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患有学校恐惧症的焦虑抑郁青少年治疗反应的预测因素。

Predictors of treatment response in anxious-depressed adolescents with school refusal.

作者信息

Layne Ann E, Bernstein Gail A, Egan Elizabeth A, Kushner Matt G

机构信息

Division of Child and Adolescent Psychiatry, University of Minnesota Medical School, Minneapolis, USA.

出版信息

J Am Acad Child Adolesc Psychiatry. 2003 Mar;42(3):319-26. doi: 10.1097/00004583-200303000-00012.

Abstract

OBJECTIVE

To identify predictors of treatment response to 8 weeks of cognitive-behavioral therapy (CBT) among anxious-depressed adolescents with school refusal, half of whom received imipramine plus CBT and half of whom received placebo plus CBT.

METHOD

A hierarchical multiple regression analysis was used to evaluate the following variables as potential predictors of treatment response as measured by school attendance at the end of treatment: baseline severity (school attendance at baseline), drug group (imipramine versus placebo), presence of separation anxiety disorder (SAD), and presence of avoidant disorder (AD).

RESULTS

Baseline attendance, CBT plus imipramine, SAD, and AD were significant predictors of treatment response and accounted for 51% of the variance in outcome. Specifically, a higher rate of attendance at baseline and receiving imipramine predicted a better response to treatment whereas the presence of SAD and AD predicted a poorer response to treatment. The relationship between sociodemographic variables and treatment outcome was also evaluated. Age and socioeconomic status were unrelated to school attendance after treatment. Males had significantly higher rates of attendance after treatment than females.

CONCLUSIONS

Adolescents with school refusal are a heterogeneous population and require individualized treatment planning. Variables such as diagnosis and severity at the start of treatment should be taken into consideration when planning treatment.

摘要

目的

确定患有学校恐惧症的焦虑抑郁青少年在接受为期8周的认知行为疗法(CBT)治疗时治疗反应的预测因素,其中一半青少年接受丙咪嗪加CBT治疗,另一半接受安慰剂加CBT治疗。

方法

采用分层多元回归分析来评估以下变量,这些变量作为治疗反应的潜在预测因素,通过治疗结束时的上学出勤率来衡量:基线严重程度(基线时的上学出勤率)、药物组(丙咪嗪与安慰剂)、分离焦虑症(SAD)的存在以及回避型障碍(AD)的存在。

结果

基线出勤率、CBT加丙咪嗪、SAD和AD是治疗反应的显著预测因素,占结果变异的51%。具体而言,基线时较高的出勤率和接受丙咪嗪治疗预测对治疗有更好的反应,而存在SAD和AD则预测对治疗的反应较差。还评估了社会人口统计学变量与治疗结果之间的关系。年龄和社会经济地位与治疗后的上学出勤率无关。治疗后男性的出勤率显著高于女性。

结论

患有学校恐惧症的青少年是一个异质性群体,需要个性化的治疗计划。在制定治疗计划时,应考虑治疗开始时的诊断和严重程度等变量。

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