Nordic Long-term Obsessive compulsive disorder (OCD) Treatment Study

ISRCTN ISRCTN66385119
DOI https://doi.org/10.1186/ISRCTN66385119
Secondary identifying numbers NordLOTS protocol 1.2
Submission date
20/10/2007
Registration date
19/03/2008
Last edited
10/07/2025
Recruitment status
No longer recruiting
Overall study status
Completed
Condition category
Mental and Behavioural Disorders
Prospectively registered
Protocol
Statistical analysis plan
Results
Individual participant data

Plain English summary of protocol

Background and study aims
Pediatric Obsessive Compulsive Disorder (OCD) is a serious and often chronic disorder involving obsessive and excessive fears, and behaviours ( i.e., rituals) that aim to neutralize the fears and dangers. The symptoms lead to impairment and reduced quality of life. There is impressive evidence for the effectiveness of Cognitive Behaviour Therapy (CBT) with exposure to the feared situations and response prevention of the rituals. Moreover, CBT gives good symptom relief in many, better than drug treatments (i.e., serotonin reuptake inhibiting drugs [SSRIs]). SSRI treatment also has an impressive evidence base. However, little is known about what treatments to offer in children and adolescents who do not benefit from CBT. So, our study aims at investigating whether continued CBT or a switch to sertraline (an SSRI) is best in these non-responding children and adolescents. However, we are also interested in investigating whether regular child and adolescent clinicians can be taught such CBT and be as efficient as psychotherapists working in specialized OCD clinics.

Who can participate?
Children and adolescents, aged 7-17 years, with moderate to severe OCD.

What does the study involve?
Following a thorough baseline diagnostic work-up, patients participate in 14 sessions of CBT. Assessments are made also at the 7th and 13th weeks of the therapy. Youngsters who do not benefit from CBT are then randomly allocated to either sertraline or to continued CBT.

What are the possible benefits and risks of participating?
The participants receive state-of-the-art CBT and drug treatment which increase the chance of symptom relief, while the risks are small.

Where is the study run from?
Three Scandinavian countries (Sweden, Norway and Denmark) contribute. The Center for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP) is the data center.

When is the study starting and how long is it expected to run for?
The study started in 2008, has now stopped inclusion, and is currently working on a long-term follow-up scheme to study whether gains from therapy are durable.

Who is funding the study?
All participating centers finance their own contribution with the aid of the local hospital or grants from research foundations. At RBUP, grants from research foundations have covered costs associated with graduate students. RBUP and the Norwegian Research Council have contributed to an electronic data capture system.

Who is the main contact?
Dr Tord Ivarsson
tord.ivarsson@r-bup.no

Contact information

Dr Tord Ivarsson
Scientific

Gullhaug Torg 4B
Oslo
0484
Norway

Phone +47 (0)22 58 60 00
Email tord.ivarsson@r-bup.no

Study information

Study designRandomized active controlled trial with three steps: 1: Open uncontrolled 2: Randomised and controlled 3: Open uncontrolled
Primary study designInterventional
Secondary study designRandomised controlled trial
Study setting(s)Not specified
Study typeTreatment
Participant information sheet Not available in web format, please use contact details to request a participant information sheet
Scientific titleNordic Long-term Obsessive compulsive disorder (OCD) Treatment Study
Study acronymNordLOTS
Study objectivesChildren and adolescents with obsessive compulsive disorder (OCD) who do not respond to a course of cognitive behaviour therapy (CBT) will benefit equally from sertraline and from continued CBT. Identification of CBT versus sertraline responders is possible. Non responders to CBT and sertraline will benefit from aripiprazol augmentation.
Ethics approval(s)1. Denmark, Institutional Review Board (IRB) (Den videnskabsetiske komité for Region Midtjylland), ref: 20070140
2. Sweden, IRB, 04/02/2008
3. Norway, IRB, 10/03/2008
Health condition(s) or problem(s) studiedObsessive compulsive disorder
InterventionStep 1: Cognitive behaviour therapy (CBT)
Step 2: Sertraline plus CBT support (less intensive CBT) or intensive CBT
Step 3: Sertraline plus CBT support plus aripiprazol

Non-responders to CBT are randomised to continued CBT or sertraline with CBT support. CBT plus sertraline non-responders are treated un-controlled with aripiprazol. Outcome is studied for 36 months.

