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Cognitive behaviour therapy (CBT) and selective serotonin reuptake inhibitors have both been established as effective interventions for paediatric obsessive-compulsive disorder (OCD), with CBT being the recommended first-line treatment in most cases. While the majority of young people respond well to these treatments, a significant proportion remain symptomatic. Although the research on treatment-resistant OCD remains limited, increasing empirical attention is being paid to predictors of treatment outcome in young people with OCD, and efforts are being made to identify the factors that hinder recovery. This article outlines potential barriers in treatment and highlights strategies for optimising outcome, with particular focus on cognitive behavioural techniques. 相似文献
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Xuan Liu Xiangyun Yang Pengchong Wang Zhanjiang Li 《International Journal of Mental Health Promotion, The》2022,24(6):843-854
Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous condition without a conclusive subtype dimension. This study will focus on the meta-analysis of the clinical responses of OCD subtypes to cognitive behavioral therapy (CBT), which might clarify this issue. Methods: We performed a systematic search and a meta-analysis for the studies of OCD subtypes and the response to CBT in PubMed, ScienceDirect, Embase, Web of Science, and Scopus databases. The selective criteria were the OCD without significant medical or psychiatric co-morbidities and pre-and post-treatment changes in scores of OCD dimension. In addition, different subtypes of OCD in symptom dimensions, such as symmetry, contamination, unacceptable thoughts, and hoarding, were compared to find the most significant subtype using the treatment response parameters by CBT. After limited selection, four studies and 479 OCD subjects were enrolled. The meta-analysis was performed by Review Manager 5.4, and only significant results were reported. Results: Among the OCD subtypes, the meta-analysis favors the hoarding subtype with poorer responses to CBT than symmetry, contamination, and unacceptable thoughts. The meta-analysis results were negative mean differences, significant tests for overall effect, and limited heterogeneities in the random effects model. In addition, the results were more significant when the hoarding subtype was compared with non-hoarding subtypes. Conclusion: The hoarding subtype might be the most significant representative subtype of OCD symptom dimension under the impression of unfavorable clinical response to CBT. However, future studies with more treatment parameters will be warranted to confirm this finding. 相似文献
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Tina R. Kilburn Merete Juul Sørensen Mikael Thastum Ronald M. Rapee Charlotte Ulrikka Rask Kristian Bech Arendt 《Nordic journal of psychiatry》2013,67(4-5):273-280
AbstractPurpose: Autism spectrum disorder (ASD) includes core symptoms that affect general and social development. High risk of developing comorbid disorders such as anxiety is prominent. Up to 60% of children with ASD suffer from anxiety disorders which can negatively influence educational, social and general development together with quality of life. This study is the first to investigate the feasibility of the manualised cognitive behavioural therapy (CBT) group programme 'Cool Kids ASD' for anxiety adapted for children with ASD in a general hospital setting.Methods: Nine children, aged 9–13 years, with ASD and anxiety recruited from a public child psychiatric health clinic were enrolled in the study. Outcome measures were collected from both child and parent pre- and post-treatment and at 3-month follow-up and included scores from a semi-structured anxiety interview, together with questionnaires on anxiety symptoms, life interference, children's automatic thoughts and satisfaction with the programme.Results: Eight out of nine families found the programme useful and would recommend it to other families in a similar situation. Six families attended all 12 sessions in the programme, two missed one session and one family only managed to attend eight sessions. At follow-up, five children were free of all anxiety diagnoses and a further two out of the nine children no longer met the criteria for their primary anxiety diagnosis.Conclusions: This study suggests that the transition of the group programme 'Cool Kids ASD' from University Clinics to standard child psychiatric clinical settings is feasible. Further randomised studies are needed to confirm the efficacy of the programme in a larger sample. 相似文献
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《Journal of anxiety disorders》2014,28(2):125-132
