Remission and Relapse Across Three Years in Pediatric Obsessive-Compulsive Disorder Following Evidence-Based Treatments

Abstract

Objective: To examine relapse rates following remission in a 3-year follow-up study in pediatric patients with obsessive-compulsive disorder (OCD) treated with cognitive–behavioral therapy (CBT) in a first step, and either continued CBT or sertraline (randomized selection) in a second step. Method: Participants (N ¼ 269) fulfilled DSM-IV OCD criteria with a mean severity on the Children’s Yale–Brown Obsessive Compulsive Scale (CY-BOCS) of 24.6 (SD ¼ 5.1) and were included in analyses according to intent-to-treat principles. CBT used manualized exposure and response prevention (ERP) during both steps 1 and 2, and step 2 sertraline medication used flexible dosing. The follow-up schedules were timed to 6, 12, 24, and 36 months following step 1 CBT. Remission was defined as a CY-BOCS score 10 and relapse as an elevated CY-BOCS score 16 in those who had remitted. Results: A good third of our patients were in stable and full remission at all examinations (n ¼ 98, 36.4%). Further, some in remission following treatment (n ¼ 36, 13.4%) had mild OCD at some examinations. Relapses during follow-up were not uncommon (n ¼ 28, 10.4%), but in many patients these improved again (n ¼ 10, 3.7%) and were in remission at the final 3-year follow-up. Furthermore, a considerable proportion (n ¼ 50, 18.6%) of the patients were initial non-remitters to the treatment but achieved remission at some point during the follow-up. In addition, 11.5% (n ¼ 31) had persistent OCD but reached remission by the last follow-up. Finally, a smaller segment of our sample (9.7%, n ¼ 26), did not attain remission at any point during the study. Conclusion: Our outcome paints a more promising picture of pediatric OCD long-term outcome than previous studies have done. However, both relapse rates and the presence of initial non-remitters and persistent OCD show that treatments need improvement, particularly for those who respond slowly, partially, or not at all. The lack of a general psychiatric interview at follow-up is a marked limitation. Clinical trial registration information: Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study; https://www.isrctn.com; ISRCTN66385119 Key words: obsessive-compulsive disorder; cognitive-behavioral therapy; serotonin re-uptake inhibitor; stepped care; relapse

Remission and Relapse Across Three Years in Pediatric Obsessive-Compulsive Disorder Following Evidence-Based Treatments