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Publications [#274967] of John S. March

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Journal Articles

  1. JS March, HL Leonard and SE Swedo (1995). Pharmacotherapy of obsessive-compulsive disorder. Child and Adolescent Psychiatric Clinics of North America. Child Psychiatric Clinics of North America: Pharmacotherapy, 4(1), 217-236.
    (last updated on 2016/01/27)

    The diagnosis and treatment of OCD in children and adolescents strongly resemble the diagnosis and treatment of OCD in adults. Differences derive largely from developmental considerations, especially limitations in insight with younger age and family dynamics and pattern of comorbidity. Ideally, children with OCD should first receive cognitive-behavioral psychotherapy tailored to OCD and, if not rapidly responsive to behavior therapy, a SRI. Some physicians and patients may choose medication first, trying to avoid the time, effort, and anxiety associated with behavior therapy. Others prefer to begin with behavior therapy in hopes of avoiding the need for medication and accompanying side effects. Most prefer to combine the two approaches, especially in severely ill patients. In all cases, the decision to begin with pharmacotherapy versus CBT or their combination depends on the clinician and the individual patient and his or her family. Because there are little empiric data favoring one SRI over another, choice of agent depends largely on side-effect profile, accumulated clinical experience, clinician and patient preference, and ultimately new evidence from controlled studies comparing SRIs. Supportive psychotherapy is useful in every case; family therapy is useful when family problems interfere with the implementation of OCD-specific interventions. Although current treatments are not curative in the majority of patients, given a correct diagnosis and the skillful combination of pharmacotherapy and CBT, most children can be helped to resume a normal developmental trajectory.

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