Clomipramine, exposure and ritual prevention, and their combination are all efficacious treatments for OCD. Intensive exposure and ritual prevention may be superior to clomipramine and, by implication, to monotherapy with the other SRIs.

Consistent with studies in adult patients, increased error-related brain activity is evident in pediatric patients with OCD. Furthermore, increased error-related brain activity does not appear to change as a function of symptom reduction after therapy. These results suggest that an increased error-related negativity may be a trait-like marker for psychopathology and might be a useful endophenotype.

Judgmental biases for threat-relevant stimuli are thought to be important mechanisms underlying the etiology and maintenance of anxiety disorders. The authors hypothesized (a) that people with generalized social phobia (GSP) would rate negative social events but not nonsocial events as more probable and costly than would nonanxious controls (NACs) and (b) that cognitive behavioral treatment would decrease probability and cost estimates for social but not nonsocial events. Participants with GSP and NACs were assessed twice, 14 weeks apart, during which the former received cognitive behavioral therapy. Those with GSP evidenced socially relevant judgmental biases prior to treatment, and these were attenuated following treatment. Reduction in cost estimates for social events, but not in probability estimates, mediated improvement in social phobia. Results are discussed in light of emotional processing theory.

We assessed anxiety consistent (i.e. “traditional”) and inconsistent (i.e. “atypical”) with diagnostic and statistical manual (DSM) definitions in autism spectrum disorder (ASD). Differential relationships between traditional anxiety, atypical anxiety, child characteristics, anxiety predictors and ASD-symptomology were explored. Fifty-nine participants (7–17 years, Mage=10.48 years; IQ>60) with ASD and parents completed semi-structured interviews, self- and parent-reports. Seventeen percent of youth presented with traditional anxiety, 15% with atypical anxiety, and 31% with both. Language ability, anxious cognitions and hypersensitivity predicted traditional anxiety, whereas traditional anxiety and ASD symptoms predicted atypical anxiety. Findings suggest youth with ASD express anxiety in ways similar and dissimilar to DSM definitions. Similarities support the presence of comorbid anxiety disorders in ASD. Whether dissimilarities are unique to ASD requires further examination.

Previous researchers have classified obsessive-compulsive disorder (OCD) patients by the themes of their obsessions and compulsions (e.g., washing, checking); however, mental compulsions have not been adequately assessed in these studies. The authors conducted 2 studies using a large sample of OCD patients (N=132). In the 1st study, they categorized patients on the basis of symptom presentation, giving adequate consideration to mental compulsions. Five patient clusters were identified: harming, contamination, hoarding, unacceptable thoughts, and symmetry. Mental compulsions were most prevalent among patients with intrusive, upsetting religious, violent, or sexual thoughts. In the 2nd study, they compared response to cognitive-behavioral therapy across symptom categories, finding poorer outcomes among patients with hoarding symptoms compared with those with other symptom themes.

Objective-To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N=112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo.Method-Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each Correspondence to: Dr. Abbe Garcia, Bradley/Hasbro Children's Research Center, 1 Hoppin St, Providence, RI 02903; Abbe_Garcia@Brown.edu. Disclosure: Dr. Garcia receives research support from the National Institute of Mental Health. Dr. Freeman receives research support from the National Institute of Mental Health. Dr. Franklin receives research support from the National Institute of Mental Health. Dr. March receives research support from Eli Lilly and Co., Pfizer, the National Institute of Mental Health, and the National Alliance for Research on Schizophrenia and Depression. He has served as a consultant or scientific advisory for Bristol-Myers Squibb, Eli Lilly and Co., Johnson and Johnson, MedAvente, Pfizer, Scion, Psymetrix, and Vivus. He is a stockholder of MedAvante. He receives royalties from MultiHealth Systems, Guilford Press, and Oxford University Press. Dr. Foa receives research support from Pfizer, Solvay, Eli Lilly and Co., SmithKline Beecham, GlaxoSmithKline, Cephalon, Bristol-Myers Squibb, Forest, Ciba Geigy, Kalo-Duphar, and the American Psychiatric Association. She has served as a speaker for Pfizer, GlaxoSmithKline, Forest Pharmaceuticals, the American Psychiatric Association, and Jazz Pharmaceuticals. She has served as a consultant for Acetelion Pharmaceuticals. Drs. Sapyta and Moore report no biomedical financial interests or potential conflicts of interest. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. candidate predictor or moderator variable were examined using GLM on the adjusted predicted week 12 CY-BOCS scores. Clinical Trials Registration Information NIH Public AccessResults-Youth with lower OCD severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had a six-fold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD.Conclusions-G...

All active treatments were superior to PBO on primary outcomes. Combined treatment did not yield any further advantage. Notwithstanding the benefits of treatment, many patients remained symptomatic after 14 weeks.

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