Little research has investigated changes in subjective distress during cognitive-behavioral therapy (CBT) for anxiety disorders in youth. In the current study, 40 youth diagnosed with primary obsessive-compulsive disorder (OCD; M age = 11.9 years, 60% male, 80% Caucasian) and 36 parent informants completed separate weekly ratings of child distress for each OC symptom during a 12-session course of CBT. Between-session changes in distress were calculated at the start of, on average throughout, and at the end of treatment. On average throughout treatment, child- and parent-reported decreases in child distress were significant. Baseline OCD severity, functional impairment, and internalizing symptoms predicted degree of change in child distress. Additionally, greater decreases in child distress were predictive of more improved clinical outcomes. Findings advance our understanding of the strengths and limitations of this clinical tool. Future studies should examine youth distress change between and within CBT sessions across both subjective and psychophysiological levels of analysis. 相似文献
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Shin-ichi Ishikawa Isa Okajima Hirofumi Matsuoka & Yuji Sakano 《Child and Adolescent Mental Health》2007,12(4):164-172
We conducted a meta-analysis using 20 randomised controlled studies of cognitive behavioural therapy (CBT) for anxiety disorders in children and adolescents. The mean pre-post effect size was d = 0.94, which was maintained at follow-up. The mean effect size when comparing the CBT and control group was d = 0.61. Within the CBT group, the mean effect size of university clinics ( d = 0.77) was larger than that of other clinics ( d = 0.37). The difference in effect sizes was hardly noticeable when comparing CBT with family or parents and CBT with child only ( d = 0.03). Further studies are required to examine the effectiveness of family CBT versus child CBT. 相似文献
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The use of a standardised protocol for the pharmacological (using Selective Serotonin Re-uptake Inhibitors—SSRIs) and psychological treatment of 10 consecutive adolescent patients with Obsessional Compulsive Disorder is reported. The psychological treatment consisted of exposure to the feared stimulus and cognitive behavioural treatment of anxiety associated with this procedure. The results suggest that there are benefits from both pharmacological and psychological treatments. However, both treatments were difficult to implement. For the SSRIs, some patients reported disinhibition of mood swings and behaviour. For those patients who showed benefits from the pharmacological treatments, there appeared to be a decrease in willingness to attempt psychological methods. The psychological methods require considerable time, which may not be available in clinics, and substantial effort by the patients. 相似文献
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Lehmkuhl HD Storch EA Bodfish JW Geffken GR 《Journal of autism and developmental disorders》2008,38(5):977-981
Obsessive Compulsive Disorder (OCD) involves exaggerated or excessive worry about threatening and non-threatening stimuli
coupled with impairing rituals believed to reduce anxiety. Autism Spectrum Disorders (ASD) are characterized by impairment
in social and communicative activities as well as restricted and repetitive behaviors. Approximately 2% of children with ASD
are also diagnosed with OCD. Although there is extensive research demonstrating the effectiveness of behavioral interventions
for pediatric OCD, little is known about how effective these treatments are for children who have a dual diagnosis of OCD
and ASD. This report describes a 12-year-old male with Autism who was treated successfully with cognitive behavioral therapy
with exposure and response prevention. This case study provides initial support that cognitive-behavioral therapy is effective
in symptom reduction for children with comorbid autism and OCD. 相似文献
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Obsessive-compulsive disorder (OCD) is ranked by the World Health Organization (WHO) among the 10 most debilitating disorders. The treatments which have been found effective are cognitive behavior therapy (CBT) and serotonin reuptake inhibitors (SRI). This meta-analysis includes all RCTs of CBT (25) and SRI (9) for OCD in youth using the Children’s Yale-Brown Obsessive Compulsive Scale (C-YBOCS). CBT yielded significantly lower attrition (12.7%) than SRI (23.5%) and placebo (24.7%). The effect sizes for comparisons of CBT with waiting-list (1.53), placebo (0.93), and SRI with placebo (0.51) were significant, whereas CBT vs. SRI (0.22) and Combo (CBT + SRI) vs. CBT (0.14) were not. Regarding response rate CBT (70%) and Combo (66%) were significantly higher than SRI (49%), which was higher than placebo (29%) and WLC (13%). As for remission CBT (53%) and Combo (49%) were significantly higher than SRI (24%), placebo (15%), and WLC (10%), which did not differ from each other. Combo was not more effective than CBT alone irrespective of initial severity of the samples. The randomized controlled trials (RCTs) have a number of methodological problems and recommendations for improving research methodology are discussed as well as clinical implications of the findings. 相似文献
