A Meta-Analysis of Cognitive Behavior Therapy and Medication for Child Obsessive-Compulsive Disorder: Moderators of Treatment Efficacy, Response, and Remission

McGuire, Joseph F.; Piacentini, John; Lewin, Adam B.; Brennan, Alan; Murphy, Tanya K.; Storch, Eric A.

doi:10.1002/da.22389

Cited by 246 publications

(121 citation statements)

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“…Although efficacious, 5 there is a clear need to improve CBT for pediatric OCD. Preliminary data among youth 29,30 and adults 24 with OCD, a recent fully powered study 28 among adults with OCD not taking an antidepressant, and several studies 12–16 of non-OCD anxiety highlight the potential for D-cycloserine to safely augment CBT.…”

Section: Discussionmentioning

confidence: 99%

“…2,3 Although most youths with OCD respond to cognitive behavior therapy (CBT) with exposure and response prevention (E/RP) or serotonin reuptake inhibitors, 4,5 many patients remain symptomatic after receiving therapy. Pharmacological interventions are efficacious but rarely produce remission, 6 may have adverse effects, 7 and may not be an acceptable intervention to parents.…”

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Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjustedd-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder

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IMPORTANCE Cognitive behavior therapy (CBT) among youth with obsessive-compulsive disorder (OCD) is effective, but many patients remain symptomatic after intervention. D-cycloserine, a partial agonist at the N-methyl-D-aspartate receptor in the amygdala, has been associated with enhanced CBT outcome for OCD among adults but requires evaluation among youth. OBJECTIVES To examine the relative efficacy of weight-adjusted D-cycloserine (25 or 50 mg) vs placebo augmentation of CBT for youth with OCD and to assess if concomitant antidepressant medication moderated effects. DESIGN, SETTING, AND PARTICIPANTS In a placebo-controlled randomized clinical trial, 142 youths (age range, 7-17 years) enrolled between June 1, 2011, and January 30, 2015, at 2 academic health science centers (University of South Florida and Massachusetts General Hospital) with a primary diagnosis of OCD were randomized in a double-blind fashion to D-cycloserine plus CBT or placebo plus CBT. Intent-to-treat analysis was performed. INTERVENTIONS Patients were randomly assigned in a 1:1 ratio to either 10 sessions of D-cycloserine plus CBT or placebo plus CBT. D-cycloserine (25 or 50 mg) or placebo was taken 1 hour before sessions 4 through 10. MAIN OUTCOMES AND MEASURES Children’s Yale-Brown Obsessive Compulsive Scale at randomization, biweekly, midtreatment, and posttreatment. Secondary outcomes included the Clinical Global Impressions–Severity or Clinical Global Impressions–Improvement, remission status, Children’s Depression Rating Scale, Multidimensional Anxiety Scale for Children, and Children’s Obsessive-Compulsive Impact Scale–Parent Version. RESULTS The study cohort comprised 142 participants. Their mean (SD) age was 12.7 (2.9) years, and 53.5% (76 of 142) were female. A mixed-effects model using all available data indicated significant declines in the Children’s Yale-Brown Obsessive Compulsive Scale total score and Clinical Global Impressions–Severity. No significant interaction between treatment group and changes in the Children’s Yale-Brown Obsessive Compulsive Scale and Clinical Global Impressions–Severity indicated that the D-cycloserine plus CBT group and the placebo plus CBT group declined at similar rates per assessment point on the Children’s Yale-Brown Obsessive Compulsive Scale total score (estimate, −2.31, 95% CI, −2.79 to −1.83 and estimate, −2.03, 95% CI, −2.47 to −1.58, respectively) and Clinical Global Impressions–Severity (estimate, −0.29, 95% CI, −0.35 to −0.22 and estimate, −0.23, 95% CI, −0.29 to −0.17, respectively). No group differences in secondary outcomes were present. Antidepressant medication use at baseline did not moderate changes for either group. CONCLUSIONS AND RELEVANCE D-cycloserine augmentation of CBT did not confer additional benefit relative to placebo among youth with OCD. Other augmentation approaches should be examined to enhance outcome. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00864123

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Section: Discussionmentioning

confidence: 99%

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Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjustedd-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder

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“…Eine rezente Meta-Analyse ermittelte für CBT (über 10 Studien) eine Remissionsrate von 57% und für Pharmakotherapie mit selektiven Serotonin-Wiederaufnahme-Hemmern (SSRI) über 3 Studien eine Remissionsrate von 47% [McGuire et al, 2015]. Einige Studien überprüften, ob die Kombination von CBT und SSRI einer Monotherapie überlegen ist.…”

Section: Empirische Evidenz Zur Behandlungunclassified

Fortschritte in der Behandlung von Zwangsstörungen bei Kindern und Jugendlichen: Empirische Evidenz, Behandlungsprobleme und Verbesserungsmöglichkeiten

Simons

Vloet

2017

Verhaltenstherapie

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Obwohl Zwangsstörungen im Kindes- und Jugendalter mittlerweile als gut behandelbar gelten, sind die Behandlungsergebnisse in der Praxis häufig unbefriedigend. Dies liegt daran, dass nachweislich wirksame Interventionen nicht oder unzureichend angewendet werden. Die vorliegende Arbeit gibt eine Übersicht über evidenzbasierte psychotherapeutische und medikamentöse Behandlungsmöglichkeiten. Die Behandlung der Wahl ist die Kognitive Verhaltenstherapie mit Exposition und Reaktionsverhinderung, die, falls erforderlich, um eine Pharmakotherapie mit einem selektiven Serotonin-Wiederaufnahme-Hemmer ergänzt wird. Befunde zu Prädiktoren, Moderatoren und Mediatoren der Behandlung sind uneinheitlich. Neue Entwicklungen in der Psychotherapie beinhalten Anwendungen der Expositionsbehandlung, die nicht einem Habituationsrational folgen, sondern auf Angsthemmung und Angsttoleranz sowie auf kognitive (Erwartungsverletzung) oder metakognitive Veränderungen abzielen. Bei Kindern mit geringer Behandlungsmotivation und starker Einbindung der Familie in die Zwänge des Kindes sind elternbezogene Interventionen indiziert. Behandlungsfehler in der Expositionsbehandlung sollten in der Ausbildung von Kinder- und Jugendlichenpsychotherapeuten besonders berücksichtigt werden.

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“…

Outcome of multidisciplinary, CBT-focused treatment for pediatric OCD Cognitive-behavioral therapy (CBT) and antidepressant medications are gold standard interventions for pediatric obsessive compulsive disorder (OCD) with evidence indicating CBT monotherapy as the single most effective intervention [6]. While these treatments as monotherapies or in combination are associated with response in as many as 80-85% of children, a sizable percentage of children either do not respond or are partial responders requiring more intensive treatment.

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confidence: 98%

Outcome of multidisciplinary, CBT-focused treatment for pediatric OCD

Eken

Jacobi

Riemann

et al. 2016

General Hospital Psychiatry

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A Meta-Analysis of Cognitive Behavior Therapy and Medication for Child Obsessive-Compulsive Disorder: Moderators of Treatment Efficacy, Response, and Remission

Cited by 246 publications

References 68 publications

Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjustedd-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder

Efficacy of Augmentation of Cognitive Behavior Therapy With Weight-Adjustedd-Cycloserine vs Placebo in Pediatric Obsessive-Compulsive Disorder

Fortschritte in der Behandlung von Zwangsstörungen bei Kindern und Jugendlichen: Empirische Evidenz, Behandlungsprobleme und Verbesserungsmöglichkeiten

Outcome of multidisciplinary, CBT-focused treatment for pediatric OCD

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