Ginsburg Golda S, Kingery Julie Newman, Drake Kelly L, Grados Marco A
Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, 600 North Wolfe Street/CMSC 340, Baltimore, MD 21287-3325, USA.
J Am Acad Child Adolesc Psychiatry. 2008 Aug;47(8):868-78. doi: 10.1097/CHI.0b013e3181799ebd.
To examine predictors of treatment response in pediatric obsessive-compulsive disorder (OCD).
A literature review of psychotherapy (i.e., cognitive-behavioral therapy) and medication studies for pediatric OCD published from 1985 to 2007 was conducted using several databases.
The literature search produced a total of 21 studies (6 cognitive-behavioral therapy, 13 medication, and 2 combination studies) that met specific methodological criteria. Across studies, the following nine predictors were examined: child sex, child age, duration of illness/age at onset, baseline severity of obsessive-compulsive symptoms, type of obsessive-compulsive symptoms, comorbid disorders/symptoms, psychophysiological factors, neuropsychological factors, and family factors. Among all of the studies, there was little evidence that sex, age, or duration of illness (age at onset) was associated with treatment response. Baseline severity of obsessive-compulsive symptoms and family dysfunction were associated with poorer response to cognitive-behavioral therapy, whereas comorbid tics and externalizing disorders were associated with poorer response in medication-only studies.
Overall, there are limited data on predictors of treatment response for pediatric OCD. The majority of studies are plagued with methodological limitations and post hoc approaches. Additional research is needed to better delineate the predictors of treatment response in pediatric OCD with the goal of developing individualized treatment approaches.
研究儿童强迫症（OCD）治疗反应的预测因素。
使用多个数据库对1985年至2007年发表的关于儿童强迫症的心理治疗（即认知行为疗法）和药物治疗研究进行文献综述。
文献检索共产生了21项符合特定方法学标准的研究（6项认知行为疗法研究、13项药物治疗研究和2项联合治疗研究）。在各项研究中，考察了以下九个预测因素：儿童性别、儿童年龄、病程/发病年龄、强迫症状的基线严重程度、强迫症状类型、共病障碍/症状、心理生理因素、神经心理因素和家庭因素。在所有研究中，几乎没有证据表明性别、年龄或病程（发病年龄）与治疗反应有关。强迫症状的基线严重程度和家庭功能障碍与认知行为疗法的反应较差有关，而在仅采用药物治疗的研究中，共病抽动和外化障碍与反应较差有关。
总体而言，关于儿童强迫症治疗反应预测因素的数据有限。大多数研究存在方法学局限性和事后分析方法的问题。需要进行更多研究，以更好地确定儿童强迫症治疗反应的预测因素，从而制定个性化的治疗方法。
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