Department of Clinical Neuroscience, The Karolinska Institute, Stockholm, Sweden; Department of Psychology, Stockholm University, Sweden; Department of Clinical Psychology, University of Bergen, Norway.
Department of Clinical Psychology, University of Bergen, Norway; Haukeland University Hospital, OCD-team, 5021 Bergen, Norway.
J Anxiety Disord. 2016 Oct;43:58-69. doi: 10.1016/j.janxdis.2016.08.003. Epub 2016 Aug 13.
Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children's Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT+SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings.
强迫症（OCD）被世界卫生组织（WHO）列为 10 大致残疾病之一。已发现有效的治疗方法是认知行为疗法（CBT）和选择性 5-羟色胺再摄取抑制剂（SRI）。这项荟萃分析包括使用儿童耶鲁-布朗强迫症量表（C-YBOCS）对青少年 OCD 进行的所有 CBT（25 项）和 SRI（9 项）的随机对照试验（RCT）。CBT 的失访率明显低于 SRI（23.5%）和安慰剂（24.7%）（12.7%）。CBT 与等待名单（1.53）、安慰剂（0.93）和 SRI 与安慰剂（0.51）的比较，以及 CBT 与 SRI（0.22）和组合治疗（CBT+SRI）与 CBT（0.14）的比较，其效果大小均具有统计学意义。而 CBT 与 SRI（0.22）和 Combo（CBT+SRI）与 CBT（0.14）之间无显著差异。就反应率而言，CBT（70%）和 Combo（66%）显著高于 SRI（49%），而 SRI 又高于安慰剂（29%）和 WLC（13%）。至于缓解率，CBT（53%）和 Combo（49%）显著高于 SRI（24%）、安慰剂（15%）和 WLC（10%），而三者之间无显著差异。无论样本的初始严重程度如何，组合治疗都不比单独的 CBT 更有效。随机对照试验（RCT）存在许多方法学问题，并讨论了改善研究方法的建议，以及研究结果的临床意义。
