Obsessive-compulsive disorder is often diagnosed too late in children and adolescents. In the current issue of Deutsches Ärzteblatt International, Susanne Walitza and her colleagues point out that appropriate early recognition and treatment can positively affect the course of the disease.
Compulsive washing, the most common obsessive-compulsive manifestation among children and adolescents, is present in up to 87% of all patients; other common types are compulsive repetitive behavior and checking, and obsessive thoughts of an aggressive type. Comorbidities such as attention deficit/hyperactivity disorder are present in more than 70% of patients. Obsessive-compulsive disorder presenting in childhood or adolescence often becomes chronic and impairs mental health onward into adulthood.
The specific manifestations of obsessive-compulsive disorder can be diagnosed early with psychodiagnostic techniques. Treatment is often highly time-consuming. Behavioral therapeutic methods have been found effective and are accordingly considered first-line treatment. In behavioral therapy, the patient is confronted with the situation that precipitates the obsessive-compulsive manifestations, but the manifestations are suppressed. Second-line treatment consists of behavioral therapeutic intervention combined with the administration of a serotonin reuptake inhibitor. The authors state that, even after a course of intensive treatment has been completed, patients still need psychotherapy or combination therapy to prevent a later recurrence.
The etiology and pathogenesis of obsessive-compulsive disorder are multifactorial, with psychological, neurobiological, and genetic factors all playing a role.
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