Melvin Glenn A, Dudley Amanda L, Gordon Michael S, Klimkeit Ester, Gullone Eleonora, Taffe John, Tonge Bruce J
Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
Early in Life Mental Health Service, Monash Health, Clayton, VIC, 3168, Australia.
Child Psychiatry Hum Dev. 2017 Jun;48(3):485-497. doi: 10.1007/s10578-016-0675-y.
This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.
本研究调查了氟西汀强化认知行为疗法（CBT）是否能改善焦虑性学校拒学青少年（11 - 16.5岁）的治疗效果。62名参与者被随机分配至单纯CBT组、CBT + 氟西汀组或CBT + 安慰剂组。所有治疗的耐受性均良好；CBT + 安慰剂组有1例自杀未遂。所有组在主要（上学出勤率）和次要结局指标（焦虑、抑郁、自我效能感及临床医生评定的整体功能）上均有显著改善；改善情况在6个月和1年时基本维持。急性治疗后几乎没有参与者摆脱焦虑症。在随访期间，焦虑和抑郁障碍持续下降，而上学出勤率保持稳定，约为54%。唯一显著的组间差异是，CBT + 氟西汀组青少年报告的治疗满意度高于单纯CBT组。这些结果表明学校拒学具有慢性特征，且未来需要研究如何最佳提高上学出勤率。
