Franklin M E, Kozak M J, Cashman L A, Coles M E, Rheingold A A, Foa E B
Allegheny University of the Health Sciences, Philadelphia, Philadelphia, PA 19129, USA.
J Am Acad Child Adolesc Psychiatry. 1998 Apr;37(4):412-9. doi: 10.1097/00004583-199804000-00019.
The purpose of this open clinical trial was to examine the efficacy of cognitive-behavioral treatment involving exposure and ritual prevention for pediatric obsessive-compulsive disorder (OCD).
Children and adolescents with diagnosed OCD (N = 14) received cognitive-behavioral treatment, seven patients received intensive treatment (mean = 18 sessions over 1 month) and seven received weekly treatment (mean = 16 sessions over 4 months). Eight of these patients received concurrent treatment with serotonin reuptake inhibitors and six received cognitive-behavioral treatment alone. Outcome was assessed via interviewer ratings on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), Obsessive Compulsive Rating Scales for Main Fear and Main Ritual, and Hamilton Depression Rating Scale.
Cognitive-behavioral treatment was effective in ameliorating OCD symptoms. Twelve of the 14 patients were at least 50% improved over pretreatment Y-BOCS severity, and the vast majority remained improved at follow-up; mean reduction in Y-BOCS was 67% at posttreatment and 62% at follow-up (mean time to follow-up = 9 months).
Results suggest that cognitive-behavioral treatment by exposure and ritual prevention is effective for pediatric OCD. Controlled studies with random assignment to conditions are warranted to evaluate the relative efficacy of cognitive-behavioral pharmacological, and combined treatments.
本开放性临床试验旨在检验针对儿童强迫症（OCD）的包含暴露和仪式预防的认知行为疗法的疗效。
确诊为OCD的儿童和青少年（N = 14）接受认知行为疗法，7名患者接受强化治疗（1个月内平均18次治疗），7名患者接受每周一次的治疗（4个月内平均16次治疗）。其中8名患者同时接受5-羟色胺再摄取抑制剂治疗，6名患者仅接受认知行为疗法。通过访谈者根据耶鲁-布朗强迫症量表（Y-BOCS）、主要恐惧和主要仪式的强迫症状评定量表以及汉密尔顿抑郁量表进行评定来评估结果。
认知行为疗法在改善OCD症状方面有效。14名患者中有12名与治疗前相比Y-BOCS严重程度改善至少50%，并且绝大多数患者在随访时仍保持改善状态；治疗后Y-BOCS平均降低67%，随访时降低62%（平均随访时间 = 9个月）。
结果表明，通过暴露和仪式预防的认知行为疗法对儿童OCD有效。有必要进行随机分组对照研究，以评估认知行为疗法、药物疗法及联合疗法的相对疗效。
