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Difficult-to-treat pediatric obsessive-compulsive disorder: Feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy

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Open access
Authors
Farrell, L.
Waters, A.
Boschen, M.
Hattingh, Laetitia
McConnell, H.
Milliner, E.
Collings, N.
Zimmer-Gembeck, M.
Shelton, D.
Ollendick, T.
Testa, C.
Storch, E.
Date
2013
Type
Journal Article

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Farrell, Lara J. and Waters, Allison M. and Boschen, Mark J. and Hattingh, Laetitia and McConnell, Harry and Milliner, Ella L. and Collings, Nigel and Zimmer-Gembeck, Melanie and Shelton, Doug and Ollendick, Thomas H. and Testa, Chris and Storch, Eric A. 2013. Difficult-to-treat pediatric obsessive-compulsive disorder: Feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy. Depression and Anxiety. 30 (8): pp. 723-731.
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Depression and Anxiety
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This is the accepted version of the following article: Farrell, Lara J. and Waters, Allison M. and Boschen, Mark J. and Hattingh, Laetitia et. al., 2013. Difficult-to-treat pediatric obsessive-compulsive disorder: Feasibility and preliminary results of a randomized pilot trial of D-cycloserine-augmented behavior therapy. Depression and Anxiety. 30 (8): pp. 723-731, which has been published in final form at http://doi.org/10.1002/da.22132

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Abstract

Background: This study examined the feasibility and preliminary effectiveness of d-cycloserine (DCS)–augmented cognitive behavioral therapy (CBT) for children and adolescents with difficult-to-treat Obsessive Compulsive Disorder, in a double-blind randomized controlled pilot trial (RCT).Methods: Seventeen children and adolescents (aged 8–18 years) with a primary diagnosis of OCD, which was deemed difficult-to-treat, were randomly assigned to either nine sessions of CBT including five sessions of DCS-augmented exposure and response prevention (ERP) [ERP + DCS] or nine sessions of CBT including five sessions of placebo-augmented ERP [ERP + PBO]. Weight-dependent DCS or placebo doses (25 or 50 mg) were taken 1 hour before ERP sessions.Results: At post treatment, both groups showed significant improvements with 94% of the entire sample classified as responders. However, a greater improvement in the ERP + DCS relative to the ERP + PBO condition was observed at 1-month follow-up on clinician-rated obsessional severity and diagnostic severity, and parent ratings of OCD severity. There were no changes across time or condition from 1- to 3-month follow-up.Conclusions: In this preliminary study, DCS-augmented ERP produced significant improvements in OCD severity from posttreatment to 1-month follow-up, relative to a placebo control condition, in severe and difficult-to-treat pediatric OCD. The significant effect on obsessional severity suggests that DCS augmentation might be associated with enhanced modification of obsessional thoughts during ERP, and warrants further investigation.