[Obsessive-compulsive disorder in children and adolescents and its continuation throughout life]

Obsessive-compulsive disorder (OCD) appears in children at the ages of 7-12 years and it usually stays undiagnosed. Its prevalence is approximately 0.6-1% and it is comorbid especially with Tourette's syndrome, chronic tics and Attention Deficit and Hyperactivity Disorder (ADHD), as well as with other disorders. Comorbidity runs up to the 75% of children and adults alike. In children it is most often represented by the above mentioned disorders. Prevalence of OCD is similar to children as in adults. One third of adults or 50% of them are affected from the illness during childhood. As in adult OCD, the main etiological disturbance seems to be located at the basal ganglia and the cortex. One of the main current pathophysiological hypotheses is that OCD is a disorder of the neuronal circuit involving the cortex-thalamus-striatum-cortex. The disease has a familial character as shown in studies where 1st degree relatives of children with OCD have increased prevalence of OCD and OC symptoms compared to controls. Cognitive behavioral therapy is indicated for children and adolescents as it is for adults with OCD. It is successful as monotherapy for the 50% of children and adolescents. Monotherapy with cognitive behavioral therapy is not indicated for patients with a family history of OCD and it should be augmented with the addition of Selective Serotonin Reuptake Inhibitors (SSRIs). The therapeutic result is similar for children and adults (70-80%). Also, the therapeutic effectiveness of SSRIs in OCD for children and adolescents supports the hypothesis that the control serotonergic routes are related to the pathophysiology of the illness. Follow-up studies of childhood OCD show the chronicity of the illness. In these studies, 50% of the children still suffered from OCD at follow-up whereas only 11% were symptom free. Prognosis is worse if the duration of the illness is long, if there is comorbidity, inpatient hospitalization and reduced initial therapeutic response. Early detection and treatment of the child and its family are related to better prognosis. Childhood OCD seems to belong to a subgroup of the illness with specific clinical and familial pattern. Nevertheless more long-term follow-up studies are needed in order to differentiate subgroups of OCD. More studies on the pathophysiology of the illness are needed in order to have better treatments for OCD in children and adults.