine, Mohammed Almaqrami, Alexander von Gontard, M. Okuno, Kurt Quaschner, Niels Bilenberg, Carsten Obel, Tine Brink Henriksen, Morten Hedegaard, Niels Jurgen Secher, Jorn Olsen, Antonio Fonseca, Isabelle Nathalie Koch, Ieva Bite, Phyllis Cohen, Katrin Russell, Nichaela Broyden, Gillian Lancaster, Christina Eichhorn, Karola Tiedtke, Ronald Feldman, Andreas Warnke, Peter Scheuerpflug, V. Vetter, Jürgen Bartling, Kerstin Konrad, Susanne Neufang, Charlotte Hanisch, Gereon R. Fink, Sarah Durston, Matthew C. Davidson, Nim Tottenham, Julie Spicer, Adriana Galvan, John Horvitz, John A. Fossella, Richard Watts, B. J. Casey, Daniel Brandeis, Andreas J. Fallgatter, Ann-Christine Ehlis, Jürgen Seifert, W. K. Strik, K. E. Zillessen, Martin J. Herrmann, Gerd Schulte-Körne, Heikki Lyytinen, Tomi Guttorm, Anna-Maija Poikkeus, Kenneth M. Eklund, Paula Lyytinen, Minna Torppa, M.-L. Laakso, E. Leskinen, A. Tolvanen, Silvia Paracchini, J. Schumacher, I. R. König, Claudia Libertus, Heide Griesemann, A. Kleensang, A. Ziegler, P. Propping, M. Näthen, Leo Wolmer, Iyad Zagout, Esti Galili-Weisstub, Gene Fisch, Ann Swillen, Annick Vogels, Christine Freitag, Jean-Francois Bouville, Laetitia Atlanti-Duault, Thierry Baubet, Robyn Osrow, Marie-Madeleine Leplomb, Yves Marchandy, Malika Bennabi, Ricardo Halpern, Odon Monteiro, Abbey-Robin Durkin, Rudy Haapanen, Susanne Bauer, Max Friedrich, Christina Stadler, Philipp Sterzer, Andreas Kleinschmidt, Irene Nowraty, W. E. Müller, Ulrich Knölker, Gabriele Schmid, Swantje Berndt, B. Behn, Jan Hendrik Puls, Luc Stevens, Joachim Jungmann, Zoran Juretic, Nela Ercegovic, Renate Schepker, Füsun Çuhadaroglu-Çetin, G. Herhaus, S. Melfsen, Daomeng Cheng, Donald Harder, Harry Laws, Yoshibumi Nakane, Kenzo Takeshita, Hiroshi Naruse, Yan Zhu, Jun Liu, Yasong Du, John Sikorski, Sannie Hamerlynck, Lisettet Hart, Lucres Nauta-Janssen, Prathiba Chitsabesan, Hien Nguyen, Jovan Simeon, Cathy Cuzner, Howard Schachter, Ana Soledade Martins, Chirstian Kieling, Julia Comassetto, Renata Goncalves, Silvia Oswald, Johannes Buchmann, J. Kirschner, M. Garvey, Gunther Moll, Hartmut Heinrich, Sameer Malhotra, Zeffie Poulakis, Sam Menahem, Karin Sauer, Tilouch Samia, Hannachi Rimeh, Missaoui Sonia, Mara Westling Allodi, Monica Biscaldi, Bettina Wagner, Chiyoko Uchida, Thomas Jozefiak, Roberta Penge, Valentina Ivancich Biaggini, Siv Fischbein, Matti Joukamaa, Anja Taanila, Juha Veijola, Juha T. Karvonen, Jouko Miettunen, Edelmira Domenech Llaberia, Teresa Corbella Domenech, Maria Claustre Jane Ballabriga, Josepa Canals Sanz, Griselda Esparo, Sergi Ballespi Sola, Xuejun Liu, Yukiko Kano, Masataka Ohta, Yoko Nagai, Takashi Arai, Su Linyan, Jeff Bridge, Boris Birmaher, Carlo Di Lorenzo, Satish Iyengar, David Brent, Bernhard Blanz, Laura Weninger, Gerhard Libal, Anna Skrabal, Michael Bowden, Howard Cooper, Inger Simonsen, Carl Bechstrom, Mette Medby, Ritva Erkolahti, Gunther Klosinski, Mihoko Oba, Satomi Murase, Takashi Murakami, Jiro Takai, Hitoshi Kaneko, Shuji Honjo, Katrina Rickards, Annhild Weber, Michael Karle, Alain Lazartigues, Pascale Planche, Eric Lemonnier, Mani Pavuluri, Lindsay Schenkel, Ryan Shaw, John Sweeny, Giancarlo Rigon, Stefano Costa, Alessandra Mancaruso, Roberta Mansi, Daniele Giovanni Poggioli, Simona Chiodo, Maja Radobuljac, Urban Groleger, Nada Ovsenik, Martina Tomori, Barbara Haas, Susanne Denoix, Franz Kimmig, Marc Weinhardt, Günter Schmitz, Berit Filschke, Conny Fliegauf, Ji-Hae Kim, Maya Krischer, Michael H. Stone, Kathrin Sevecke, Manfred Doepfner, Cornelia König, Dörte Grasmann, Michael Schlander, Stephen Ralston, R. Rodrigues Pereira, W. Brussel, L. Vlasveld, H. G. Tuynman-Qua, M. J. Lorenzo, R. Tauscher-Wisniewski, Stefano Palazzi, Ettore Guaia, Artur Kolakowski, Agnieszka Pisula, Timothy Wilens, Tobias Banaschewski, Henrik Uebel, Björn Albrecht, Monika Robatzek, Kristen Migliaccio-Walle, Jaime Caro, Albert J. Allen, R. Bart Sangal, Judith Owens, Douglas Kelsey, Virginia