Psychotic Risk in Pediatric Obsessive-Compulsive Disorder: Correlations with Clinical Traits and Treatment Results

Background<br/>Children and adolescents with obsessive-compulsive disorder (OCD) face a heightened risk of developing psychotic disorders, however, the characteristics of psychotic vulnerability in children and adolescents with OCD remain largely unexplored.<br/><br/>Method<br/>This study used the 15 item Thought Problems subscale from the Child Behavior Checklist (CBCL) to investigate the prevalence of psychotic vulnerability in children and adolescents with OCD from Scandinavia (n = 215) and the United States (n = 125). Participants with and without psychotic vulnerability were compared on various clinical characteristics, including psychosocial functioning, anxiety and depression, both before and after cognitive-behavioral therapy (CBT). We also explored whether psychotic vulnerability could predict CBT outcomes, measures with The Children’s Yale-Brown Obsessive-Compulsive Scale (CY-BOCS).<br/><br/>Results<br/>Psychotic vulnerability was observed in 41.6% of the Scandinavian sample and 34.4% of the North American sample. In both groups, children and adolescents with psychotic vulnerability exhibited more depressive symptoms and lower psychosocial functioning at baseline. Post-CBT, those with psychotic vulnerability in the Scandinavian group continued to show poorer psychosocial functioning and had more symptoms from the symmetry/hoarding dimension, whereas in the North American sample, it was associated with the contamination-cleaning dimension. Psychotic vulnerability did not influence CBT outcomes in either group.<br/><br/>Conclusions<br/>Consistent with prior research, our findings indicate that a comprehensive, second-tier evaluation of psychosis risk is warranted in numerous cases of youth with obsessive-compulsive disorder (OCD), especially in children and adolescents exhibiting impaired global functioning. Additionally, our results suggest that immediate CBT outcome is not affected by psychotic vulnerability in pediatric OCD.<br/>