A randomized controlled clinical trial of Citalopram versus Fluoxetine in children and adolescents with obsessive-compulsive disorder (OCD) Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. Fluoxetine in children and adolescents with OCD: a placebo-controlled trial. Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. Impact of comorbidity on treatment response to paroxetine in pediatric obsessive-compulsive disorder: is the use of exclusion criteria empirically supported in randomized clinical trials? A multicenter investigation of fixed-dose fluoxetine in the treatment of obsessive-compulsive disorder. The effect of fluvoxamine and behavior therapy on children and adolescents with obsessive-compulsive disorder. A Randomized Controlled Trial of Japanese Patients with Obsessive-Compulsive Disorder – Effectiveness of Behavior Therapy and Fluvoxamine Predictors of drug treatment response in obsessive-compulsive disorder. A pilot controlled study of fluoxetine for obsessive-compulsive symptoms in children with Tourette's syndrome. A double-blind placebo-controlled trial of fluoxetine for repetitive behaviors and global severity in adult autism spectrum disorders. Duloxetine Augmentation in Resistant Obsessive-Compulsive Disorder: A Double-Blind Controlled Clinical Trial Obsessive and compulsive symptoms in schizophrenia: a randomized controlled trial with fluvoxamine and neuroleptics. Fluoxetine has no marked effect on tic symptoms in patients with Tourette's syndrome: a double-blind placebo-controlled study. Cognitive and behavioral therapies alone versus in combination with fluvoxamine in the treatment of obsessive compulsive disorder. Decrease in thalamic volumes of pediatric patients with obsessive-compulsive disorder who are taking paroxetine.
ObjectiveS everal controlled trials have demonstrated the efficacy and safety of Fluoxetine in children and adolescents with Obsessive-Compulsive Disorder ( OCD ) , but there is no controlled study on the effectiveness of Citalopram in this group . This report describes the use of Citalopram in comparison with Fluoxetine in childhood-onset OCD . Method This study is a r and omized , double blind , fixed-does ( 20 mg ) trial of Fluoxetine versus Citalopram in 29 children and adolescents ( 17 boys and 12 girls ) with OCD , aged 7–18 years ( mean 13.8 and SD 3.05 ) . The length of study was 6 weeks . Obsessive-Compulsive symptom severity was measured by Yale – Brown Obsessive-Compulsive Scale ( CY-BOCS ) and Clinician ’s Global Impression Scale ( CGI ) . DICA ( Diagnostic Interview of Children and Adolescents ) was used to diagnose the psychiatric disorders . Results Each group showed significant improvement over the baseline as measured by the CY-BOCS ( p < 0.01 ) but not by CGI ( p = NS ) . The Comparison between two groups showed no significant differences in efficacy and safety of the drugs . Most common adverse effects were headache for Citalopram and tremor for Fluoxetine . Conclusion The results suggest that Citalopram is as safe and effective as Fluoxetine for children and adolescents with OCD . Further studies are needed to replicate our findings OBJECTIVE This study assesses the efficacy and tolerability of fluoxetine in the acute treatment of child and adolescent obsessive-compulsive disorder ( OCD ) during a 13-week , double-blind , placebo-controlled study . METHOD Eligible patients aged 7 to 17 ( N = 103 ) were r and omized at a ratio of 2:1 to receive either fluoxetine or placebo . Dosing was initiated at 10 mg daily for 2 weeks , then increased to 20 mg daily . After 4 weeks of treatment , and again after 7 weeks of treatment , non-responders could have their dosage increased by 20 mg daily , for a maximum possible dosage of 60 mg daily . Primary measure of efficacy was improvement in OCD symptoms as measured by the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . All analyses were intent-to-treat . RESULTS Fluoxetine was associated with significantly greater improvement in OCD as assessed by the CY-BOCS ( p = .026 ) and other measures than was placebo . Fluoxetine was well tolerated and had a rate of discontinuation for adverse events similar to that of placebo ( p = 1.00 ) . CONCLUSIONS Fluoxetine 20 to 60 mg daily was effective and well tolerated for treatment of OCD in this pediatric population Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD OBJECTIVE To examine the safety and efficacy of fluoxetine in child and adolescent obsessive-compulsive disorder ( OCD ) . METHOD Between 1991 and 1998 , 43 patients were r and omly assigned to fluoxetine or placebo for 8 weeks . Dosing was fixed for