When outpatient care falls short: A case report of complex pediatric obsessive-compulsive disorder treated in a day clinic

Abstract

Pediatric obsessive compulsive disorder (OCD) frequently presents with comorbid psychiatric disorders and may show limited response to first-line interventions such as selective serotonin reuptake inhibitors (SSRI) and cognitive behavioral therapy (CBT). The day treatment model, which provides structured, intensive, and multidisciplinary care, is particularly effective for such complex, treatment-resistant cases. This case report presents a 16-year-old female with severe OCD and comorbid skin picking disorder, trichotillomania, hoarding disorder, and major depressive disorder. She had early-onset symptoms, a history of suicide attempts and severe functional impairment. Due to insufficient clinical improvement in outpatient follow-up, she was subsequently admitted to a day clinic. She received comprehensive treatment, including pharmacotherapy (SSRI, antipsychotics, and N-acetylcysteine), CBT, milieu therapy, group therapy, and family psychoeducation/counseling. Following eight weeks of treatment in the day clinic, significant clinical improvement was observed. This case highlights the effectiveness of day treatment in managing severe pediatric OCD with comorbidities. The intensive, multimodal approach led to symptom reduction, improved functioning, and increased self-esteem. Additionally, N-acetylcysteine, which is not commonly used in pediatric psychiatry, appeared to contribute to improvements in skin picking and hair pulling behaviors in this case. This suggests that N-acetylcysteine is a promising option that warrants further investigation. This case report highlights the important role of day clinics in the management of complex psychiatric disorders in children and adolescents, and underscores the need to expand this model, which is currently available in only one center in Türkiye, nationwide.