Sutton, Kory Schuh, Aliye Tugba Bahadir, Zeynep Yaman, Ayse Rodopman Arman, Kemal Kuscu, Yanki Yazgan, Meral Berkem, Peter Feldman, Milton Denai, Alexander Simpson, Christopher Kratochvil, Jeffrey Newcorn, Joseph Biederman, Douglas Gelowitz, Christine Thomason, Haitao Gao, Patricia Bijttebier, Steff Decoene, Pia Niklaus, Nils Duits, Ulrich Auer, Kathleen Schnoor, Detlef Schläfke, Füsun Çuhadaroälu Çetin, Gordon Harper, Sami Hamdan, Muhammed El-Haib, Saynur Canat, Olivier Halfon, Monique Bolognini, B. Plancherel, Olivier Phan, Maurice Corcos, Jean-René Cardinaux, Pierre J. Magistretti, Blaise Pierrehumbert, Minna Koskinen, Ulf Engqvist, Matthew Allin, Larry Rifkin, Sandra Lancaster, Ayala Borghini, Laure Jaugey, Margarita Forcada-Guex, Lyne Jaunin, Carole Müller-Nix, François Ansermet, Mariada Conceicao Taborda Simoes, Luiza Nobre Lima, Mariada Luz Vale Dias, Rainer Georg Siefen, Ariel Como, Valbona Alikaj, Sonila Tomori, Flavia Capozzi, Angela Romano, Mara Roello, Francesca Piperno, Mali A. Mann, Dieter Stösser, Gottfried Barth, Alina Pimenov, Jenny Schwab, Hülya Bingöl, Rémy Barbe, Heba Elkshishy, Ana Jovanovic, Aneta Lakic, Vesna Milovanovic, Milorad Vukasinovic, Jeffrey Bridge, David Kolko, David A. Brent, Kathryn Gilson, Roslyn Montague, Ian Shochet, Cristina Maria Ribeiro Marques, Teresa Cepeda, Carolin Ligges, Marc Ligges, Ralph Huonker, Paavo Leppänen, Torni K. Guttorm, Jarmo Hämäläinen, Anne Puolakanaho, Ellen Plume, Inke R. König, Wolfgang Deimel, Markus M. Nöthen, Peter Propping, André Kleensang, Bertram Müller-Myhsok, Andreas Ziegler, Sung-Do David Hong, Xueping Gao, Xuerong Li, Soyoung Irene Lee, Eui-Jung Kim, In-Hee Cho, Ji-Hoon Kim, Se-Hyun Park, J-Wook Choi, Steffen Heger, Andreas Schreiner, Klaus Rettig, Rossella Medori, Peik Gustafsson, Kjell Hansson, Lena Eidevall, Gunilla Thernlund, Philip Heiser, A. Dempfle, Judith Smidt, Justyna Grabarkiewicz, Hans Kiefl, U. Hemminger, K. Saar, James Swanson, Nora D. Volkov, S. Gupta, L. Williams, D. Agler, M. Wasdell, S. Wigal, Silvia Martins, Silza Tramontina, Mariana Eizirik, Benedetto Vitiello, Walter Clevenger, Stephen Faraone, James McGough, James McCracken, Luis Augusto Rohde, Larry Greenhill, Michael Leary, Bo Larsson, W. Boudewijn Gunning, Jean-Marie Villat, Redmond O’Connell, Mark A. Bellgrove, Paul Dockree, Raymond Traube, Mary Braunschweig, Jacques Chabanier, Germana De Leo, Margerita Ibanez, Olivette Mikolajaks, Ida Ropstad, J. Gerald Young, Rachele Aiello, Viviana Porcari, Maria Patrizia Salatiello, Anna Lo Bue, Valentina Dell’Oglio, Rosaria Cardella, Sabrina Chifari, Anne Mari Undheim, Linyan Su, Xuerong Luo, Joanne Barton, Lioba Baying, Thomas Rellum, Emrah Duezel, Hermann Hinrichs, Christoph Bartel, Iris Linde, E. Friederichs, Mark Bangs, Helmut Remschmidt, Theodore Doreleijers, Elisabeth Rebernig, Giovanni Battista Camerini, Soraya Otero, Ana Rivas, Guadalupe Pombo, Maruke Yeghiyan, Gasparyan Kachatur, Arman Danileyan, Tord Ivarsson, Robert Valderhaug, Susanne Walitza, Christoph Wewetzer, Nikolaus Barth, F. Hahn, Fernando Asbahr, Ana Regina Castillo, Ligia Ito, Mariado Rosario Latorre, Michelle Moreira, Francisco Lotufo-Neto, Sophie Symann, Dominique Charlier, Belinda Plattner, Astrid Elisabeth Schallauer, Beat Mohler, P. Staub, Carsten Müller, Rieke Oelkers-Ax, Jochen Fischer, Uta Hermanns, Anne Nickel, Hans Volker Bolay, Miguel Cherro-Aguerre, Merete Juul Sorensen, Judith Becker Nissen, Ole Mors, Per Hove Thomsen, Anne Mari Sund, May Britt Drugli, Lars Wichstrom, Matthias Schwannauer, Emily Taylor, Rob Wrate, Matthias Martin, Jan-Olov Larsson, Henrik Larsson, Paul Lichtenstein, Andrea G. Ludolph, Felix Mottaghy, Susanne Kraemer, Dieter Claus, Bernhard Krause, Jbrg M. Fegert, Tuula Hurtig, Anna Malakhova, Katerina Maniadaki, Efthymios Kakouros, Peter Jensen, Joe Albert Garcia, Sherry Glied, Maura Crowe, E. Michael Foster, Bernard Golse, Jenny Junghanß, Aino-Maija Salin, Päivi Rytölä, and Pauliina Hiltunen