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Himanshu Tyagi Annemieke M. Apergis-Schoute Harith Akram Tom Foltynie Patricia Limousin Lynne M. Drummond Naomi A. Fineberg Keith Matthews Marjan Jahanshahi Trevor W. Robbins Barbara J. Sahakian Ludvic Zrinzo Marwan Hariz Eileen M. Joyce 《Neuropsychopharmacology》2019,85(9):726-734
Background
Deep brain stimulation (DBS) is an emerging treatment for severe obsessive-compulsive disorder (OCD). We compared the efficacy of ventral capsule/ventral striatal (VC/VS) and anteromedial subthalamic nucleus (amSTN) DBS in the same patients and tested for mechanistic differences on mood and cognitive flexibility and associated neural circuitry. The possible synergistic benefit of DBS at both sites and cognitive behavioral therapy was explored.Methods
Six patients with treatment-refractory OCD (5 men; Yale-Brown Obsessive Compulsive Scale score >32) entered double-blind counterbalanced phases of 12-week amSTN or VC/VS DBS, followed by 12-week open phases when amSTN and VC/VS were stimulated together, in which optimal stimulation parameters were achieved and adjunctive inpatient cognitive behavioral therapy was delivered. OCD and mood were assessed with standardized scales and cognitive flexibility with the Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional Set-Shift task. Diffusion-weighted and intraoperative magnetic resonance imaging scans were performed for tractography from optimally activated electrode contacts.Results
DBS at each site significantly and equivalently reduced OCD symptoms with little additional gain following combined stimulation. amSTN but not VC/VS DBS significantly improved cognitive flexibility, whereas VC/VS DBS had a greater effect on mood. The VC/VS effective site was within the VC. VC DBS connected primarily to the medial orbitofrontal cortex, and amSTN DBS to the lateral orbitofrontal cortex, dorsal anterior cingulate cortex, and dorsolateral prefrontal cortex. No further improvement followed cognitive behavioral therapy, reflecting a floor effect of DBS on OCD.Conclusions
Both the VC/VS and amSTN are effective targets for severe treatment-refractory OCD. Differential improvements in mood and cognitive flexibility and their associated connectivity suggest that DBS at these sites modulates distinct brain networks. 相似文献15.
Tsung-Jen Lin Jo Yung-Wei Wu Tian Po Oei Hsien-Yuan Lane Chung-Hey Chen 《Archives of Suicide Research》2019,23(1):82-99
In this study the effectiveness of the condensed Dialectical Behavior Therapy Skills Training Group (DBTSTG) was compared to the Cognitive Therapy Group (CTG) in reducing depression and suicide reattempt and modifying emotion regulation strategies among those with borderline personality disorder (BPD). A total of 82 depressed BPD college students with a suicidal history within the past 6-months were randomly allocated to DBTSTG or CTG. Both groups had similar reductions in suicide reattempts and depression after the intervention and 6-month follow-ups. However, the CTG showed improvements in cognitive errors, but the DBTSTG revealed increases in acceptance and decreases in suppression scores. Both groups were effective in decreasing depression and suicide reattempt in BPD college students, probably through increasing adaptive antecedent-focused or response-focused strategies of emotion regulation, respectively. 相似文献
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Sung-Chul Jin Do Hoon Kwon Jae-Sung Ahn Byung-Duk Kwun Young Song Choong-Gon Choi 《Journal of Korean Neurosurgical Society》2009,45(1):5-10
Objective
Direct surgical clipping of paraclinoid aneurysms poses technical challenges to even very experienced neurosurgeons, making endovascular treatment an alternative treatment modality in many centers. We have therefore retrospectively evaluated the safety and efficacy of endovascular detachable coil embolization of paraclinoid aneurysms.Methods
From June 1997 to June 2007, 65 patients underwent endovascular detachable coiling for 67 paraclinoid aneurysms (of which 9 were ruptured and 58 were unruptured) in our institute. Their medical records, radiological images and readings, and operation records were reviewed retrospectively.Results
After the initial embolization procedure, complete occlusion was achieved in 29 (43.3%) of the aneurysms treated by endovascular detachable coiling. Six aneurysms required retreatment, with two each requiring one, two, or three additional endovascular procedures. Fifty-five (82.1%) aneurysms were measured by three-dimensional time of flight (TOF) magnetic resonance images (MRI) or transfemoral cerebral angiography (TFCA) at a mean follow-up of 29.7 months (range from 4 to 94 months), with 39 aneurysms (70.9%) showing complete occlusion. Thromboembolic events (3.8%) were the most frequent complication. Rupture did not occur during or after any of the procedures. According to the Glasgow Outcome Scale (GOS), 98.4% of the patients treated by coil embolization had a score of 4 or 5.Conclusion
Our results indicate that endovascular detachable coiling is a safe and effective treatment modality in paraclinoid aneurysms. 相似文献17.
