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Cheap hotel lille Thirty-five treatment-naive children and adolescentswith DSM-IV diagnosis of OCD (mean age: 13.113.16; 54.3% males) were included. Standard questionnaires were administered for assessing the study variables.
Insight and comorbidities were assessed based on clinicians 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. Pearsons correlation coefficients were cheap hotel lille calculated for the remaining variables of interest.
Mediation analysis was carried out using structural equation modeling. Relative to those in the high insight group, subjects in the low insight group were younger, had cheap hotel lille 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 cheap hotel lille cheap hotel lille related to disease severity, symptom severity, and functional impairment.
Family accommodation totally mediated the relationship between symptom severity and functional impairment. 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 cheap hotel lille displayed clinical characteristics of increased severity compared cheap hotel lille 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 cheap hotel lille severity and functional impairment; the use of family-based approaches to cognitive behavioral therapy, with one of the aims of reducingmitigating FA, may provide better treatment outcomes in pediatric OCD. Obsessive-compulsive disorder; Child; Adolescent; Pediatric; Insight; Family accommodation Background Obsessive-compulsive disorder (OCD) is a chronic anxiety disorder characterized by the presence of unwanted and recurrent thoughts, ideas, feelings, or mental images (collectively referred to as obsessions) that drive the patient to engage in behaviors or cheap hotel lille mental acts (referred to as compulsions) designed cheap hotel lille to prevent or reduce anxiety.
OCD occurs not only in adults, but also in children and adolescents and results in cheap hotel lille substantial distress and functional impairment 1. Childhood OCD, estimated to affect 1 to cheap hotel lille 4% of the population 2 , is associated with significant multi-domain impairment 3.
This, together cheap hotel lille with the observation that majority of the adult cases of OCD (up to 80%) have an onset during childhood 4 , underscores the importance of early intervention.
Current treatment options for pediatric OCD include cognitive behavioral therapy (CBT), pharmacotherapy, or both.
According cheap hotel lille to the AACAP practice parameters 2012 5 , CBT is recommended as the first-line treatment for mild to moderate cases of OCD in children.
In more severe cheap hotel lille cases, selective serotonin reuptake cheap hotel in israel inhibitors (SSRIs) can be added to CBT.
These recommendations are based on the numerous studies that cheap hotel lille have shown the efficacy and acceptability of CBT, including well-conducted systematic trials 6 -10. A meta-analysis 11 of five randomized controlled trials of CBT in children (N161) found a large mean pooled effect size for CBT of 1.45 (95% confidence cheap hotel accommodation in prague interval CI 0.682.22).
In addition, CBT has been demonstrated to be effective when delivered individually, or using a family-based or group-setting approach 12 -15.
Besides being the first-line treatment cheap port dickson hotel for OCD, cheap hotel lille CBT has other advantages, particularly related to patients with comorbid disorders, for example, comorbid tic disorders were found to adversely impact treatment outcome of SSRIs, but not that of CBT 16.
In addition, group CBT was found to be effective for youth with complex comorbid conditions, including depression, attention deficithyperactivity disorder (ADHD) and pervasive developmental disorders (PDD) 12. Current practice parameters recommend addition of pharmacotherapy to CBT for cheap hotel lille cheap hotel lille more severe cases of the disorder. Although addition of pharmacotherapy to CBT confers additional benefit 10 ,17 , many children still cheap hotel lille fail to respond to the combined cheap hotel lille treatment and remain symptomatic.
In recent clinical intervention studies investigating CBT, pharmacological treatment, or the combination of both in pediatric OCD, cheap hotel lille cheap hotel lille cheap albacete hotel results indicated remission rates of 39% with CBT, and from 54% to a maximum of 69% with cheap hotel lille the combination therapy 10 ,17.
This emphasizes cheap hotel lille the need cheap port dickson hotel to further investigate the factors that affect cheap hotel lille treatment outcome and devise novel strategies (based on these factors) for treating pediatric OCD.



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