Masi Gabriele, Pfanner Chiara, Mucci Maria, Berloffa Stefano, Magazù Angela, Parolin Giulia, Perugi Giulio
IRCCS Stella Maris, Scientific Institute of Child Neurology and Psychiatry, Calambrone (Pisa), Italy.
J Child Adolesc Psychopharmacol. 2012 Dec;22(6):410-4. doi: 10.1089/cap.2012.0007.
Pediatric social anxiety disorder (SAD) is associated with an increased risk of comorbid mental disorders, with implications for prognosis and treatment strategy. The aim of this study is to explore predictors of treatment response, and the role of comorbidity in affecting refractoriness.
One hundred and forty consecutive youths (81 males, 57.9%), ages 7-18 years (mean age 13.7 ± 2.5 years, mean age at onset of SAD 10.6 ± 2.7 years) met American Psychiatric Association, Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) criteria for SAD as primary diagnosis, according to a structured clinical interview (Kiddie Schedule for Affective Disorders and Schizophrenia for School-Aged Children-Present and Lifetime Version [K-SADS-PL]). All received a pharmacological treatment with serotonin reuptake inhibitors (SSRIs) targeted to SAD, associated with additional medications for comorbidities (mood stabilizers in 27.1%, antipsychotics in 12.8%) and 57.9% received an additional psychotherapy.
Eighty-nine patients (63.6%) responded to treatments after 3 months, namely 72.8% with psychotherapy plus medication and 50.8% with medication only. Nonresponders had more severe symptoms at baseline in terms of both clinical severity and functional impairment, and had more comorbid disruptive behavior disorders. The backward logistic regression indicated that clinical severity and functional impairment at baseline, comorbid disruptive behavior disorders, and bipolar disorders were predictors of nonresponse.
Our data suggest that SSRIs can be effective in pediatric SAD, but that the more severe forms of the disorder and those with heavier comorbidity are associated with poorer prognosis.
儿童社交焦虑障碍（SAD）与共病精神障碍风险增加相关，这对预后和治疗策略具有重要意义。本研究旨在探索治疗反应的预测因素，以及共病在影响难治性方面的作用。
140名连续入选的青少年（81名男性，占57.9%），年龄7 - 18岁（平均年龄13.7 ± 2.5岁，SAD起病平均年龄10.6 ± 2.7岁），根据结构化临床访谈（儿童情感障碍和精神分裂症量表 - 当前及终生版[K - SADS - PL]），符合美国精神病学协会《精神障碍诊断与统计手册》第4版（DSM - IV）中SAD的主要诊断标准。所有患者均接受了针对SAD的5 - 羟色胺再摄取抑制剂（SSRI）药物治疗，并针对共病使用了其他药物（27.1%使用情绪稳定剂，12.8%使用抗精神病药物），57.9%的患者还接受了额外的心理治疗。
89名患者（63.6%）在3个月后对治疗有反应，即72.8%的患者接受心理治疗加药物治疗有效，50.8%的患者仅接受药物治疗有效。无反应者在基线时临床严重程度和功能损害方面症状更严重，且有更多共病的破坏性行为障碍。向后逻辑回归表明，基线时的临床严重程度和功能损害、共病的破坏性行为障碍以及双相情感障碍是无反应的预测因素。
我们的数据表明，SSRI对儿童SAD可能有效，但病情更严重的形式以及共病较多的患者预后较差。
