91 Exposure and response prevention for tics & ocd: a uk paediatric case series

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BackgroundTourette Syndrome (TS) has high rates of comorbidity, with Obsessive Compulsive Disorder (OCD) amongst the most common (361%–50%2) resulting from shared genetic and neurobiological substrates.3,4Cognitive Behaviour Therapy incorporating Exposure and Response Prevention (CBT-ERP) is a first-line treatment for OCD, and more recent research has established ERP as effective in the treatment of TS.5 Principles of ERP apply to OCD and TS, i.e., exposure to a triggering stimulus followed by inhibiting the linked behaviour, leading to habituation and reducing the frequency and intensity of the urges/behaviours. This series aims to evaluate whether using ERP to treat OCD/TS has a corresponding impact on and reduction of co-occurring TS/OCD symptoms.MethodFour children diagnosed with TS and OCD were identified in a specialist outpatient clinic. All children completed two phases of treatment; i) CBT-ERP for OCD followed by ii) ERP for TS. Each phase of treatment started with disorder-specific psycho-education before undertaking ERP. Outcomes evaluated tic severity (YGTSS) and obsessions/compulsions (CY-BOCS).ResultsFollowing OCD treatment, there was a significant decrease in CY-BOCS scores but no decrease in YGTSS scores. Following TS treatment, there was a significant decrease in YGTSS scores and further reductions in CY-BOCS scores. Fewer TS treatment sessions were required compared to standard protocols.ConclusionAll children showed a clinically significant decrease in tics or OCD symptoms following symptom specific treatment. There was no secondary impact on tics following treatment for OCD. There was a continued decrease in OCD symptoms whilst receiving ERP for tics, however it is unclear whether this is a reflection of the ERP treatment for TS, or a continued effect of primary OCD treatment. Encouragingly, all children who received TS treatment required few sessions to reduce symptoms. Further discussion and clinical implications are discussed.ReferencesMM Robertson. A personal 35 year perspective on Gilles de la Tourette syndrome: prevalence, phenomenology, comorbidities, and coexistent psychopathologies. The Lancet Psychiatry 2015;2(1):68–87.MH Bloch, JF Leckman. Clinical course of Tourette syndrome. Psychosomatic Research 2009;67(6):497–501.R Marsh, TV Maia, BS Peterson. Functional disturbances within frontostriatal circuits across multiple childhood psychopathologies. American Journal of Psychiatry 2009;166(6):664–674.N Khalifa, AL von Knorring. Tourette syndrome and other tic disorders in a total population of children: Clinical assessment and background. Acta Paediatrica 2005;94(11):16081614.C Verdellen, J Griendt, A Hartmann, T Murphy. European clinical guidelines for Tourette Syndrome and other tic disorders. Part III: behavioural and psychosocial interventions. European child & adolescent psychiatry 2011;20(4):197–207.

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