51.3 THE NORDIC LONG-TERM OBSESSIVE-COMPULSIVE DISORDER TREATMENT STUDY: EFFECTIVENESS OF A STEPPED-CARE TREATMENT

Objectives: The goals of this session are to evaluate the impact of continued CBT and sertraline (SRT) in partial and nonresponders to an initial full dose of CBT in pediatric OCD and to investigate predictors and moderators of outcome. Methods: Participants with a primary diagnosis of OCD (age 7-17 years) were first treated with manual-based CBT (14 sessions). Eligibility requirements included the following: DSM-IV diagnostic criteria for primary OCD [based on Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS) and Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), total score >15]. All assessments were completed by independent evaluators; exclusion criteria were minimal. Nineteen clinics in Denmark, Sweden, and Norway participated in the Nordic Long-term OCD Treatment Study (NordLOTS) trial. CBT partial and nonresponders (CYBOCS score >15 after short-term treatment) were then randomized to either 16 weeks of continued CBT (10 sessions) or SRT. Results: A total of 269 youth participated in step 1 CBT treatment, and >70 percent was rated as treatment responders, with mean CY-BOCS total scores moving from 24.6 (SD = 6.6) at baseline to 10.5 (SD = 6.7) by week 14. Partial and nonresponse occurred in 27.4 percent of participants; these participants were then randomized to step 2 SRT (n = 22) or CBT (n = 28). Analyses at the end of step 2 treatment revealed that both groups showed additional improvement, with no significant between group differences at week 30. Mean CY-BOCS total scores for continued CBT and SRT were 13.6 (SD = 7.0) and 11.7 (SD = 8.8), respectively (p = nonsignificant). Binary treatment response was 50 percent for CBT and 45.4 percent for sertraline (p = ns). The overall treatment response at the end of step 2 treatment was 81.4 percent (using an intention to treat analysis). Although younger age was the sole predictor of better outcome in step 1 (using multivariate analysis), the presence of comorbid tic disorders moderated treatment outcomes in step 2, with SRT showing greater benefit than continued CBT (p < 0.001). Conclusions: CBT is an efficient treatment for the overwhelming majority of children with a primary diagnosis of with OCD and may confer additional benefit when more sessions are provided, a benefit equal to switching to sertraline. Almost 20 percent of patients, however, did not respond after 30 weeks of evidence-based treatments, underscoring the need for further development of treatments for pediatric