Objective: To evaluate indications and effectiveness of antipsychotic use in pediatric obsessive compulsive disorder (OCD) patients and the relation between the treatment response and characteristics of the disorder.
Method: Fifteen patients between the ages of 12 and 17, who were followed for at least 1 year in our department with the diagnosis of OCD and received antipsychotic treatment, were evaluated retrospectively. Patients with pervasive developmental disorders and mental retardation were excluded. The response to treatment was evaluated with Clinical Global Impression (CGI) scale. The symptomatology, age of onset, comorbid conditions and psychiatric history of the patients were also examined.
Results: Mean age at the admission was 12.03±2.63 years and follow-up period was 2.8±2.14 years. Four of the patients were receiving antipsychotics primarily due to co-morbid conditions (2 tic disorder, 1 anorexia nervosa, 1 conduct disorder) and 11 of them used them for augmentation. The obsessional symptoms were contamination (n=11), religious (n=8), symmetry- order (n=6), sexual (n=4) and aggression (n=3) related obsessions. Compulsions were repetition (n=13), clearance (n=12), sorting/organizing (n=4) and counting compulsions (n=1). All but three patients had comorbid diseases, which were attention deficit/hyperactivity disorder (n=5), anxiety disorders (n=4), tic disorder (n=2), major depression (n=2), conduct disorder (n=1), anorexia nervosa (n=1) and stereotypic movement disorder (n=1). Eight and two patients had familial history of OCD and tic disorder, respectively. The average severity of the disorder (CGI-S) in the initial evaluation was 4.27±0.77. After treatment with a SSRI, CGI improvement scores (CGI-I) were 3.47±0.51, and after adding an antipsychotic mean CGI-I was 2.6±0.98. Nine patients had significant improvement (CGI-I<=2) for OCD symptoms with antipsychotics; 7 of them were using it for augmentation and 2 of them for the comorbid disorder. During the initial assessments 4 patients were considered as being in the prodromal period of psychosis but following examinations revealed that they had OCD with poor insight. Aripiprazole (n=9), risperidone (n=7), quetiapine (n=1) and olanzapine (n=1) were used for the antipsychotic treatment. The clinically improved patients with antipsychotic medication (CI group, n=9) did not differ statistically from the non-improved patients (NCI group, n=6) with respect to age of onset, type of the OCD symptoms and pretreatment CGI-S scores. There was statistically near significance (p=0.054) between two groups for the follow up period and it was longer in the CI group. The CGI-I with SSRI was correlated with CGI-I with antipsychotic treatment (r=.721, p=0.002). Six of the 7 patients who had family history of OCD and 3 of the 8 patients who did not have family history of OCD had clinically significant improvement with antipsychotics but this data did not have statistical significance.
Conclusion: In this retrospective study we found that the patients who received antipsychotic treatment for OCD due to lack of adequate response to SSRI treatment or comorbidity had significant response to antipsychotics.