BackgroundCyclooxygenase (COX) enzymes oxidise arachidonic acid to prostaglandins, which modulate neuronal function and inflammation in the central nervous system. Consensus guidelines suggest ...non-steroidal anti-inflammatory drugs as a possible adjunctive approach in adults with obsessive–compulsive disorder (OCD) and in children with acute-onset OCD subtypes. However, there is limited evidence to support this approach. The primary objective of this study is to determine the efficacy of the COX-2-selective inhibitor celecoxib as an adjunct to treatment-as-usual in children and youth with moderate-to-severe OCD. The safety of this intervention including adverse events will also be systematically assessed.MethodsThe Adjunctive CElecoxib in childhood-onset OCD (ACE-OCD) study is a single-centre randomised, quadruple-blind, placebo-controlled superiority trial with two parallel groups: celecoxib 100 mg twice daily and placebo. Treatments will be added to participants’ routine clinical care, which will not change over the course of the study. Target recruitment is 80 participants ages 7–18 with no recent treatment changes. The primary outcome is OCD severity after 12 weeks of treatment, measured by clinician-administered Children’s Yale-Brown Obsessive Compulsive Scale (CY-BOCS). Secondary outcomes include CY-BOCS score after 6 weeks; difference in the proportion of participants achieving a clinically meaningful response or remission; mean clinical global impression of severity and improvement after 6 and 12 weeks; and proportion of participants reporting adverse events possibly or probably related to the study intervention. The primary analyses, carried out according to intention-to-treat principles, will compare the celecoxib to placebo group on each outcome of interest, adjusting for baseline scores using analysis of covariance or logistic regression. Participants will be offered a 12-week open-label celecoxib extension and will be invited to participate in an ancillary study for biomarker analyses.Ethics and disseminationThis protocol has been approved by the University of British Columbia Children’s and Women’s Research Ethics Board and has received a No Objection Letter from Health Canada. The findings will be disseminated in peer-reviewed journals and presentations to multiple stakeholders including patients, parents and healthcare providers.Trial registration numberNCT04673578.
Canadians endured unprecedented mental health (MH) and support access challenges during the first COVID-19 wave. Identifying groups of individuals who remain at risk beyond the acute pandemic phase ...is key to guiding systemic intervention efforts and policy. We hypothesized that determinants of three complementary, clinically actionable psychiatric outcomes would differ across Canadian age groups.
The Personal Impacts of COVID-19 Survey (PICS) was iteratively developed with stakeholder feedback, incorporating validated, age-appropriate measures. Baseline, cross-sectional online data collected between November 2020-July 2021 was used in analyses. Age group-specific determinants were sought for three key baseline MH outcomes: (1) current probable depression, generalized anxiety disorder, obsessive-compulsive disorder and/or suicide attempt during COVID-19, (2) increased severity of any lifetime psychiatric diagnosis, and (3) inadequate MH support access during COVID-19. Multivariable logistic regression models were constructed for children, youth (self- and parent-report), young adults (19-29 years) and adults over 29 years, using survey type as a covariate. Statistical significance was defined by 95% confidence interval excluding an odds ratio of one.
Data from 3140 baseline surveys were analyzed. Late adolescence and early adulthood were identified as life phases with the worst MH outcomes. Poverty, limited education, home maker/caregiver roles, female and non-binary gender, LGBTQ2S + status and special educational, psychiatric and medical conditions were differentially identified as determinants across age groups.
Negative psychiatric impacts of COVID-19 on Canadians that include poor access to MH support clearly persisted beyond the first wave, widening pre-existing inequity gaps. This should guide policy makers and clinicians in current and future prioritization efforts.
Introduction:
Optimizing individual outcomes of cognitive-behavioral therapy (CBT) remains a priority.
Methods:
Youth were randomized to receive intensive CBT at a hospital clinic (
n
= 14) or within ...their home (
n
= 12). Youth completed 3 × 3 h sessions (Phase I) and up to four additional 3-h sessions as desired/needed (Phase II). An independent evaluator assessed youth after Phase I, Phase II (when applicable), and at 1- and 6-months post-treatment. A range of OCD-related (e.g., severity, impairment) and secondary (e.g., quality of life, comorbid symptoms) outcomes were assessed.
Results:
Families' satisfaction with the treatment program was high. Of study completers (
n
= 22), five youth (23%) utilized no Phase II sessions and 9 (41%) utilized all four (Median Phase II sessions: 2.5). Large improvements in OCD-related outcomes and small-to-moderate benefits across secondary domains were observed. Statistically-significant differences in primary outcomes were not observed between settings; however, minor benefits for home-based treatment were observed (e.g., maintenance of gains, youth comfort with treatment).
Discussion:
Intensive CBT is an efficacious treatment for pediatric OCD. Families opted for differing doses based on their needs. Home-based treatment, while not substantially superior to hospital care, may offer some value, particularly when desired/relevant.
