Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety.
Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety.
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认知行为疗法、舍曲林或联合疗法治疗儿童焦虑症。
DOI：
10.1056/nejmoa0804633
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发表时间：
2008-12-25
影响因子：
158.5
通讯作者：
Kendall, Philip C.
中科院分区：
文献类型：
--
作者：
Walkup, John T.;Albano, Anne Marie;Piacentini, John;Birmaher, Boris;Compton, Scott N.;Sherrill, Joel T.;Ginsburg, Golda S.;Rynn, Moira A.;McCracken, James;Waslick, Bruce;Iyengar, Satish;March, John S.;Kendall, Philip C.
焦虑症是影响儿童和青少年的常见精神疾病。虽然认知行为疗法和选择性降钙素再摄取抑制剂在治疗这些疾病中显示出疗效，但对其相对或联合疗效知之甚少。在这项随机对照试验中，我们将488名年龄在7岁至17岁之间，初步诊断为分离焦虑症、广泛性焦虑症或社交恐惧症的儿童分配接受14次认知行为治疗，舍曲林（每天剂量高达200毫克）、舍曲林和认知行为治疗的组合或安慰剂药物，以2：2：2：1的比例持续12周。我们在基线和第4、8、12周对焦虑严重程度和损伤进行了分类和维度评级。在临床医生总体印象改善量表上被评定为非常或非常改善的儿童百分比在联合治疗组为80.7%（P<0.001），认知行为治疗组为59.7%（P<0.001），舍曲林组为54.9%（P<0.001）;所有治疗均上级安慰剂组（23.7%）。联合治疗组上级疗效明显优于单药治疗组（P<0.001）。儿童焦虑评定量表的结果记录了类似的反应程度和模式;联合治疗的反应大于认知行为治疗，与舍曲林相当，所有治疗均上级安慰剂。不良事件，包括自杀和杀人意念，舍曲林组并不比安慰剂组更频繁。没有孩子试图自杀。与舍曲林相比，认知行为治疗组的失眠、疲劳、镇静和躁动较少。认知行为疗法和舍曲林都能降低焦虑症儿童的焦虑程度;两种疗法联合使用有更高的上级应答率。（ClinicalTrials.gov编号，NCT 00052078。）
Anxiety disorders are common psychiatric conditions affecting children and adolescents. Although cognitive behavioral therapy and selective serotonin-reuptake inhibitors have shown efficacy in treating these disorders, little is known about their relative or combined efficacy. In this randomized, controlled trial, we assigned 488 children between the ages of 7 and 17 years who had a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia to receive 14 sessions of cognitive behavioral therapy, sertraline (at a dose of up to 200 mg per day), a combination of sertraline and cognitive behavioral therapy, or a placebo drug for 12 weeks in a 2:2:2:1 ratio. We administered categorical and dimensional ratings of anxiety severity and impairment at baseline and at weeks 4, 8, and 12. The percentages of children who were rated as very much or much improved on the Clinician Global Impression-Improvement scale were 80.7% for combination therapy (P<0.001), 59.7% for cognitive behavioral therapy (P<0.001), and 54.9% for sertraline (P<0.001); all therapies were superior to placebo (23.7%). Combination therapy was superior to both monotherapies (P<0.001). Results on the Pediatric Anxiety Rating Scale documented a similar magnitude and pattern of response; combination therapy had a greater response than cognitive behavioral therapy, which was equivalent to sertraline, and all therapies were superior to placebo. Adverse events, including suicidal and homicidal ideation, were no more frequent in the sertraline group than in the placebo group. No child attempted suicide. There was less insomnia, fatigue, sedation, and restlessness associated with cognitive behavioral therapy than with sertraline. Both cognitive behavioral therapy and sertraline reduced the severity of anxiety in children with anxiety disorders; a combination of the two therapies had a superior response rate. (ClinicalTrials.gov number, NCT00052078.)