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A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder

BACKGROUND: Factors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these pre...

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Autores principales: Bipeta, Rajshekhar, Yerramilli, Srinivasa SRR, Pingali, Srilakshmi, Karredla, Ashok Reddy, Ali, Mohammad Osman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698013/
https://www.ncbi.nlm.nih.gov/pubmed/23786761
http://dx.doi.org/10.1186/1753-2000-7-20
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author Bipeta, Rajshekhar
Yerramilli, Srinivasa SRR
Pingali, Srilakshmi
Karredla, Ashok Reddy
Ali, Mohammad Osman
author_facet Bipeta, Rajshekhar
Yerramilli, Srinivasa SRR
Pingali, Srilakshmi
Karredla, Ashok Reddy
Ali, Mohammad Osman
author_sort Bipeta, Rajshekhar
collection PubMed
description BACKGROUND: Factors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these predictors are not targeted with conventional therapy. Among these, insight and FA were identified to be modifiable predictors of special relevance to pediatric OCD. Despite their clinical relevance, insight and FA remain understudied in youth with OCD. This study examined the clinical correlates of insight and FA and determined whether FA mediates the relationship between symptom severity and functional impairment in pediatric OCD. METHODS: This was a cross-sectional, outpatient study. Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.11 ± 3.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables. Insight and comorbidities were assessed based on clinician’s interview. Subjects were categorized as belonging to a high insight or a low insight group, and the differences between these two groups were analyzed using ANOVA. Pearson’s correlation coefficients were calculated for the remaining variables of interest. Mediation analysis was carried out using structural equation modeling. RESULTS: Relative to those in the high insight group, subjects in the low insight group were younger, had more severe disease and symptoms, and were accommodated to a greater extent by their families. In addition, comorbid depression was more frequent in subjects belonging to the low insight group. Family accommodation was positively related to disease severity, symptom severity, and functional impairment. Family accommodation totally mediated the relationship between symptom severity and functional impairment. CONCLUSIONS: Results support the differences in the diagnostic criteria between adult and pediatric patients with OCD with respect to the requirement of insight. Subjects with low insight displayed clinical characteristics of increased severity compared with their high insight counterparts, suggesting that subjects with low insight may require multimodal approach to treatment. Family accommodation was found to mediate the relationship between symptom severity and functional impairment; the use of family-based approaches to cognitive behavioral therapy, with one of the aims of reducing/mitigating FA, may provide better treatment outcomes in pediatric OCD.
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spelling pubmed-36980132013-07-02 A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder Bipeta, Rajshekhar Yerramilli, Srinivasa SRR Pingali, Srilakshmi Karredla, Ashok Reddy Ali, Mohammad Osman Child Adolesc Psychiatry Ment Health Research BACKGROUND: Factors predicting treatment outcome in pediatric patients with obsessive-compulsive disorder (OCD) include disease severity, functional impairment, comorbid disorders, insight, and family accommodation (FA). Treatment of pediatric OCD is often only partly successful as some of these predictors are not targeted with conventional therapy. Among these, insight and FA were identified to be modifiable predictors of special relevance to pediatric OCD. Despite their clinical relevance, insight and FA remain understudied in youth with OCD. This study examined the clinical correlates of insight and FA and determined whether FA mediates the relationship between symptom severity and functional impairment in pediatric OCD. METHODS: This was a cross-sectional, outpatient study. Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.11 ± 3.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables. Insight and comorbidities were assessed based on clinician’s interview. Subjects were categorized as belonging to a high insight or a low insight group, and the differences between these two groups were analyzed using ANOVA. Pearson’s correlation coefficients were calculated for the remaining variables of interest. Mediation analysis was carried out using structural equation modeling. RESULTS: Relative to those in the high insight group, subjects in the low insight group were younger, had more severe disease and symptoms, and were accommodated to a greater extent by their families. In addition, comorbid depression was more frequent in subjects belonging to the low insight group. Family accommodation was positively related to disease severity, symptom severity, and functional impairment. Family accommodation totally mediated the relationship between symptom severity and functional impairment. CONCLUSIONS: Results support the differences in the diagnostic criteria between adult and pediatric patients with OCD with respect to the requirement of insight. Subjects with low insight displayed clinical characteristics of increased severity compared with their high insight counterparts, suggesting that subjects with low insight may require multimodal approach to treatment. Family accommodation was found to mediate the relationship between symptom severity and functional impairment; the use of family-based approaches to cognitive behavioral therapy, with one of the aims of reducing/mitigating FA, may provide better treatment outcomes in pediatric OCD. BioMed Central 2013-06-20 /pmc/articles/PMC3698013/ /pubmed/23786761 http://dx.doi.org/10.1186/1753-2000-7-20 Text en Copyright © 2013 Bipeta et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research
Bipeta, Rajshekhar
Yerramilli, Srinivasa SRR
Pingali, Srilakshmi
Karredla, Ashok Reddy
Ali, Mohammad Osman
A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title_full A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title_fullStr A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title_full_unstemmed A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title_short A cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
title_sort cross-sectional study of insight and family accommodation in pediatric obsessive-compulsive disorder
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698013/
https://www.ncbi.nlm.nih.gov/pubmed/23786761
http://dx.doi.org/10.1186/1753-2000-7-20
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