Dosing schedule of sertraline:
Week 0: no dose given
Week 1: 25 mg for 3 days, then 50 mg (range: 25 - 50 mg)
Week 2: 75 mg (range: 50 - 75 mg)
Weeks 3 - 4: 100 mg (range: 75 - 100 mg)
Weeks 5 - 7: 150 mg (range: 75 - 150 mg)
Weeks 8 - 12: 200 mg (range: 75 - 200 mg)
Weeks 6 - 12: 200 mg (range: 75 - 200 mg)

Dosing schedule of aripiprazol:
Week 0: no dose given
Week 1: 2.5 mg for 7 days (range: 2.5 mg)
Weeks 2 - 4: 5 mg (range: 2.5 - 5 mg)
Weeks 5 - 7: 7.5 mg (range: 2.5 - 7.5 mg)
Weeks 8 - 12: 10 - 20 mg (range: 2.5 - 20 mg)
Weeks 12 onwards: 2.5 - 20 mg
Intervention typeDrug
Pharmaceutical study type(s)
PhaseNot Applicable
Drug / device / biological / vaccine name(s)Sertraline, aripiprazole
Primary outcome measure1. CYBOCS
2. Clinical Global Impression Scale
3. Clinical Global Improvement Scale
4. Children's OCD Impact Scale
Outcomes measured (approximately) at weeks 0, 7, 13, and months 6, 12, 24, 36.
Secondary outcome measures1. Screen for Child Anxiety Related Disorders Revised (SCARED-R)
2. Mood and Feelings Questionnaire (MFQ)
3. Children's Global Assessment Scale (CGAS)
4. Child Behaviour Checklist (CBCL)
5. Family Accomodation Scale (FAS)
6. Need to add another treatment
Outcomes measured (approximately) at weeks 0, 7, 13, and months 6, 12, 24, 36.
Overall study start date01/01/2008
Completion date31/12/2013

Eligibility

Participant type(s)Patient
Age groupChild
Lower age limit7 Years
Upper age limit17 Years
SexBoth
Target number of participants300 in step 1; 100 in step 2; 30 in step 3
Total final enrolment269
Key inclusion criteria1. Patients 7 - 17 years of age
2. Moderate-severe obsessive compulsive disorder according to Diagnostic and Statistical Manual of Mental Disorders - Fourth Edition (DSM IV). Severity is defined by Children's Yale-Brown Obsessive Compulsive Scales (CY-BOCS) scores of 16 or above
Key exclusion criteria1. Co-morbidity has not higher treatment priority (e.g. psychosis, anorexia nervosa, severe depression with suicidality, an autistic disorder or Asperger's syndrome)
2. Pervasive developmental disorders (PDD) not otherwise specified (NOS) is allowed if Clinical Global Impression (CGI) score for the PDD is less than or equal to 3 and CGI for the PDD NOS is less than or equal to CGI for the OCD
3. Mental retardation (intelligence quotient [IQ] less than 70)
4. Patients have not been treated with selective serotonin reuptake inhibitor (SSRI) or CBT for their OCD during the last year
5. If the patient is of non-Nordic ethnicity both the patient and one parent must speak a Nordic language
Date of first enrolment01/01/2008
Date of final enrolment31/12/2013

Locations

Countries of recruitment

  • Denmark
  • Norway
  • Sweden

Study participating centre

Gullhaug Torg 4B
Oslo
0484
Norway

Sponsor information

The Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (R.BUP) (Norway)
Research organisation

Gullhaug Torg 4B
Oslo
0484
Norway

Phone +47 (0)22 58 60 00
Email tord.ivarsson@r-bup.no
Website http://www.r-bup.no/
ROR logo "ROR" https://ror.org/042s03372

Funders

Funder type

Research organisation

The Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (Regionsenter for Barn og Unges Psykiske helse [R.BUP]) (Norway) - for the Nordic coordination

No information available

The participating clinics finance their participation from local funding agencies

No information available

Results and Publications

Intention to publish date
Individual participant data (IPD) Intention to shareNo
IPD sharing plan summaryNot provided at time of registration
Publication and dissemination planNot provided at time of registration
IPD sharing plan

Study outputs

Output type Details Date created Date added Peer reviewed? Patient-facing?
Results article 29/10/2014 Yes No
Results article 01/03/2015 Yes No
Results article 01/11/2019 21/04/2020 Yes No
Results article 01/04/2021 19/04/2021 Yes No
Results article Quality of life results 01/04/2021 22/04/2021 Yes No
Results article Relapse rates following remission 03/12/2023 11/12/2023 Yes No
Results article 09/07/2025 10/07/2025 Yes No

Editorial Notes

10/07/2025: Publication reference added.
11/12/2023: Publication reference added.
22/04/2021: Publication reference added.
19/04/2021: Publication reference added.
21/04/2020: The following changes were made to the trial record:
1. Publication reference added.
2. The total final enrolment was added.
20/10/2016: Publication reference added.

Updated 21/02/2014:
31/10/2012: the last patient in the step 1 of the study was treated and post-treatment assessment was performed.
31/03/2013: the last patient in the step 2 of the study was treated and post-treatment assessment was performed.
01/04/2013: the study entered the long-term follow-up stage, which is expected to continue until 31/12/2016.