Instability of Remission in Pediatric Patients with Obsessive Compulsive Disorder

Aims: to show instable and stable remission across three years in the NordLOTS following evidence based stepwise treatments.<br/>Methods: patients with moderate-severe OCD (n=269) who fulfilled DSM IV criteria using semi-structured interviews were assessed at baseline and following treatments (CBT, and for CBT non-responders’ randomization to either continued CBT or sertraline). Further, patients were followed up yearly for three years. Remission was defined as CY-BOCS scores of 10 or below; mild OCD as 11-15; and moderate-severe OCD as 16 or above.<br/>Results and Conclusions: Six months following baseline assessments, all treatments were finalized and most of the patients (60.2%, n=162) were in remission. Out of these, a fifth got worse symptoms during the 3-year follow-up period: to a mild level (n = 36, 22.22%); or relapsed to moderate-severe OCD (n=28, 17%). However, out of the relapsers, many recovered again and were in remission at the 3-year follow-up (n=10, 37%). Further, among those who remitted following treatments a majority was in full remission at all FU (n=98, 60.5%). On the other hand, among initial non-remitters (n=107, 39.8%), many did remit during follow up (n=50, 47%). Thus, persistent OCD was less common (n=57, 53% (about a fifth of our whole cohort (21.2%)).<br/>Evidence-based treatments (CBT and sertraline) provide substantial and increasing relief across time, although unstable remission occurs as well as poor response. Improved treatment strategies need to be developed.