the first 6 weeks ( up to 60 mg/day ) and then could be increased to 80 mg/day . Responders entered an 8-week maintenance phase . The primary outcome measures were the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinical Global Impression-Improvement ( CGI-I ) scale . Analyses were done on the intent-to-treat sample . RESULTS Fluoxetine patients ( n = 21 ) had significantly lower CY-BOCS scores than placebo patients ( n = 22 ) after 16 ( but not 8) weeks . Fluoxetine responders ( n = 11 ) had significantly lower CY-BOCS scores than placebo responders ( n = 7 ) after an additional 8 weeks of treatment . After 16 weeks , 57 % of fluoxetine ( versus 27 % of placebo ) patients were much or very much improved on the CGI-I scale ( p < .05 ) . No patient terminated the study because of adverse medication effects . CONCLUSION Fluoxetine was well tolerated and effective for the treatment of child and adolescent OCD , but fluoxetine 's full effect took more than 8 weeks to develop OBJECTIVE To determine the safety and efficacy of fluvoxamine for the treatment of children and adolescents with obsessive-compulsive disorder ( OCD ) with a double-blind , placebo-controlled , multicenter study . METHOD Subjects , aged 8 to 17 years , meeting DSM-III-R criteria for OCD were recruited from July 1991 to August 1994 . After a 7- to 14-day single-blind , placebo washout/screening period , subjects were r and omly assigned to fluvoxamine 50 to 200 mg/day or placebo for 10 weeks . Subjects who had not responded after 6 weeks could discontinue the double-blind phase of the study and enter a long-term , open-label trial of fluvoxamine . Analyses used an intent-to-treat sample with a last-observation-carried-forward method . RESULTS Mean Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) scores with fluvoxamine were significantly ( p < .05 ) different from those with placebo at weeks 1 , 2 , 3 , 4 , 6 , and 10 . Significant ( p < .05 ) differences between fluvoxamine and placebo were observed for all secondary outcome measures at all visits . Based on a 25 % reduction of CY-BOCS scores , 42 % of subjects taking fluvoxamine were responders compared with 26 % taking placebo . Forty-six ( 19 fluvoxamine , 27 placebo ) of 120 r and omized subjects discontinued early . Adverse events with a placebo-adjusted rate greater than 10 % were insomnia and asthenia . CONCLUSIONS Fluvoxamine has a rapid onset of action and is well tolerated and efficacious for the short-term treatment of pediatric OCD OBJECTIVE To examine the influence of psychiatric comorbidity on response and relapse rates in children and adolescents treated with paroxetine for obsessive-compulsive disorder ( OCD ) . METHODS Patients responding following 16 weeks of treatment ( phase I ) were r and omized to continued paroxetine or to placebo for 16 additional weeks ( phase II ) . OCD response ( phase I ) and relapse ( phase II ) criteria were based on the Clinical Global Impression-Improvement Scale and the Children 's Yale-Brown Obsessive Compulsive Scale . The presence of OCD and other psychiatric disorders was ascertained using the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version interview . RESULTS At entry , 193 of 335 ( 57.6 % ) patients had at least one psychiatric disorder in addition to OCD , and 102 of 335 ( 30.4 % ) had multiple other disorders . Although the response rate to paroxetine in the overall population was high ( 71 % ) , the response rates in patients with comorbid attention deficit hyperactivity disorder , tic disorder , or oppositional defiant disorder ( 56 % , 53 % , and 39 % , respectively ) were significantly less than in patients with OCD only ( 75 % ) ( intent-to-treat population , last observation carried forward analysis , p < 0.05 ) . Psychiatric comorbidity was associated with a greater rate of relapse in the total patient population ( 46 % for one or more comorbid disorders [ p = 0.04 ] and 56 % for two or more comorbid disorders [ p < 0.05 ] vs. 32 % for no comorbidity ) . CONCLUSIONS The results of these post hoc analyses show that comorbid illness adversely impacted response to pharmacotherapy with paroxetine in pediatric OCD and significantly increased risk of relapse following withdrawal from treatment . Continued paroxetine treatment reduced the relapse rates in all groups compared with placebo , including those with comorbid illness . Because pediatric OCD is frequently comorbid with other psychiatric disorders , results of r and omized , controlled pediatric OCD trials that use multiple exclusion criteria may not generalize to more naturalistic OCD sample OBJECTIVES To