Pharmacological treatment of childhood obsessive-compulsive disorder: Fromtheory to practice

Discusses pharmacological treatment of childhood obsessive-compulsive disor der (OCD), chronic and underrecognized psychiatric condition that affects u p to 2% to 3% of children and adolescents. Research in OCL) in children, in cluding neuropharmacology, brain imaging, generics, and clinical phenomenol ogy, informs current views of OCD pathophysiology. Contemporary research su pports the notion of a dysregulation in serotonin subsystems in the central nervous system, with target areas of dysfunction including basal ganglia a nd orbitofrontal cortex. Pharmacotherapy, along with cognitive-behavioral a pproaches, constitutes the indicated treatment for childhood OCD. Pharmacol ogical treatment is best guided by a phenomenological understanding of the type of obsessions and compulsions. the intensity and frequency of their pr esentation with attention to behavioral reinforcements, and psychosocial fa ctors that affect the course of the disease. Serotonin-enhancing agents. su ch as fluoxetine, fluvoxamine, paroxetine, and sertraline and citalopram (S SRIs) are first-line pharmacological agents, whereas refractory symptoms ca n be treated by augmentation with neuroleptics or other agents. Clomipramin e is as effective as the SSRIs bur its use may be accompanied by increased side effects. Genetic factors probably influence susceptibility to OCD as w ell as response to treatment, and the elucidation of these and other risk f actors will be important elements in the future understanding and treatment of this disorder.