A number of clinical descriptions of Obsessive‐Compulsive Disorder (OCD) in adolescence are available but are often of small numbers of cases with highly selective recruitment methods. We describe the findings of a systematic case note review of 44 consecutive OCD patients referred to Oxford Regional Adolescent Unit between 1974 and 1984. The relative frequencies of previously described features of the condition in this age group are presented. Many patients had problems with peer relationships and social isolation, which often preceded the onset of other symptoms by many years. The management of the cases and outcome at discharge are outlined.

Cognitive behaviour therapy (CBT) for young people with obsessive compulsive disorder (OCD) has become the treatment of first choice. However, the literature is largely based on studies emphasising exposure and response prevention. In this study, we report on a randomised controlled trial of CBT for young people carried out in typical outpatient clinic conditions which focused on cognitions. A randomised controlled trial compares 10 sessions of manualised cognitive behavioural treatment with a 12-week waiting list for adolescents and children with OCD. Assessors were blind to treatment allocation. 21 consecutive patients with OCD aged between 9 and 18 years were recruited. The group who received treatment improved more than a comparison group who waited for 3 months. The second group was treated subsequently using the same protocol and made similar gains. In conclusion, CBT can be delivered effectively to young people with OCD in typical outpatient settings.

A consecutive series of six adolescents referred for obsessive compulsive disorder were treated using a cognitive behavioural approach that included procedures intended to:(1) reach a shared understanding of the psychological nature of the problem; (ii) normalize intrusive thoughts; (iii) help the patient to reappraise notions of responsibility; and (iv) help the patient re-evaluate the basis of their fears. The effects of treatment were measured using standardized questionnaires designed to elicit beliefs about responsibility, and symptoms of anxiety, depression, and obsessive compulsive disorder. During the course of treatment, appraisals of responsibility changed at the same time as changes in symptom levels. The results suggest a more cognitive approach to treatment can be helpful for this age group, and that cognitive change is associated with clinical improvement.

ObjectivesExamination of current temporal trends and clinical management patterns of eating disorders (ED) in primary care is lacking. We aimed to calculate annual incidence rates of EDs in primary care by age, sex and deprivation. We also explored the care received through referrals, psychotropic prescriptions and associated secondary care service use.Participants and settingsA retrospective electronic cohort study was conducted using the Clinical Practice Research Datalink in those aged 11–24 years between 2004 and 2014 in England (n=1 135 038).ResultsA total of 4775 individuals with a first ever recorded ED diagnosis were identified. The crude incidence rate was 100.1 per 100 000 person years at risk (95% CI 97.2 to 102.9). Incidence rates were highest in females (189.3 per 100 000 person years, 95% CI 183.7 to 195.0, n=4336), 16–20 years of age (141.0 per 100 000 person years, 95% CI 135.4 to 146.9, n=2348) and individuals from the least deprived areas (115.8 per 100 000 person years (95% CI 109.3 to 122.5, n=1203). Incidence rates decreased across the study period (incidence rate ratio (IRR) 0.6, 95% CI 0.5 to 0.8), particularly for individuals with bulimia nervosa (IRR 0.5, 95% CI 0.3 to 0.7) and from the most deprived areas (IRR 0.5, 95% CI 0.4 to 0.7). A total of 17.4% (95% CI 16.3 to 18.5, n=831) of first ever recorded ED cases were referred from primary to secondary care. 27.1% (95% CI 25.9 to 28.4, n=1294) of individuals had an inpatient admission 6 months before or 12 months after an incident ED diagnosis and 53.4% (95% CI 52.0 to 54.9, n=2550) had an outpatient attendance. Antidepressants were the most commonly prescribed psychotropic medication.ConclusionsNew ED presentations in primary care are reducing. Understanding the cause of this decrease (coding behaviours, changes in help-seeking or a genuine reduction in new cases) is important to plan services, allocate resources and deliver effective care.