系统评价和荟萃分析：儿童和青少年强迫症的认知行为疗法。
Systematic Review and Meta-Analysis: Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents.
机构信息
Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark.
Child and Adolescent Mental Health Centre, Mental Health Services, Capital Region, Denmark; Faculty of Health Sciences, University of Copenhagen, Denmark; Danish Research Centre for Magnetic Resonance, Hvidovre Hospital, Denmark.
出版信息
J Am Acad Child Adolesc Psychiatry. 2020 Jan;59(1):64-77. doi: 10.1016/j.jaac.2019.08.480. Epub 2019 Oct 4.
OBJECTIVE
To assess benefits and harms of cognitive-behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD).
METHOD
We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
RESULTS
Nine trials (N = 645) were included comparing CBT with no intervention and 3 trials (N = 146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD] = -8.51, 95% CI = -10.84 to -6.18, p < .00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD] = -0.90, 95% CI = -1.19 to -0.62, p < .00001, very low certainty; parent-rated: SMD = -0.68, 95% CI = -1.12 to -0.23, p = .003, very low certainty), had similar proportions of participants with adverse events (risk ratio = 1.06, 95% CI = 0.93-1.22, p = .39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio = 0.50, 95% CI = 0.37-0.67, p < .00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD = -0.75, 95% CI = -3.79 to 2.29, p = .63, GRADE: very low certainty), and was associated with similar risk of still having OCD (risk ratio = 0.85, 95% CI = 0.66-1.09, p = .20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events.
CONCLUSION
CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
目的
评估认知行为疗法（CBT）与无干预或与其他干预措施相比治疗儿科强迫症（OCD）的疗效和安全性。
方法
我们检索了 CBT 治疗儿科 OCD 的随机临床试验。主要结局为 OCD 严重程度、严重不良事件和功能水平。次要结局为生活质量和不良事件。将 OCD 缓解情况作为探索性结局纳入评估。我们使用 Grading of Recommendations Assessment, Development and Evaluation（GRADE）对偏倚风险进行评估，并评估证据的确定性。
结果
纳入了 9 项比较 CBT 与无干预的试验（N=645）和 3 项比较 CBT 与选择性 5-羟色胺再摄取抑制剂（SSRIs）的试验（N=146）。与无干预相比，CBT 降低了 OCD 严重程度（均数差[MD]=-8.51，95%置信区间[CI]：-10.84 至-6.18，p<0.00001，低确定性），改善了功能水平（患者自评：标准化 MD[SMD]=-0.90，95%CI：-1.19 至-0.62，p<0.00001，极低确定性；家长自评：SMD=-0.68，95%CI：-1.12 至-0.23，p=0.003，极低确定性），不良事件发生率相似（风险比[RR]=1.06，95%CI：0.93-1.22，p=0.39，GRADE：低确定性），且 OCD 持续存在的风险降低（RR=0.50，95%CI：0.37-0.67，p<0.00001，极低确定性）。我们的数据不足以评估 CBT 与无干预对严重不良事件和生活质量的影响。与 SSRIs 相比，CBT 导致 OCD 严重程度的降低相似（MD=-0.75，95%CI：-3.79 至 2.29，p=0.63，GRADE：极低确定性），且 OCD 持续存在的风险相似（RR=0.85，95%CI：0.66-1.09，p=0.20，极低确定性）。我们的数据不足以评估 CBT 与 SSRIs 对严重不良事件、功能水平、生活质量和不良事件的影响。
结论
CBT 可能比无干预更有效，与 SSRIs 相比治疗儿科 OCD 可能相当，但我们对疗效估计的把握度非常低。
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