Hisato Matsunaga Tokuzo Matsui Kenzo Ohya Kenya Okino Kazuhisa Hayashida Kensei Maebayashi 《International journal of psychiatry in clinical practice》2013,17(2):142-145
Even though selective serotonin reuptake inhibitors (SSRIs) are the mainstay of pharamacological treatment for obsessive-compulsive disorder (OCD), as many as 40% of patients do not have an adequate response to these medications. For such SSRI-refractory patients, the augmentation of SSRIs with new-generation antipsychotics that modulate both 5-HT and DA systems has recently been proven effective in controlled augmentation studies. The benzisothiazole derivative perospirone is a new serotonin 5-HT2 and dopamine D2 antagonist available in Japan for the treatment of schizophrenia. As its unique property, perospirone also exhibits 5-HT1A agonistic action. We present two SSRI-refractory OCD patients who showed little improvement with adequate trials of SSRI monotherapy, but exhibited significant improvement in their OCD symptoms after the addition of perospirone to ongoing SSRI treatment. The cases suggest that perospirone augmentation may be an effective and well-tolerated strategy for SSRI-refractory OCD patients. Controlled studies are required to further confirm the efficacy and tolerability of perospirone augmentation for treatment-resistant OCD. 相似文献
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Heather D. Hadjistavropoulos Vanessa Peynenburg David L. Thiessen Marcie Nugent Eyal Karin Lauren Staples Blake F. Dear Nickolai Titov 《Revue canadienne de psychiatrie》2022,67(3):192
Objective:There is strong evidence supporting internet-delivered cognitive behaviour therapy (iCBT) and consequently growing demand for iCBT in Canada. Transdiagnostic iCBT that addresses both depression and anxiety is particularly promising as it represents an efficient method of delivering iCBT in routine care. The Online Therapy Unit, funded by the Saskatchewan government, has been offering transdiagnostic iCBT for depression and anxiety since 2013. In this article, to broadly inform implementation efforts, we examined trends in utilization, patient characteristics, and longitudinal improvements for patients receiving transdiagnostic iCBT over 6 years.Methods:Patients who completed telephone screening between November 2013 and December 2019 were included in this observational study. Patients provided demographics and mental health history at screening and completed measures at pre-treatment, post-treatment and at 3- to 4-month follow-up. Treatment engagement and satisfaction were assessed.Results:A total of 5,321 telephone screenings were completed and 4,283 of patients were accepted for treatment over the 6-year period (80.5% acceptance). The most common reason for referral to another service was high suicide risk/severe symptoms (47.1%). Examination of trends showed growing use of transdiagnostic iCBT over time (37% increase per year). There was remarkable stability in patient characteristics across years. Most patients were concurrently using medication (57.3%) with 11.9% reporting using iCBT while on a waiting list for face-to-face treatment highlighting the importance of integrating iCBT with other services. Consistent across years, large improvements in depression and anxiety symptoms were found and maintained at 3- to 4-month follow-up. There was strong patient engagement with iCBT and positive ratings of treatment experiences.Conclusions:As there is growing interest in iCBT in Canada, this large observational study provides valuable information for those implementing iCBT in terms of likely user characteristics, patterns of use, and improvements. This information has potential to assist with resource allocation and planning in Canada and elsewhere. 相似文献
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Tamara Pringsheim Lauren Hirsch David Gardner Daniel A Gorman 《Revue canadienne de psychiatrie》2015,60(2):52-61
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Attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) are among the most common psychiatric diagnoses in childhood. Aggression and conduct problems are a major source of disability and a risk factor for poor long-term outcomes.Methods:
We performed a systematic review and meta-analysis of randomized controlled trials (RCTs) of antipsychotics, lithium, and anticonvulsants for aggression and conduct problems in youth with ADHD, ODD, and CD. Each medication was given an overall quality of evidence rating based on the Grading of Recommendations Assessment, Development and Evaluation approach.Results:
Eleven RCTs of antipsychotics and 7 RCTs of lithium and anticonvulsants were included. There is moderate-quality evidence that risperidone has a moderate-to-large effect on conduct problems and aggression in youth with subaverage IQ and ODD, CD, or disruptive behaviour disorder not otherwise specified, with and without ADHD, and high-quality evidence that risperidone has a moderate effect on disruptive and aggressive behaviour in youth with average IQ and ODD or CD, with and without ADHD. Evidence supporting the use of haloperidol, thioridazine, quetiapine, and lithium in aggressive youth with CD is of low or very-low quality, and evidence supporting the use of divalproex in aggressive youth with ODD or CD is of low quality. There is very-low-quality evidence that carbamazepine is no different from placebo for the management of aggression in youth with CD.Conclusion:
With the exception of risperidone, the evidence to support the use of antipsychotics and mood stabilizers is of low quality. 相似文献20.
Lana Donse Frank Padberg Alexander T. Sack A. John Rush Martijn Arns 《Brain stimulation》2018,11(2):337-345