OCD CME Course

Date of Release: October 14, 1997
Date of Expiration: October 14, 1998

This web based CME course is sponsored by University of Pittsburgh School of Medicine, Center for Continuing Education in the Health Sciences and The Department of Psychiatry, University of Pittsburgh.

This CME activity was planned in accordance with the ACCME standards and essentials. It is estimated that for this internet activity, the average time required to read this material and complete the test will be 1.0 hours.

The University of Pittsburgh School of Medicine, as part of the Consortium for Academic Continuing Medical Education, is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

The Center for Continuing Education in the Health Sciences designates this continuing medical education activity for a maximum of 1.0 hours of Category 1 credit towards the AMA Physician's Recognition Award. Each physician should claim only those hours of credit that he/she actually spent in the educational activity.

The presentors and the titles of their talks are:

John March, M.D., Associate Professor, Duke University School of Medicine
Durham, NC, "Psychosocial Treatment of Child/Adolescent Obsessive Compulsive Disorder"
Neal D. Ryan, M.D., Joaquim Puig-Antich Professor in Child and Adolescent Psychiatry, University of Pittsburgh, "Pharmacological Treatment of Child/Adolescent Obsessive Compulsive Disorder"
David R. Rosenberg, M.D., Associate Professor of Psychiatry and Behavioral Neuroscience and Pediatrics, Wayne State University School of Medicine, "Imaging Studies in Child/Adolescent Obsessive Compulsive Disorder"
Mark A. Riddle, M.D., Associate Professor, John Hopkins, "Obsessive Compulsive Disorder Related Psychiatric Disorders in Children and Adolescents"

In accord with the standards set forth by the ACCME, speakers have been asked to disclose any relationship to companies producing pharmaceuticals, medical equipment or other relevant products or services which might be germane to the content of their lectures. The following speakers have disclosed the following information:

Dr. Neal Ryan, Joaquim Puig-Antich Professor in Child Psychiatry, University of Pittsburgh, "Pharmacological Treatment of Child/Adolescent Obsessive Compulsive Disorder", research support, SmithKline Beecham, speakers' bureau, Solvay and Abbott
Dr. Rosenberg, other support, Solvay, SmithKline Beecham
Dr. March, grant support and consultant, Solvay, SmithKline Beecham, Bristol Meyer, Pfizer, CIBA-Geigy, Glaxo, Reid-Rowell, Lilly
Dr. Riddle, none

The objective of this CME course is to teach the presentation and psychotherapeutic and pharmacotherapeutic treatment of child and adolescent obsessive compulsive disorder and the related PANDAS syndrome.

The target audience is psychiatrists, psychologists, and other mental health and primary care clinicians.

This CME course was designed to address the under appreciation of recent diagnostic and recent treatment work in treating this disorder which effects perhaps 1% of children and adolescents. The disorder is remarkably underrecognized. Effective treatments are possible. Thus, the greater understanding on the part of the clinician may directly lead to improved health for those she/he cares for.