determine the effectiveness of fluoxetine hydrochloride at fixed doses of 20 mg/d , 40 mg/d , and 60 mg/d in patients with obsessive-compulsive disorder ( OCD ) and to evaluate its safety . METHODS Fixed-dose fluoxetine hydrochloride ( 20 mg/d , 40 mg/d , 60 mg/d ) was compared with placebo in two r and omized , double-blind , parallel , 13-week trials of identical design in 355 out patients with OCD aged 15 to 70 years ( DSM-III-R criteria ; 1 year 's duration or longer ; depression secondary if present ) . RESULTS Fluoxetine ( all doses ) was significantly ( P < or = .001 ) superior to placebo on the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) total score ( mean baseline-to-end-point decrease , 4.6 , 5.5 , and 6.5 vs 0.9 , respectively , studies pooled ) and other efficacy measures ( P < or = .01 ) . A trend suggesting greater efficacy at 60 mg/d was observed . Most patients ( 79.2 % ) completed the study . Eight adverse events were statistically significantly more frequent with fluoxetine and one , with placebo . For some events , incidence tended to increase with increasing dosage ; however , few patients discontinued treatment for any single event . CONCLUSION Fluoxetine was associated with a statistically significant reduction in OCD severity , including time engaged in obsessional and /or compulsive behaviors . Adverse events infrequently led to study discontinuation OBJECTIVE The efficacy of medications , consisting of serotonin partial and specific reuptake blockers , and behavior therapy , consisting of exposure and response prevention in addition to social skills training , cognitive therapy , and habit reversal , in the treatment of obsessive-compulsive disorder are well documented . The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy . METHODS Ten children/adolescents who had not previously responded to behavior therapy  were r and omly assigned to two groups : fluvoxamine alone or fluvoxamine with behavior therapy . All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year . RESULTS Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable , the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . According to the other measurements -National Institute of Mental Health-Global Obses-sive-Compulsive Scale , Clinical Global Impression-Improvement ( assessing level of im-provement from week to week ) , and Clinical Global Impression-Severity of Illness Scale ( as-sessing how ill the patient is from week to week)-improvement was not as evident . According to the CY-BOCS , those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication . At two-year follow-up , all patients continued to improve , with those in the combined approach improving more than those in the medication-alone group . CONCLUSIONS Future studies should determine the specific effect of each treatment group , combined and singularly . Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed . The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy , according to the CY-BOCS Background : The aim of this study was to confirm and compare the efficacy of fluvoxamine ( the only licensed SSRI for treatment for OCD in Japan ) and behavior therapy in treating Japanese patients with OCD . In addition , we investigated predictors of these treatments . Methods : Thirty-one out patients meeting the DSM-III-R criteria for OCD without any axis I disorder were r and omly assigned to one of three treatment conditions : BT ( behavior therapy ± pill placebo ) , FLV [ autogenic training ( a psychological placebo for OCD ) ± fluvoxamine ] and control group [ autogenic training ( psychological placebo ) ± pill placebo ] for 12 weeks of treatment . The Yale-Brown Obsessive-Compulsive Scale ( Y-BOCS ) and the Clinical Global Impression-Improvement Scale ( CGI-I ) were administered blindly at baseline and week 4 , 8 and 12 . Results : Twenty-eight patients completed this study . Patients in the BT and FLV groups showed significantly more improvement than those in the control group in the mean score of total Y-BOCS ; moreover , the BT group showed significantly more reduction in total Y-BOCS score at the end of treatment than the FLV group ( BT > FLV , p < 0.01 ) . Patients with  lower baseline total Y-BOCS , past history of a major depressive episode and absence of cleaning compulsion improved more with fluvoxamine . Conclusions : We confirmed the effectiveness of behavior therapy and fluvoxamine for Japanese patients with OCD .  