Paediatrics: Obsessive compulsive disorder

Obsessive compulsive disorder

Diagnostic criteria

·  Obsessions: recurrent persistent thoughts, images or impulses that are distressing, time-consuming and functionally impairing. Young people recognize these thoughts as their own, and perceive them as unhelpful and at times senseless.

·  Compulsions: mental or physical behaviours, completed in an attempt to neutralize anxiety caused by the obsessional thoughts or images.

·  Rituals and habits: present in 2/3 pre-school children. They are similar in form and content to compulsions in OCD, but:

·  are less frequent and intense;

·  do not impact on functioning;

·  do not cause distress.

A diagnosis of OCD requires symptoms to be present on most days for at least 2 successive weeks and be a source of distress or interference with activities. Children are not required to have insight into the nature of their thoughts to meet the criteria for a diagnosis of OCD.

Prevalence

Prevalence of OCD in children and adolescents is estimated as 0.5%. This is lower than in the general population where estimates of prevalence vary between 1 and 3%. 30–50% of adults who have been diagnosed with OCD will have had symptoms before age 18yrs. Onset is more common in boys pre-puberty and girls post-puberty.

Treatment

Age and developmentally appropriate psycho-education and guided self-help regarding both the psychological and biological perspectives of OCD are essential components of treatment for all children and young people. CBT (usually conducted in a 12-wk block of weekly therapy) and phar-macotherapy are effective and often required for more severe cases. Fluvoxamine and sertraline are licensed for the treatment of OCD in children and adolescents.

Prognosis

The course of OCD may be acute or chronic. Longitudinal studies of adults who with a diagnosis of OCD suggest that prognosis is variable, but that most people fall into one of three patterns. 40% will recover and experience only mild symptoms, 40% will experience a fluctuating illness course with symptoms remitting and relapsing. 20% will develop chronic illness pattern.