Biomedical subjects
Publications and source records attributed to J S March.
Patients with obsessive-compulsive disorder complain of anxiety-producing intrusive thoughts and/or perform repetitive, anxiety-reducing rituals. A combination of behavior therapy and drug therapy is generally beneficial in this relatively common disorder. Behavior therapy consists of exposing patients to anxiety-provoking situations and helping them avoid ritualistic responses. Drug therapy appears to work by blocking serotonin reuptake in the brain.
Recognized since the Middle Ages, and clearly described for more than 100 years, obsessive-compulsive disorder (OCD) continues to intrigue and challenge mental health professionals. Recent evidence has implicated dysfunctional serotonergic neurotransmission in OCD. This review summarizes the evidence favoring a serotonergic hypothesis for OCD followed by a more detailed discussion of the implications the hypothesis holds for treatment.
We examined the test-retest reliability of the Multidimensional Anxiety Scale for Children (MASC) in a school-based sample of children and adolescents. One classroom at each grade from 3 to 12 was randomly selected to participate. Teachers were trained to administer the MASC at baseline and again 3 weeks later. The intraclass correlation coefficient (ICC) was used to estimate stability of the MASC over time. For both single case and mean ICCs, the MASC exhibited satisfactory to excellent stability across all factors and subfactors. Stability was unaffected by age or gender, but was lower for African American than Caucasian subjects. Satisfactory test-retest reliability also was demonstrated for two empirically derived subscales, the MASC-10 and Anxiety Index.
OBJECTIVE: The authors present an open trial of cognitive-behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder. METHOD: The authors developed a treatment manual explicitly designed to facilitate (1) patient and parental compliance, (2) exportability, and (3) empirical evaluation. Successive versions of the manual were used to treat 15 consecutive child and adolescent patients with obsessive-compulsive disorder, most of whom were also treated with medications. RESULTS: Statistical analyses showed a significant benefit for treatment immediately posttreatment and at follow-up. Nine patients experienced at least a 50% reduction in symptoms on the Yale-Brown Obsessive-Compulsive Scale at posttreatment; 6 were asymptomatic on the National Institute of Mental Health Global Obsessive-Compulsive Scale. No patients relapsed at follow-up intervals as long as 18 months. Booster behavioral treatment allowed medication discontinuation in 6 patients. No patient refused treatment; 2 discontinued prematurely. CONCLUSIONS: Cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, appears to be a safe, acceptable, and effective treatment for obsessive-compulsive disorder in children and adolescents.