Clinical Trial Registration:
www.ClinicalTrials.gov
;
https://clinicaltrials.gov/ct2/show/NCT03672565
, identifier: NCT03672565.
•Safe disclosure may allow for earlier school supports and improve functioning.•Education about obsessive-compulsive disorder can increase disclosure in schools.•A safe space allows youth to ...determine their individualized disclosure boundaries.•Deep and reciprocal connections increase trust and the subsequent details shared.•Confidential and personalized supports empower a youth after a disclosure.
Disclosure of an OCD diagnosis in the high school setting could allow for timely provision of individualized school-based supports. As few studies have examined adolescent perspectives on the disclosure process in schools, we adopted a qualitative approach to explore this, and to gather recommendations for making disclosure of OCD at school safer and more helpful. Twelve participants, ranging from 13 to 17 years old, were recruited using maximum variance-based heterogeneous purposive sampling. Semi-structured interviews were conducted and analyzed inductively through Interpretive Description. From participants’ stories, we generated a theoretical model describing the journey from concealment of an OCD diagnosis to disclosure. Four phases of youth disclosure were identified: managing enacted and perceived stigma related to the diagnosis, internal bargaining to determine their individualized disclosure boundaries, trust building with school members, and empowerment by being treated as a person first. Participants’ recommendations for the school setting included meaningful education, safe spaces, deep reciprocal connections, and confidential personalized support. The model we developed can help inform school disclosure strategies and optimize support to promote best outcomes for youth with OCD.
Childhood-onset obsessive-compulsive disorder (OCD) has been associated with immune dysregulation, including aberrant plasma inflammatory markers and increased rates of infectious and immune-mediated ...disorders. Saliva may provide a minimally-invasive tool for assessing oral mucosal immunity and inflammatory biomarkers in this population. The primary aim of this study was to compare salivary defense proteins and inflammatory mediators in saliva from children and youth with OCD and healthy controls, and evaluate their associations with measures of oral health and OCD phenotype.
In this cross-sectional observational study, saliva was collected from 41 children and youth with childhood-onset OCD and 46 healthy controls. Levels of lysozyme, α-amylase, secretory immunoglobulin A (sIgA), C-reactive protein (CRP), interleukin-6 (IL-6), IL-1β, and tumor necrosis factor-α (TNF-α) were quantified by enzyme-linked immunosorbent assays or electrochemiluminescent-based immunoassays.
All analytes were detectable in saliva. When adjusting for salivary flow rate and total protein, multiple linear regression models including demographic variables, oral health measures, and OCD status explained a significant proportion of the variance in IL-6, IL-1β, and sIgA but not TNF-α, CRP, α-amylase, or lysozyme levels. Diagnosis of OCD was associated with significantly higher IL-6 (β = 0.403, p = 0.026), while severity of OCD was a significant predictor of increased cytokines (IL-6, β = 0.325, p = 0.009; IL-1β, β = 0.284, p = 0.020; TNF-α, β = 0.269, p = 0.036), but not other analytes.
These data point to the feasibility of analyzing soluble immune mediators in the saliva in childhood-onset OCD, suggesting that pro-inflammatory cytokines are associated with OCD diagnosis and symptom severity. Further work is required to elucidate the factors contributing to this association and implications for clinical practice.
•Analyses of immune-related salivary proteins is feasible in children with OCD.•Oral health and demographic factors were associated with salivary analyte levels.•OCD diagnosis was associated with high salivary IL-6.•Severe OCD predicted high IL-6, IL-1β, and TNF-α levels.
Obsessive-compulsive disorder (OCD)-affected youth face notable impairments in the school setting related to concentration, homework, certain subject material, and overall program completion. We aim ...to examine the relative perspectives of school personnel versus parents regarding the OCD-affected child's (a) executive function (EF) deficits via the teacher and parent behavior rating inventory of EF (BRIEF), (b) OCD-specific symptoms via the teacher report form (TRF) and child behavior checklist (CBCL), and (c) common childhood psychiatric disorder symptoms via the TRF and CBCL. Correlational analyses revealed significant concordance between respondent groups regarding EF deficits and common childhood psychiatric disorder symptoms (e.g. guilt, worries). Inter-rater agreement was less consistent regarding the presence of OCD-specific symptoms, with school personnel reporting lower rates overall. However, when considering OCD-specific and common childhood psychiatric disorder symptoms together, school personnel reported some youth above the OCD threshold despite parents reporting them below. Our findings highlight that having multiple informants who communicate their concerns with one another about students' impairing symptoms at school may help with earlier recognition of pediatric OCD and better long-term outcomes. Future research can explore optimal school-family communication strategies, specialized OCD training for school personnel, and direct disclosure of an OCD diagnosis by a family.
•This study explored relative perspectives of school personnel and parents regrading OCD-affected youth.•School personnel and parents were similar in identifying executive function problems and non-specific psychiatric symptoms.•Inter-rater agreement was much lower with respect to OCD symptoms, which were recognized less by school personnel.•Improved school-family communication may lead to optimization of OCD recognition and support.
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