Alpert Medical School of Brown University, USA.
J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):1024-33; quiz 1086. doi: 10.1016/j.jaac.2010.06.013. Epub 2010 Sep 6.
To identify predictors and moderators of outcome in the first Pediatric OCD Treatment Study (POTS I) among youth (N = 112) randomly assigned to sertraline, cognitive behavioral therapy (CBT), both sertraline and CBT (COMB), or a pill placebo.
Potential baseline predictors and moderators were identified by literature review. The outcome measure was an adjusted week 12 predicted score for the Children's Yale Brown Obsessive Compulsive Scale (CY-BOCS). Main and interactive effects of treatment condition and each candidate predictor or moderator variable were examined using a general linear model on the adjusted predicted week 12 CY-BOCS scores.
Youth with lower obsessive-compulsive disorder (OCD) severity, less OCD-related functional impairment, greater insight, fewer comorbid externalizing symptoms, and lower levels of family accommodation showed greater improvement across treatment conditions than their counterparts after acute POTS treatment. Those with a family history of OCD had more than a sixfold decrease in effect size in CBT monotherapy relative to their counterparts in CBT without a family history of OCD.
Greater attention is needed to build optimized intervention strategies for more complex youth with OCD. Youth with a family history of OCD are not likely to benefit from CBT unless offered in combination with an SSRI.
Treatment of Obsessive Compulsive Disorder (OCD) in Children, http://www.clinicaltrials.gov, NCT00000384.
在儿科强迫症治疗研究（POTS I）中，识别青少年（N=112）随机分配到舍曲林、认知行为疗法（CBT）、舍曲林和 CBT（COMB）或安慰剂的预测因素和调节因素。
通过文献回顾确定潜在的基线预测因素和调节因素。结果测量为儿童耶鲁布朗强迫症量表（CY-BOCS）的调整后第 12 周预测评分。使用一般线性模型对调整后的第 12 周 CY-BOCS 评分进行治疗条件和每个候选预测因子或调节变量的主要和交互效应检验。
与急性 POTS 治疗后相比，强迫症严重程度较低、与强迫症相关的功能障碍较少、洞察力较强、共患外化症状较少和家庭适应程度较低的青少年在治疗后改善程度较大。与没有强迫症家族史的青少年相比，有强迫症家族史的青少年在 CBT 单一疗法中的效果降低了六倍以上。
需要更加关注为更复杂的强迫症青少年制定优化的干预策略。除非提供 SSRI 联合治疗，否则有强迫症家族史的青少年不太可能从 CBT 中受益。
