A preliminary study of D-cycloserine augmentation of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder
Eric A Storch, Tanya K Murphy, Wayne K Goodman, Gary R Geffken, Adam B Lewin, Aude Henin, Jamie A Micco, Susan Sprich, Sabine Wilhelm, Michael Bengtson, Daniel A Geller, Eric A Storch, Tanya K Murphy, Wayne K Goodman, Gary R Geffken, Adam B Lewin, Aude Henin, Jamie A Micco, Susan Sprich, Sabine Wilhelm, Michael Bengtson, Daniel A Geller
Abstract
Background: Research on the neural circuitry underlying fear extinction has led to the examination of D-cycloserine (DCS), a partial agonist at the N-methyl-D-aspartate receptor in the amygdala, as a method to enhance exposure therapy outcome. Preliminary results have supported the use of DCS to augment exposure therapy in adult anxiety disorders; however, no data have been reported in any childhood anxiety disorder. Thus, we sought to preliminarily examine whether weight-adjusted DCS doses (25 or 50 mg) enhanced the overall efficacy of cognitive-behavioral therapy (CBT) for pediatric obsessive-compulsive disorder (OCD).
Method: Participants were 30 youth (aged 8-17) with a primary diagnosis of OCD. The study design was a randomized, double-blinded, placebo-controlled augmentation trial examining CBT + DCS versus CBT + Placebo (15 youth per group). All patients received seven exposure and response prevention sessions paired with DCS or placebo taken 1 hour before sessions.
Results: Although not significantly different, compared with the CBT + Placebo group, youth in the CBT + DCS arm showed small-to-moderate treatment effects (d = .31-.47 on primary outcomes). No adverse events were recorded.
Conclusions: These results complement findings in adult OCD and non-OCD anxiety disorders and provide initial support for a more extensive study of DCS augmentation of CBT among youth with OCD.
Trial registration: ClinicalTrials.gov NCT00864123.
Conflict of interest statement
Disclosures
Dr. Storch receives grant funding from the NIMH, NICHD, All Children’s Hospital Research Foundation, Centers for Disease Control, National Alliance for Research on Schizophrenia and Affective Disorders, Obsessive Compulsive Foundation, Tourette Syndrome Association, Janssen Pharmaceuticals, and Foundation for Research on Prader-Willi Syndrome. He receives textbook honorarium from Springer publishers and Lawrence Erlbaum. Dr. Storch has been an educational consultant for Rogers Memorial Hospital.
Dr. Murphy has received research support from NIMH, Forest Laboratories, Janssen Pharmaceuticals, Endo, Obsessive Compulsive Foundation, Tourette Syndrome Association, All Children’s Hospital Research Foundation, Centers for Disease Control, and National Alliance for Research on Schizophrenia and Affective Disorders. Dr. Murphy is on the Medical Advisory Board for Tourette Syndrome Association. She receives textbook honorarium from Lawrence Erlbaum.
Dr. Lewin reports research support funding from the National Alliance for Research on Schizophrenia and Affective Disorders, the International OCD Foundation, the Joseph Drown Foundation, and the Friends of the Semel Institute.
Dr. Geffken receives grant funding from the NIMH.
Dr. Henin has received honoraria from Shire, Abbott Laboratories, and AACAP. She receives royalties from Oxford University Press. She has also received honoraria from Reed Medical Education (a company working as a logistics collaborator for the MGH Psychiatry Academy). The education programs conducted by the MGH Psychiatry Academy were, in part, supported though Independent Medical Education grants from pharmaceutical companies, including AstraZeneca, Lilly, McNeil Pediatrics, Shire, Forest Laboratories Inc., Sanofi aventis, Janssen, Bristol-Myers Squibb, and Pfizer.
Dr. Micco receives grant funding from the NIMH.
Dr. Sprich receives grant funding from the NIMH and receives funding from the Michael A. Jenike Endowed Fund and receives royalties from Oxford University Press.
Dr. Wilhelm has received research support from NIMH, the FDA, the Obsessive-Compulsive Foundation, the Tourette Syndrome Association. Forest Laboratories provided her with medication for an NIMH funded study. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications and from Oxford University Press. Dr. Wilhelm has also received speaking honoaria from various academic institutions.
Dr. Bengtson has received research support from Boehringer Ingelheim.
Dr. Geller has received research support from National Institute of Neurological Disorders and Stroke; National Institute of Mental Health; Eli Lilly and Co.; Forest Laboratories; Glaxo-SmithKline; Pfizer; Boehringer Ingelheim; Otsuka; Obsessive Compulsive Foundation; Tourette Syndrome Association; Wallace Foundation; Pediatric Obsessive Compulsive and Related Disorders fund (philanthropic); and McIngvale Family Foundation (philanthropic). He has received Speaker Honoraria from: Alza; Bristol-Myers-Squibb; Eli Lilly; Forest Laboratories; Glaxo-SmithKline; Novartis; Pfizer; Shire; and Wyeth. Dr. Geller is on the Medical Advisory Board or consults for the following companies: Eli Lilly, Solvay, Lundbeck and Glaxo-SmithKline. He has been an educational consultant for Rogers Memorial Hospital, and received honorarium from the American Psychiatric Publishing.
Dr. Goodman reports no biomedical financial interests or potential conflicts of interest.
Copyright © 2010 Society of Biological Psychiatry. Published by Elsevier Inc. All rights reserved.
Source: PubMed