From the Editor-in-Chief's Desk

Among many strong articles in this issue, I would like to highlight two that concern a common clinical presentation: obsessive-compulsive disorder (OCD) with comorbid tic disorder. First, Tanidir et al. examine OCD and comorbid disorders in a Turkish population, which in itself adds valuable breadth to our understanding of the disorder. Their observations confirm the growing consensus of OCD as “a heterogeneous disorder with high rates of comorbid psychiatric disorders,” they write, and they provide evidence that “the presence of specific comorbid diagnoses, gender, and the age at onset of the symptoms may influence the clinical presentation of OCD.”

Of particular interest to the treating professional is the authors' description of how a history of tics impacts not only OCD symptoms but patient self-image, with a higher percentage perceiving the disorder as “egosyntonic.” They conclude reasonably that this research supports “the recent introduction of tic-related OCD as a specifier in DSM-5.”

Elsewhere, Skarphedinsson et al. turn their eyes to the specific correlation between comorbid tics and treatment response. The authors take as their subjects children ages seven to 17 from the Nordic Long-Term OCD Study who were labeled treatment nonresponders after a course of cognitive behavioral therapy (CBT). The result of the follow-on study, where the patients were randomized to continued CBT or to sertraline, is fascinating. “SRT was significantly superior to continued CBT in CBT nonresponders with a comorbid tic disorder, whereas patients without tic disorders showed no significant differences between treatments.”

Though Skarphedinsson et al. note that these observations “are in contrast to previous studies,” this research certainly opens up possibilities for new inquiry and new, better-informed interventions. It is clearly exciting to look at these articles together and wonder how our understanding of OCD, tics, and other pediatric psychiatric disorders will evolve in the future.

I cannot end without drawing your attention to Lohr et al.'s investigation of Medicaid antipsychotic prescribing trends in children six years of age or younger in Kentucky. The authors' finding that prescriptions increased dramatically over the previous decade, but appear to be falling off, both confirms and complicates accepted opinion. Also of interest are more granular details the authors undercover that could and should lead to further investigation. These include clear changes in specific medications prescribed; broad geographical variations in prescribing habits; and thought-provoking data on diagnoses most commonly treated with antipsychotics.

I encourage you to read further.