McGuire Joseph F, Lewin Adam B, Geller Daniel A, Brown Ashley, Ramsey Kesley, Mutch Jane, Mittelman Andrew, Micco Jamie, Jordan Cary, Wilhelm Sabine, Murphy Tanya K, Small Brent J, Storch Eric A
Department of Psychology, University of South Florida, 4202 East Fowler Avenue, Tampa, FL 33620, USA ; Department of Pediactrics, University of South Florida, 880 6th Street South, Suite 460, Box 7523, St Petersburg, FL 33701, USA.
Neuropsychiatry (London). 2012 Aug;2(4). doi: 10.2217/npy.12.38.
Exposure-based cognitive-behavioral therapy and serotonin reuptake inhibitor medications are efficacious treatment options for the management of pediatric obsessive-compulsive disorder. Despite established efficacy, many youths receiving either therapy remain symptomatic after acute treatment. Regardless of the rationale for persistent symptoms, a clear need emerges for treatment options that restore functioning efficiently to symptomatic youths. One innovative approach builds upon the identified role of NMDA receptors in the fear extinction process. Instead of breaking existing connections during fear extinction, new associations develop that eventually predominate over prior associations. Recent investigations have explored augmenting exposure-based cognitive-behavioral therapy with the NMDA partial agonist d-cycloserine, with preliminary results demonstrating expedited treatment gains and moderately larger effects above exposure and response prevention therapy alone. A large randomized clinical trial is underway to evaluate the efficacy and efficiency of this therapeutic combination in pediatric obsessive-compulsive disorder. Results from this trial may translate into improved management practices.
基于暴露的认知行为疗法和5-羟色胺再摄取抑制剂药物是治疗儿童强迫症的有效选择。尽管已证实其疗效，但许多接受这两种疗法之一的青少年在急性治疗后仍有症状。无论持续出现症状的原因是什么，对于能让有症状的青少年有效恢复正常功能的治疗选择都有明确需求。一种创新方法基于已确定的N-甲基-D-天冬氨酸（NMDA）受体在恐惧消退过程中的作用。在恐惧消退过程中，不是打破现有的联系，而是形成新的关联，最终这些新关联会超过先前的关联。最近的研究探索了用NMDA部分激动剂d-环丝氨酸增强基于暴露的认知行为疗法，初步结果表明，与单独的暴露与反应阻止疗法相比，治疗效果更快，且有适度更大的效果。一项大型随机临床试验正在进行，以评估这种治疗组合在儿童强迫症中的疗效和效果。该试验的结果可能会转化为更好的治疗方法。