Behavior therapy improved the condition of OCD patients more than fluvoxamine BACKGROUND Although a large body of evidence indicates the efficacy of pharmacotherapy in the treatment of obsessive-compulsive disorder ( OCD ) , a considerable percentage of these patients do not respond . Very few studies focus on factors related to treatment response of OCD . The purpose of this study was to investigate which clinical factors are related to drug treatment response in OCD . METHOD We examined 53 OCD patients treated with either clomipramine or fluoxetine for a period of 6 months , dividing the sample into " responders " and " nonresponders " to treatment . At admission , patients were evaluated using a semistructured clinical interview , the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Hamilton Rating Scale for Depression , and the Hamilton Rating Scale for Anxiety . We then compared acute-phase patient characteristics and response to drug treatment . Response was defined as a decrease of at least 40 % in the Y-BOCS total score and a rating of " improved " or " very improved " on the Clinical Global Impressions scale within 16 weeks of treatment and maintained over three consecutive evaluations . RESULTS By the sixth month of treatment , 31 patients ( 58.5 % ) responded to either clomipramine or fluoxetine . Nonresponders had lower age at onset and longer duration of the disorder ; in addition , they showed higher frequency of compulsions , washing rituals , chronic course , concomitant schizotypal personality disorder , and previous hospitalizations . A worse response to drug treatment was predicted in a stepwise multiple regression by ( 1 ) concomitant schizotypal personality disorder , ( 2 ) presence of compulsions , and ( 3 ) longer illness length . CONCLUSION Our findings suggest that there are distinct types of OCD with respect to drug treatment response . They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities , which may be of value in the selection of patients for alternative treatments We carried out a double-blind , r and omized , parallel-groups clinical trial of fluoxetine ( 20 - 40 mg/day ) and placebo in 11 children with Tourette 's syndrome ( TS ) and associated obsessive-compulsive symptoms ( OCS ) . The treatment period lasted 4 months . No significant differences between treatment groups were observed for measures of OCS .  Fluoxetine therapy , however , was associated with a trend toward some improvement in tic severity , attentional abilities , and social functioning . Given these observations and the limitations of this pilot study , which include selection biases , small sample size , and significant placebo effects , the efficacy of fluoxetine in children with TS deserves further larger-scale investigation OBJECTIVE The effects of fluoxetine and placebo on repetitive behaviors and global severity were compared in adults with autism spectrum disorders ( ASDs ) . METHOD Adults with ASDs were enrolled in a 12-week double-blind placebo-controlled fluoxetine trial . Thirty-seven were r and omly assigned to fluoxetine ( N=22 ) or placebo ( N=15 ) . Dosage followed a fixed schedule , starting at 10 mg/day and increasing as tolerated up to 80 mg/day . Repetitive behaviors were measured with the compulsion subscale of the Yale-Brown Obsessive Compulsive Scale ; the Clinical Global Impression ( CGI ) improvement scale was used to rate improvement in obsessive-compulsive symptoms and overall severity . RESULTS There was a significant treatment-by-time interaction indicating a significantly greater reduction in repetitive behaviors across time for fluoxetine than for placebo . With overall response defined as a CGI global improvement score of 2 or less , there were significantly more responders at week 12 in the fluoxetine group than in the placebo group . The risk ratio was 1.5 for CGI global improvement ( responders : fluoxetine , 35 % ; placebo , 0 % ) and 1.8 for CGI-rated improvement in obsessive-compulsive symptoms ( responders : fluoxetine , 50 % ; placebo , 8 % ) . Only mild and moderate side effects were observed . CONCLUSIONS Fluoxetine treatment , compared to placebo , result ed in significantly greater improvement in repetitive behaviors , according to both the Yale-Brown compulsion subscale and CGI rating of obsessive-compulsive symptoms , as well as on the CGI overall improvement rating .  