March J S, Mulle K, Herbel B
Department of Psychiatry, Duke University Medical Center, NIMH Scientist Development Award for Clinicians, Durham, NC 27710.
J Am Acad Child Adolesc Psychiatry. 1994 Mar-Apr;33(3):333-41. doi: 10.1097/00004583-199403000-00006.
The authors present an open trial of cognitive-behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder.
The authors developed a treatment manual explicitly designed to facilitate (1) patient and parental compliance, (2) exportability, and (3) empirical evaluation. Successive versions of the manual were used to treat 15 consecutive child and adolescent patients with obsessive-compulsive disorder, most of whom were also treated with medications.
Statistical analyses showed a significant benefit for treatment immediately posttreatment and at follow-up. Nine patients experienced at least a 50% reduction in symptoms on the Yale-Brown Obsessive-Compulsive Scale at posttreatment; 6 were asymptomatic on the National Institute of Mental Health Global Obsessive-Compulsive Scale. No patients relapsed at follow-up intervals as long as 18 months. Booster behavioral treatment allowed medication discontinuation in 6 patients. No patient refused treatment; 2 discontinued prematurely.
Cognitive-behavioral psychotherapy, alone or in combination with pharmacotherapy, appears to be a safe, acceptable, and effective treatment for obsessive-compulsive disorder in children and adolescents.
作者开展了一项针对患有强迫症的儿童和青少年的认知行为心理治疗开放性试验。
作者编写了一本治疗手册，明确旨在促进（1）患者和家长的依从性，（2）可推广性，以及（3）实证评估。该手册的后续版本用于治疗15例连续的患有强迫症的儿童和青少年患者，其中大多数患者还接受了药物治疗。
统计分析表明，治疗后即刻及随访时治疗有显著益处。9例患者在治疗后耶鲁-布朗强迫症量表上症状至少减轻了50%；6例在国立精神卫生研究所总体强迫症量表上无症状。在长达18个月的随访期内无患者复发。强化行为治疗使6例患者能够停用药物。无患者拒绝治疗；2例提前终止治疗。
认知行为心理治疗，单独使用或与药物治疗联合使用，似乎是治疗儿童和青少年强迫症的一种安全、可接受且有效的方法。
