OCD in CYP

• The efficacy of remotely-delivered cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD) was examined in a meta-analysis
• This analysis compared remotely-delivered CBT to face-to-face CBT and non-CBT control conditions

Efficacy of Remotely-Delivered CBT

• Remotely-delivered CBT is more effective than non-CBT control conditions for:
• OCD symptoms (g = 0.936, p < .001)
• Depressive symptoms (g = 0.358, p = .003)
• Anxiety symptoms (g = 0.468, p = .006)

Comparison to Face-to-Face CBT

• No significant differences in efficacy were found for:
• OCD symptoms (g = -0.104, p = .479)
• Depressive symptoms (g = 0.138, p = .138)
• Anxiety symptoms (g = 0.166, p = .601)
• Quality of life (g = 0.057, p = .489)

Influence of Symptom Severity

• Higher baseline OCD symptom severity correlated with lower efficacy of remotely-delivered CBT compared to face-to-face CBT (β = -0.092, p = .036)

Study Quality

• Most included studies were identified as having a "low risk of bias" (45.5%) or "some concerns" (45.5%)
• Remotely-delivered CBT is an effective treatment option for OCD, potentially increasing treatment access
• Individuals with severe OCD may benefit more from face-to-face CBT

Obsessive-Compulsive Disorder (OCD) in Children and Adolescents

• OCD is manifested by repetitive, intrusive thoughts (obsessions) and distressing, time-consuming rituals (compulsions)
• Current understanding of causes and mechanisms underlying OCD in youth are discussed
• Difficulties in distinguishing OCD from autism spectrum disorders and tic disorders in young people are addressed
• Recommended treatments include cognitive behavior therapy and serotonin reuptake inhibitors/selective serotonin reuptake inhibitors (SSRIs)
• Emerging clinical developments and areas for future research in pediatric OCD are covered

Paediatric OCD

• OCD often develops in youth, with bimodal distribution of age at onset, peaking in late childhood and early adulthood
• Onset occurs <18 years in 50% of cases
• Point prevalence is 1-2% of children and adolescents
• 25% of OCD cases have onset before 14 years; 50% before 18 years (Solmi et al., 2022, Molecular Psych)
• Slight male preponderance in youth, more common in women in adulthood, though overall quite equal ratio between men and women
• Highly disabling
• Chronic - spontaneous remission estimated as 4%

Ethnicity

• Prevalence of OCD is stable across ethnic and cultural groups
• People with OCD from ethnic minorities are underrepresented in mental health services (Fernandez de al Cruz et al, 2015)
• Children and young people from ethnic minority backgrounds respond equally well to treatment for OCD

Diagnoses

• Obsessions include recurrent and persistent thoughts, images or impulses that are experiences as intrusive and inappropriate and that cause marked anxiety or distress
• The person attempts to ignore or suppress such thoughts, impulses, or images, or to neutralise them with some other thought or action
• Compulsions include repetitive behaviours or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
• The behaviours or mental acts are aimed at preventing or reducing distress or preventing some dreaded event or situation
• Young children may not be able to articulate the aims of these behaviours or mental acts

DSM-V Diagnostic Criteria

• Presence of obsessions, compulsions, or bot
• Obsessions are recurrent and persistent unwanted thoughts, impulses or urges which are unwanted and the sufferer attempts to suppress or neutralize
• Compulsions are repetitive behaviours or mental acts that are performed to reduce anxiety and/or prevent a feared event from occurring
• The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
• The obsessive-compulsive symptoms are not attributable to the physiological effects of a substance or another medical condition
• The disturbance is not better explained by the symptoms of another mental disorder
• Obsessive Compulsive, Body Dysmorphic, and Hoarding Disorders are related
• Obsessions/Checking is a main symptom dimensions
• Contamination/Washing is a main sumptom dimensions
• Symmetry/Order/“just right" is a main sympton dimensions
• Hoarding/Saving is a main symptom dimensions

Aetiology

• Genetic and Environmental Risk both contribute
• Families share environments as well as genes
• First degree relative with OCD → 5x higher risk
• GWAS studies have not yet convincingly demonstrated specific genes involved; it is highly polygenic

Genetics

• OCD symptoms in adults: 27-47% genetic; in children: 45-65% genetic
• Which environmental experiences increased OCD risk?
• Stressful life events is a candidate

Evidence-Based OCD Treatments

• NICE guidelines: Use CBT with or without SSRI medication (NICE, 2005)
• Over 25 RCTs for CBT for OCD in young people
• Psychoeducation - re. OCD and Anxiety are key components

Key CBT Components

• Exposure and response prevention
• 14 sessions on a weekly basi
• Long waitlists are a barier to accessing CBT

SSRI for OCD

• Use Sertraline, Paroxetine, or Fluoxetine
• Crucial to achieve optimal doses for sufficient amount of time
• Higher doses associated with greater efficacy

Conclusions

• OCD is common and highly impairing
• Aetiology remains poorly understood, particularly environmental risk factors
• Highly effective treatments, but major barriers to access
• CBT has long-term effects, and may be delivered remotely for most people, without compromising outcomes
• Remotely-Delivered CBT for OCD is commonplace since COVID-19 pandemic; overall, as effective as face-to-face CBT