A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION.
A META-ANALYSIS OF COGNITIVE BEHAVIOR THERAPY AND MEDICATION FOR CHILD OBSESSIVE-COMPULSIVE DISORDER: MODERATORS OF TREATMENT EFFICACY, RESPONSE, AND REMISSION.
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DOI：
10.1002/da.22389
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发表时间：
2015-08
影响因子：
7.4
通讯作者：
Storch EA
中科院分区：
文献类型：
--
作者：
McGuire JF;Piacentini J;Lewin AB;Brennan EA;Murphy TK;Storch EA
个体随机对照试验（RCT）已经证明了认知行为疗法（CBT）和5-羟色胺再摄取抑制剂（SRI）治疗青少年强迫症（OCD）的疗效。虽然荟萃分析证实了这些结果，但对这两种治疗类型的治疗调节剂或治疗反应和症状/诊断缓解的检查很少。本报告研究了治疗效果，治疗反应，症状/诊断缓解与青少年强迫症接受CBT或SRI相对于比较条件，并检查治疗主持人。一项全面的文献检索确定了20项符合纳入标准的RCT，并产生了507名CBT参与者和789名SRI参与者的样本量。CBT试验的随机效应荟萃分析发现，治疗疗效（g=1.21）、治疗反应[相对风险（RR）=3.93]和症状/诊断缓解（RR=5.40）的治疗效应较大。更大的共病焦虑症，治疗接触，和较低的治疗损耗与更大的CBT效果。治疗反应和症状/诊断缓解需要治疗的人数（NNT）为3人。SRI试验的随机效应荟萃分析发现，治疗有效性（g=0.50）、治疗反应（RR=1.80）和症状/诊断缓解（RR=2.06）的治疗效应中等。更高的方法学质量与SRI试验的较低治疗反应相关。治疗反应和症状/诊断缓解的NNT为5。研究结果证明了CBT和SRI在三个重要结局指标上的治疗效果，并为CBT在试验中的调节作用提供了证据。
Individual randomized controlled trials (RCTs) have demonstrated the efficacy of cognitive behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) for the treatment of youth with obsessive-compulsive disorder (OCD). While meta-analyses have confirmed these results, there has been minimal examination of treatment moderators or an examination of treatment response and symptom/diagnostic remission for these two treatment types. The present report examined the treatment efficacy, treatment response, and symptom/diagnostic remission for youth with OCD receiving either CBT or SRIs relative to comparison conditions, and examined treatment moderators. A comprehensive literature search identified 20 RCTs that met inclusion criteria, and produced a sample size of 507 CBT participants and 789 SRI participants. Random effects meta-analyses of CBT trials found large treatment effects for treatment efficacy (g=1.21), treatment response [relative risk (RR)=3.93], and symptom/diagnostic remission (RR=5.40). Greater co-occurring anxiety disorders, therapeutic contact, and lower treatment attrition were associated with greater CBT effects. The number needed to treat (NNT) was three for treatment response and symptom/diagnostic remission. Random effects meta-analyses of SRI trials found a moderate treatment effect for treatment efficacy (g=0.50), treatment response (RR=1.80), and symptom/diagnostic remission (RR=2.06). Greater methodological quality was associated with a lower treatment response for SRI trials. The NNT was five for treatment response and symptom/diagnostic remission. Findings demonstrate the treatment effects for CBT and SRIs across three important outcome metrics, and provide evidence for moderators of CBT across trials.