Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder

Background: The presence of a comorbid tic disorder may predict a poorer outcome in the acute treatment of pediatric obsessive-compulsive disorder (OCD). Methods: Using data from the National Institute of Mental Health (NIMH)-funded Pediatric OCD Treatment Study (POTS) that compared cognitive-bebavior therapy (CBT), medical management with sertraline (SER), and the combination of CBT and SIR (COMB), to pill placebo (PBO) in children and adolescents with OCD, we asked whether the presence of a comorbid tic disorder influenced symptom reduction on the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) after 12 weeks of treatment. Results: Fifteen percent (17 of 112) of patients exhibited a comorbid tic disorder. Inpatients without tics, results replicated previously published intent-to-treat outcomes: COMB > CBT > SER > PBO. Inpatients with a comorbid tic disorder, SER did not differ from PBO, while COMB remained superior to CBT and CBT remained superior to PBO. Conclusions: In contrast to CBT outcomes, which are not differentially impacted, tic disorders appear to adversely impact the outcome of medication management of pediatric OCD. Children and adolescents with obsessive-compulsive disorder and a comorbid tic disorder should begin treatment with cognitive-bebavior therapy alone or the combination of cognitive-bebavior therapy plus a serotonin reuptake inhibitor.