Published
2004

27. Cognitive Behavior Treatment for Child and Adolescent Obsessive-Compulsive Disorder (OCD): One Year Treatment Responder Outcomes from the Nordic Long-term OCD Treatment Study (NordLOTS)

Author

Davíð R.M.A. Højgaard, Katja Anna Hybel, Tord Ivarsson, Gudmundur Skarphedinsson, Judith Becker Nissen, Bernhard Weidle, Karin Melin, Nor Christian Torp, Robert Valderhaug, Kitty Dahl, Erik Lykke Mortensen, Compton, Scott N., Sanne Jensen, Fabian Lenhard, and Per Hove Thomsen

Abstract

Background: Obsessive-compulsive Disorder (OCD) affects between 0.25% and 4% of children and adolescents.Around 40% of youth with OCD continue to meet criteria for OCD well into adulthood. Cognitive behavioraltherapy (CBT) is the recommended first line treatment for pediatric OCD. Consistent with the available followupresearch on pediatric OCD, we expected treatment effects, for initial treatment responders, to lastthroughout the first year following acute treatment. Methods: This prospective follow-up study was a part ofthe Nordic Long-term OCD Treatment Study (NordLOTS) in which 177 responders to 14 weeks of manualizedCBT in an open trial program were assessed six and twelve months after treatment termination. Treatmentresponse was defined as a Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) total score < 16, andremission was defined as a CY-BOCS total score ≤10. Results: At one-year follow-up 155 (87.6%) of the originalsample were available for assessment and 142 (91.6%) were still rated as responders. Of these 121 (78.1%)were in remission. Mixed effects analysis revealed that patients continued to show symptom reduction overthe one year follow-up period (F[2, 313.15] = 11.230, p < 0.001). Twenty-eight patients relapsed (CY-BOCS ≥16)during the one-year follow-up where of 11 returned to responder status by the 12-month assessment point.Conclusion: Results of this follow-up study suggest that manualized CBT applied in community settings hasdurable effects for initial responders to treatment, and that patients continue to improve during the first yearfollowing acute treatment. Clinical trials registration information: Nordic Long-term Obsessive-CompulsiveDisorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.Long-Term Effectiveness of Cognitive Behavioral Treatment (CBT) and Sertraline

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