Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial.
Side-effects of SSRIs disrupt multimodal treatment for pediatric OCD in a randomized-controlled trial.
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DOI：
10.1016/j.jpsychires.2015.10.006
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发表时间：
2015-12
影响因子：
4.8
通讯作者：
Bussing R
中科院分区：
文献类型：
--
作者：
Reid AM;McNamara JP;Murphy TK;Guzick AG;Storch EA;Goodman WK;Geffken GR;Bussing R
激活综合征（AS）是抗抑郁药的副作用，包括易怒、躁狂、自伤、静坐不能和抑制解除。本研究旨在分析AS如何阻碍儿童和青少年强迫症多模式治疗的疗效。五十六名儿童或青少年在两个治疗点被招募到一个双盲随机对照试验中，参与者接受认知行为治疗，并随机接受缓慢滴定舍曲林，定期滴定舍曲林或安慰剂。使用最近开发的AS测量方法，结果表明，所有五个AS症状群的平均水平较高，显著干扰了治疗反应，并解释了治疗期间强迫症状18%的方差。有趣的是，只有一次又一次的烦躁增加导致了一次又一次的强迫症状增加。添加SSRI剂量作为协变量后，观察结果未发生变化。结果提供了实证支持的假设，即AS可能会阻碍多模式治疗儿童强迫症的结果。这些发现表明，剂量变化，由于AS不能解释为什么那些与高AS有更差的多模式的结果。其他可能的机制解释这种观察到的中断提出，包括如何AS可能会干扰认知行为治疗。
Activation Syndrome (AS) is a side-effect of antidepressants consisting of irritability, mania, self-harm, akathisia, and disinhibition. The current study was conducted to analyze how AS may hinder treatment outcome for multimodal treatment for children and adolescents with Obsessive-Compulsive Disorder. Fifty-six children or adolescents were recruited at two treatment sites in a double-blind randomized-controlled trial where participants received Cognitive-Behavioral Therapy and were randomized to slow titration of sertraline, regular titration of sertraline or placebo. Using a recently developed measure of AS, results suggested that higher average levels of all five AS symptom clusters significantly interfered with treatment response and explained 18% of the variance in obsessive-compulsive symptoms during treatment. Interestingly, only session-to-session increases in irritability resulted in a session-to-session increase in obsessive-compulsive symptoms. The observed results were unchanged with the addition of SSRI dosage as a covariate. Results provide empirical support for the proposed hypothesis that AS may hinder multimodal treatment outcome for pediatric OCD. These findings suggest that dosage changes due to AS do not explain why those with higher AS had worse multimodal outcome. Other possible mechanisms explaining this observed disruption are proposed, including how AS may interfere with Cognitive-Behavioral Therapy.