References

Flament, Martine F; Koby, Elisabeth; Rapoport, Judith L; Berg, Carol J; et al. Childhood obsessive-compulsive disorder: A prospective follow-up study. Annual Progress in Child Psychiatry & Child Development. 373-394, 1991.
Giedd, Jay N; Rapoport, Judith L; Leonard, Henrietta L; Richter, Daniel; et al. Case study: Acute basal ganglia enlargement and obsessive-compulsive symptoms in an adolescent boy. Journal of the American Academy of Child & Adolescent Psychiatry. Vol 35(7) 913-915, Jul 1996.
Leonard, Henrietta L; Swedo, Susan E; Rapoport, Judith L; Koby, Elisabeth V; et al. Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents: A double-blind crossover comparison. Annual Progress in Child Psychiatry & Child Development. 467-480, 1990.
March, John S; Mulle, Karen; Herbel, Bryon. Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: An open trial of a new protocol-driven treatment package. Journal of the American Academy of Child & Adolescent Psychiatry. Vol 33(3) 333-341, Mar-Apr 1994.
Riddle, Mark A; Scahill, Lawrence; King, Robert A; Hardin, Maureen T; et al. Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child & Adolescent Psychiatry. Vol 31(6) 1062-1069, Nov 1992.
Scahill, Lawrence; Riddle, Mark A; McSwiggin-Hardin, Maureen; Ort, Sharon I; et al. Children's Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child & Adolescent Psychiatry. Vol 36(6) 844-852, Jun 1997.
Swedo, Susan E; Rapoport, Judith L; Leonard, Henrietta L; Lenane, Marge; et al. Obsessive-compulsive disorder in children and adolescents: Clinical phenomenology of 70 consecutive cases. Archives of General Psychiatry. Vol 46(4) 335-341, Apr 1989.
Swedo, Susan E; Leonard, Henrietta L; Rapoport, Judith L. Childhood-onset obsessive compulsive disorder. Psychiatric Clinics of North America. Vol 15(4) 767-775, Dec 1992.

We gratefully acknowledge an educational grant from Solvay Pharmaceuticals, Inc. and Pharmacia & Upjohn in support of this conference.

Instructions

You must score 75% correct on the questions below for credit
You may only take the test once
We will soon have a much more automated system to handle electronic CME. For now, to obtain credit for this CME course, you need to send email to simkopd@msx.upmc.edu which contains all of the following:
- A subject line that indicates your are submitting an OCD CME response
- Your name
- Your address
- Your phone number
- Your social security number
- Your degree
- The answers to questions 1-4 below
We will respond by email telling you whether or not you passed
Review the March, Ryan and Riddle slides from the OCD symposium below before taking the test.

Questions

Question 1:

In the pharmacological treatment of child and adolescent obsessive compulsive disorder:

A. Serotonin reuptake blocking agents and norepinephrine reuptake block agents have approximately equal efficacy.

B. Serotonin reuptake blocking agents are efficacious but norepinephrine reuptake blocking agents are not.

C. Norepinephrine reuptake blocking agents are efficacious but serotonin reuptake blocking agents are not.

D. Data is not yet available in child and adolescent OCD to adequately answer questions about the relative efficacy of serotonergic versus noradrenergic agents..

Question 2:

Comparing behavioral therapy to pharmacotherapy in child and adolescent OCD:

A. Both behavioral therapy and pharmacotherapy have significant long lasting clinical effect even after stopping treatment.

B. Behavioral therapy appears to have long lasting effect after stopping successful treatment while pharmacotherapy does not have significant effect after stopping treatment.

C. Pharmacotherapy appears to have lon lasting effect after stopping successful treatment while behavioral therapy does not.

D. Both have efficacy while the treatment is ongoing but neither have long lasting effects that continue after the treatment has been stopped.

Question 3:

All of the following statements are true about child OCD except:

A. There is a male predominance in childhood OCD in contrast to the 1:1 sex ratio seen in adult onset OCD.

B. Compulsions without obsessions are more often seen in child onset OCD than in adult onset OCD.

C. Childhood OCD is somewhat less responsive to psychological and pharmacological treatment than is adult OCD.

D. Motor tics are more often seen in childhood onset OCD than in adult onset OCD.

Question 4:

All of the following statements are true about PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) except:

A. PANDAS is characterized by abrupt onset and either postive step culture or positive anti-GABHS antibody titre.

B. PANDAS is much more frequent in childhood than in adulthood.

C. PANDAS is strongly associated with the D8/17 B-cell marker.

D. Antiobsessional agents are not effective in treating obsessions seen with PANDAS.

Evaluation Questions: Please answer the following questions in your email to help us evaluate the quality of this CME offering. They do not count towards passing this test.

Evaluation Question A: Please indicate the impact this topic will have on your clinical practice:

a. to a great degree
b. moderately
c. minimally

Evaluation Question B: The objectives of this material were met:

a. to a great degree
b. moderately
c. minimally