Indian Journal of PsychiatryIndian Journal of Psychiatry
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Year : 2019  |  Volume : 61  |  Issue : 7  |  Page : 119-130

Challenges in the diagnosis and treatment of pediatric obsessive–compulsive disorder


1 Department of Psychiatry, Faculty of Medicine, University of British Columbia, Vancouver, Canada
2 Department of Psychiatry, Faculty of Medicine, University of British Columbia; BC Children's Hospital Research Institute; BC Mental Health and Substance Use Research Institute, Vancouver, Canada

Correspondence Address:
Dr. S Evelyn Stewart
950 West 28th Avenue, British Columbia, V5Z 4H4, Vancouver
Canada
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_524_18

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Obsessive–compulsive disorder (OCD) affects 1%–3% of children worldwide and has a profound impact on quality of life for patients and families. Although our understanding of the underlying etiology remains limited, data from neuroimaging and genetic studies as well as the efficacy of serotonergic medications suggest the disorder is associated with the fundamental alterations in the function of cortico-striato-thalamocortical circuits. Significant delays to diagnosis are common, ultimately leading to more severe functional impairment with long-term developmental consequences. The clinical assessment requires a detailed history of specific OCD symptoms as well as psychiatric and medical comorbidities. Standardized assessment tools may aid in evaluating and tracking symptom severity and both individual and family functioning. In the majority of children, an interdisciplinary approach that combines cognitive behavioral therapy with a serotonin reuptake inhibitor leads to meaningful symptom improvement, although some patients experience a chronic, episodic course. There are limited data to guide the management of treatment-refractory illness in children, although atypical antipsychotics and glutamate-modulating agents may be used cautiously as augmenting agents. This review outlines a clinical approach to the diagnosis and management of OCD, highlighting associated challenges, and limitations to our current knowledge.



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