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Outpatient Treatment Patterns of Pediatric Obsessive-Compulsive Disorder
Joseph L Smith1, Nicole M McBride1, Eric A Storch1,2,3,4,5
11 Department of Health Policy & Management, College of Public Health, University of South Florida , Tampa, Florida.
Insights
Pediatric obsessive-compulsive disorder (OCD) is often treated with serotonin reuptake inhibitors (SRIs) and psychotherapy. However, some children receive atypical antipsychotics or no treatment, highlighting a need for better guideline adherence.
Area of Science:
- Pediatric Psychiatry
- Child and Adolescent Mental Health
- Clinical Psychology
Background:
- Limited understanding of community physician treatment for pediatric obsessive-compulsive disorder (OCD).
- This study is the first to document treatment practices for pediatric OCD by US physicians.
Purpose of the Study:
- To describe current treatment modalities for pediatric OCD in US office-based and outpatient settings.
- To identify patterns in pharmacotherapy and psychotherapy utilization for children with OCD.
Main Methods:
- Utilized data from the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey (2003-2011).
- Employed descriptive statistics and logistic regression to analyze treatment differences based on comorbidities and care settings.
Main Results:
- Serotonin reuptake inhibitors (SRIs) were prescribed in 55% of visits, and psychotherapy in 46%.
- Atypical antipsychotics were used in 22% of cases; 11% received no psychotherapy or pharmacotherapy.
- Combined psychotherapy and pharmacotherapy were administered in 36% of pediatric OCD cases.
Conclusions:
- Pediatric OCD treatment primarily involves SRI medication and/or psychotherapy.
- A significant proportion of children receive atypical antipsychotics, warranting further investigation.
- Enhanced dissemination of evidence-based psychological treatments and guideline adherence monitoring are recommended.
Introduction:
Little is known about community physician treatment practices for children with obsessive-compulsive disorder (OCD). This study is the first to describe the treatment of pediatric OCD in office-based and outpatient department-based physicians in the United States.
Methods:
Data from the 2003-2011 National Ambulatory Medical Care Survey and the National Hospital Ambulatory Medical Care Survey were used. We provided descriptive statistics for sample characteristics and treatments administered during the visit, and examined differences in treatment by comorbid conditions and settings using logistic regression.
Results:
Psychotherapy was provided in 46% of visits in children with OCD overall, while serotonin reuptake inhibitor (SRI) medication was prescribed to 55% overall, atypical antipsychotics were prescribed to 22% of youth either alone or in combination with another medication; 11% received no psychotherapy or pharmacotherapy. Psychotherapy and at least one pharmacotherapy were provided to 36% of patients. There were no significant differences in characteristics of patients receiving each class of medication.
Conclusion:
Among children and adolescents, OCD was primarily treated by physicians using SRI medication and/or psychotherapy. A sizeable proportion of children were given atypical antipsychotic medications. Wider dissemination of evidence-based psychological treatments and continued monitoring of adherence to guidelines is warranted.