Fluoxetine appeared to be well tolerated . These findings st and in contrast to findings in a trial of citalopram for childhood autism Introduction The aim of this study is to evaluate the efficacy of duloxetine augmentation in treatment of resistant obsessive-compulsive disorder ( OCD ) . Methods This augmentation trial was design ed as an 8-week r and omized controlled , double-blind study . Forty-six patients experiencing OCD who had failed to respond to at least 12 weeks of treatment with a selective serotonin reuptake inhibitor ( fluoxetine , citalopram , or fluvoxamine ) were r and omly allocated to receive duloxetine or sertraline plus their current anti-OCD treatment . The Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) was the primary outcome measure . Treatment response was defined as 25 % or more decrease in scores of Y-BOCS . The mean dosage of duloxetine was 44.4 mg/d ( range , 20–60 mg/d ) , and the mean dosage of sertraline was 123.8 mg/d ( range , 50–200 mg/d ) . Results Forty-six patients ( 24 of 30 in duloxetine group and 22 of 27 in sertraline group ) completed the trial . Both groups showed improvement during the 8-week study period ( mean Y-BOCS total score at week 8 as compared with baseline : P < 0.001 & P < 0.001 ) without significant difference ( P = 0.861 ) . Those receiving duloxetine plus their initial medications experienced a mean decrease of 33.0 % in Y-BOCS score , and the patients with sertraline added to their initial medication experienced a mean decrease of 34.5 % in Y-BOCS . Discussion Our double-blind controlled clinical trial showed duloxetine to be as effective as sertraline in reducing obsessive and compulsive symptoms in patients with resistant OCD . However , it needs to be noted that our study is preliminary , and larger double-blind placebo-controlled studies are necessary to confirm the results Obsessive-compulsive-related disorders are frequently comorbid with schizophrenia . The existence of obsessive and compulsive symptoms in patients with schizophrenia represents one of the most severe types of psychotic disorders and may predict a poor prognosis in most cases . Previous pilot studies and case reports have shown that the condition of some patients with schizophrenia did not exacerbate and even improved when serotonin reuptake inhibitors ( SSRIs ) were added to their st and ard neuroleptic regimen . The aim of this study was to evaluate the efficacy of a combination treatment of an SSRI ( fluvoxamine ) and st and ard neuroleptics for the treatment of obsessive-compulsive ( OC ) symptomatology in patients with schizophrenia compared with administration of neuroleptics only . Thirty in patients who met DSM-IV criteria for schizophrenia and also had prominent OC symptoms were r and omly divided into two groups . Fourteen patients were treated with conventional neuroleptics and fluvoxamine in doses of 100 to 200 mg/day for 8 weeks . Sixteen patients comprised a control group and received only their previous therapeutic neuroleptic therapy . The patients were assessed using the Yale-Brown Obsessive Compulsive Scale ( Y-BOCS ) , the Positive and Negative Syndrome Scale ( PANSS ) , and the Clinical Global Impression Scale ( CGI ) at baseline and endpoint . Side effects were assessed weekly . The data were analyzed using an analysis of variance . A considerable reduction in PANSS ( 34.3 % ) and Y-BOCS ( 29.4 % ) scores was noted , and CGI scores decreased moderately in both groups . None of the patients showed an acute exacerbation at the end of the study . Side effects were mild and easily tolerated in most patients . This open , r and omized , controlled study reveals that coadministration of fluvoxamine , an SSRI , and neuroleptics in patients with schizophrenia and OC symptoms was associated with specific improvements of these symptoms . Thus , the use of an SSRI in treating a patient with schizophrenia and OC symptomatology may be warranted and safe . Other implication s of the findings , including general safety of the combined pharmacotherapy and the use of new antipsychotic medications , are also discussed To evaluate the efficacy of fluoxetine in the treatment of  tics and obsessive-compulsive symptoms  in patients with Tourette 's syndrome ( TS ) , 14 subjects ( 8 - 33 years old ) with TS participated in a 20-week , fixed-dose ( 20 mg daily ) , double-blind , placebo-controlled crossover trial of fluoxetine monotherapy .  