Department of Psychiatry and Behavioral Neuroscience, Anxiety Disorders Research Program, College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
Department of Economics, Lindner College of Business, University of Cincinnati, Cincinnati, Ohio, USA.
J Child Adolesc Psychopharmacol. 2022 May;32(4):215-223. doi: 10.1089/cap.2022.0012. Epub 2022 May 9.
To characterize executive function in adolescents with generalized anxiety disorder (GAD) and its relationship to treatment. Using data from a double-blind, placebo-controlled trial of escitalopram in adolescents ( = 51) 12-17 years of age with GAD, we used the self-report version of the Behavior Rating Inventory of Executive Function (BRIEF-SR) to assess executive function, at baseline, and examined its relationship to treatment response as measured by the Pediatric Anxiety Rating Scale (PARS). For all baseline subscores of the BRIEF-SR, T-scores were significantly elevated in adolescents with GAD compared to an age- and sex-matched normative healthy sample. In escitalopram-treated patients, baseline BRIEF-SR scores for Emotional Control ( = 0.256, 95% credibility interval [CrI]: 0.367 to 0.146, < 0.001), Working Memory ( = 0.204, CrI: 0.2952 to 0.1134, < 0.001), Planning/Organizing ( = 0.223, CrI: -0.1021 to -0.3436, = 0.004), and Task Completion ( = -0.152, CrI: 0.075 to 0.228, = 0.002) predicted the trajectory of improvement in PARS score over the 8-week trial. For youth who received placebo, only the Inhibit score was significantly, but weakly, associated with response trajectory ( = -0.081, CrI: -0.0167 to -0.1461, = 0.015). For adolescents who had clinically significant impairment in Emotional Control, Working Memory, Planning/Organizing, and Task Completion (i.e., T-score >65), the trajectory of improvement significantly differed from patients without scores in the clinically significant range. Taken together, these findings point to the potential value of assessing executive function in youth with anxiety disorders as one strategy for guiding treatment selection. These data suggest that executive function may predict treatment response to psychopharmacologic treatment and point to numerous avenues for further personalizing treatment.
为了描述广泛性焦虑障碍（GAD）青少年的执行功能及其与治疗的关系。利用一项双盲、安慰剂对照的依地普仑治疗青少年（ = 51）12-17 岁 GAD 的试验数据，我们使用行为评定量表的自我报告版本（BRIEF-SR）评估执行功能，在基线时，并检查其与治疗反应的关系，以儿科焦虑评定量表（PARS）来衡量。对于 BRIEF-SR 的所有基线亚评分，GAD 青少年的 T 评分明显高于年龄和性别匹配的健康正常样本。在依地普仑治疗的患者中，基线 BRIEF-SR 评分的情绪控制（ = 0.256，95%可信区间[CrI]：0.367 至 0.146， < 0.001）、工作记忆（ = 0.204，CrI：0.2952 至 0.1134， < 0.001）、计划/组织（ = 0.223，CrI：-0.1021 至-0.3436， = 0.004）和任务完成（ = -0.152，CrI：0.075 至 0.228， = 0.002）预测了 8 周试验中 PARS 评分改善的轨迹。对于接受安慰剂的年轻人，只有抑制评分与反应轨迹显著相关，但较弱（ = -0.081，CrI：-0.0167 至-0.1461， = 0.015）。对于那些在情绪控制、工作记忆、计划/组织和任务完成方面有临床显著障碍的青少年（即 T 评分>65），改善的轨迹与没有临床显著范围评分的患者显著不同。综上所述，这些发现表明，评估焦虑障碍青少年的执行功能可能是指导治疗选择的一种策略。这些数据表明，执行功能可能预测抗精神病药物治疗的反应，并为进一步个性化治疗指明了许多途径。