Five subjects met criteria for obsessive-compulsive disorder ( OCD ) , 6 additional subjects had obsessive-compulsive features , and 3 subjects had TS without obsessive-compulsive symptoms . There was no improvement in tics after 8 weeks of treatment with fluoxetine ( p = 0.58 ) . In contrast , fluoxetine treatment was associated with a significant reduction in obsessive-compulsive symptoms for the group of 6 subjects initially r and omized to fluoxetine ( p = 0.04 ) . Crossover analysis showed that fluoxetine had no marked effect on tics ( n = 10 , p = 0.30 , but produced a modest decrease in obsessive-compulsive symptoms ( n = 8 , p = 0.06 ) . Order effects and carry-over effects were not significant . Withdrawal to placebo was associated with a 55 % increase in obsessive-compulsive symptoms ( p = 0.05 ) , but there was no effect on tics . The most common side effect was transient behavioral activation , which occurred in about half of the subjects and was more common in children . Fluoxetine may be useful for the treatment of obsessive-compulsive symptoms in some patients with TS , but does not appear to be effective for tics The purpose of this treatment package design study was to investigate the differential efficacy of cognitive therapy or exposure in vivo with response prevention for obsessive compulsive disorder ( OCD ) versus the sequential combination with fluvoxamine .  Patients with OCD ( N = 117 ) were r and omized to one of the following five conditions : a ) cognitive therapy for weeks 1 to 16 , b ) exposure in vivo with response prevention for weeks 1 to 16 , c ) fluvoxamine for weeks 1 to 16 plus cognitive therapy in weeks 9 to 16 , d ) fluvoxamine for weeks 1 to 16 plus exposure in vivo with response prevention in weeks 9 to 16 , or e ) waiting list control condition for weeks 1 to 8 only . Assessment s took place before treatment ( pretest ) and after 8 ( midtest ) , and 16 weeks ( posttest ) . In the first 8 weeks , six treatment sessions were delivered . During weeks 9 to 16 , another 10 sessions were given . Thirty-one patients dropped out . Outcome was assessed by patient- , therapist- and assessor-ratings of the Anxiety Discomfort Scale , the Yale-Brown Obsessive Compulsive Scale , and the Padua Inventory-Revised . In contrast with the four treatments , after 8 weeks the waiting list control condition did not result in a significant decrease of symptoms . After 16 weeks of treatment , all four treatment packages were effective on these OCD ratings , but they did not differ among each other in effectiveness . In OCD , the sequential combination of fluvoxamine with cognitive therapy or exposure in vivo with response prevention is not superior to either cognitive therapy or exposure in vivo alone BACKGROUND Thalamic dysfunction has been implicated in obsessive-compulsive disorder ( OCD ) . While OCD frequently has its onset during childhood , to our knowledge , no prior study has measured neuroanatomical changes in the thalamus of patients with OCD near the onset of illness , and before and after treatment . METHODS Volumetric magnetic resonance imaging studies were conducted in 21 psychotropic drug-naive children , aged 8 to 17 years , with OCD and 21 case-matched healthy comparison subjects .  Magnetic resonance imaging studies were also conducted in 10 of the 21 patients with OCD after 12 weeks of monotherapy with the selective serotonin reuptake inhibitor , paroxetine hydrochloride . RESULTS Thalamic volumes were significantly greater in treatment-naive patients with OCD than in controls but declined significantly after paroxetine monotherapy to levels comparable with those of controls . Decrease in thalamic volume in patients with OCD was associated with reduction in OCD symptom severity . CONCLUSIONS Our findings provide new evidence of thalamic abnormalities in pediatric OCD and further suggest that paroxetine treatment may be paralleled by a reduction in thalamic volume . These reductions may , however , not be specific to paroxetine treatment and could be due to a more general treatment response , and /or spontaneous improvement in symptoms . Our findings are preliminary given the small sample size and our inability to measure discrete thalamic nuclei
Conclusions and implication s of key findings : Fluoxetine is associated with a significantly greater reduction in OCD severity , as measured by the CY-BOCS , NIMH-OC and CGI-S , in children and adolescents .
Additionally , it is well tolerated in children and adolescents .
The acceptability is comparable to that of the placebo-treated group .
Background : Obsessive-compulsive disorder ( OCD ) is a common psychiatric illness in children and adolescents .
Previous evidence suggests that fluoxetine is effective in the treatment of OCD in children and adolescents .
However , those studies had small sample sizes .
As a result , a systematic review , which is a more powerful method to calculate the true effect size , can be applied to examine the efficacy , acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents .
Objectives : The aims of this study were to review the efficacy , acceptability and tolerability of fluoxetine in the treatment of OCD in children and adolescents .