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Continued cognitive-behavior therapy versus sertraline for children and adolescents with obsessive-compulsive disorder that were non-responders to cognitive-behavior therapy: a randomized controlled trial.

Skarphedinsson G, Weidle B, Thomsen PH, Dahl K, Torp NC, Nissen JB, Melin KH, Hybel K, Valderhaug R, Wentzel-Larsen T, Compton SN, Ivarsson T - Eur Child Adolesc Psychiatry (2014)

Bottom Line: Within-group effect sizes were large and significant across both treatments.These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial.However, there was no significant between-group differences in SRT or continued CBT at post-treatment.

View Article: PubMed Central - PubMed

Affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484, Oslo, Norway, gudmundr@gmail.com.

ABSTRACT
Expert guidelines recommend cognitive-behavior therapy (CBT) as a first-line treatment in pediatric obsessive-compulsive disorder (OCD) and the addition of selective serotonin reuptake inhibitors when CBT is not effective. However, the recommendations for CBT non-responders are not supported by empirical data. Our objective was to investigate the effectiveness of sertraline (SRT) versus continued CBT in children and adolescents that did not respond to an initial course of CBT. Randomized controlled trial conducted in five sites in Denmark, Sweden and Norway, 54 children and adolescents, age 7-17 years, with DSM-IV primary OCD were randomized to SRT or continued CBT for 16 weeks. These participants had been classified as non-responders to CBT following 14 weekly sessions. Primary outcomes were the CY-BOCS total score and clinical response (CY-BOCS <16). The study was a part of the Nordic Long-Term OCD Treatment Study (NordLOTS). Intent-to-treat sample included 50 participants, mean age 14.0 (SD = 2.7) and 48 (n = 24) males. Twenty-one of 28 participants (75%) completed continued CBT and 15 of 22 participants (69.2%) completed SRT. Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments (p = .351), the response rate was 50.0% in the CBT group and 45.4% in the SRT group. The multivariate χ (2) test suggested that there were no statistically significant differences between groups (p = .727). Within-group effect sizes were large and significant across both treatments. These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial. However, there was no significant between-group differences in SRT or continued CBT at post-treatment.

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Related in: MedlinePlus

CONSORT flow diagram of the NordLOTS Step 2
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Fig1: CONSORT flow diagram of the NordLOTS Step 2

Mentions: A total of 54 participants were randomized to SRT or continued CBT. Four participants assigned to SRT were re-evaluated using the CY-BOCS due to a treatment delay of more than 3 weeks. These four participants scored below 16 on the CY-BOCS reassessment and were therefore considered Step 1 treatment responders and not eligible for Step 2 treatment. Thus, they were not included in the Step 2 ITT sample. There were no significant differences between treatment condition in the percentage of participants who dropped out (i.e., withdrew consent) of the study, χ2(1, 49) = 0.046, p = .830 (CBT = 25 %; SRT = 32 %). All SRT participants who dropped out did so because they were opposed to medication use for pediatric OCD. Six participants randomized to continued CBT did not wish to continue with CBT, while one participant terminated treatment because of somatic disease. For the remaining participants, treatment adherence for CBT was adequate, with 61.9 % (n = 13) of participating children showing “good” or “very good” levels of compliance and 95.2 % (n = 20) for CBT parents. In SRT, 53.3 % (n = 8) of participating children showed good or very good compliance and 90.5 % (n = 19) for SRT parents. The CONSORT flow diagram for the trial is shown in Fig. 1.Fig. 1


Continued cognitive-behavior therapy versus sertraline for children and adolescents with obsessive-compulsive disorder that were non-responders to cognitive-behavior therapy: a randomized controlled trial.

Skarphedinsson G, Weidle B, Thomsen PH, Dahl K, Torp NC, Nissen JB, Melin KH, Hybel K, Valderhaug R, Wentzel-Larsen T, Compton SN, Ivarsson T - Eur Child Adolesc Psychiatry (2014)

CONSORT flow diagram of the NordLOTS Step 2
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4419185&req=5

Fig1: CONSORT flow diagram of the NordLOTS Step 2
Mentions: A total of 54 participants were randomized to SRT or continued CBT. Four participants assigned to SRT were re-evaluated using the CY-BOCS due to a treatment delay of more than 3 weeks. These four participants scored below 16 on the CY-BOCS reassessment and were therefore considered Step 1 treatment responders and not eligible for Step 2 treatment. Thus, they were not included in the Step 2 ITT sample. There were no significant differences between treatment condition in the percentage of participants who dropped out (i.e., withdrew consent) of the study, χ2(1, 49) = 0.046, p = .830 (CBT = 25 %; SRT = 32 %). All SRT participants who dropped out did so because they were opposed to medication use for pediatric OCD. Six participants randomized to continued CBT did not wish to continue with CBT, while one participant terminated treatment because of somatic disease. For the remaining participants, treatment adherence for CBT was adequate, with 61.9 % (n = 13) of participating children showing “good” or “very good” levels of compliance and 95.2 % (n = 20) for CBT parents. In SRT, 53.3 % (n = 8) of participating children showed good or very good compliance and 90.5 % (n = 19) for SRT parents. The CONSORT flow diagram for the trial is shown in Fig. 1.Fig. 1

Bottom Line: Within-group effect sizes were large and significant across both treatments.These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial.However, there was no significant between-group differences in SRT or continued CBT at post-treatment.

View Article: PubMed Central - PubMed

Affiliation: Center for Child and Adolescent Mental Health, Eastern and Southern Norway, Gullhaugveien 1-3, 0484, Oslo, Norway, gudmundr@gmail.com.

ABSTRACT
Expert guidelines recommend cognitive-behavior therapy (CBT) as a first-line treatment in pediatric obsessive-compulsive disorder (OCD) and the addition of selective serotonin reuptake inhibitors when CBT is not effective. However, the recommendations for CBT non-responders are not supported by empirical data. Our objective was to investigate the effectiveness of sertraline (SRT) versus continued CBT in children and adolescents that did not respond to an initial course of CBT. Randomized controlled trial conducted in five sites in Denmark, Sweden and Norway, 54 children and adolescents, age 7-17 years, with DSM-IV primary OCD were randomized to SRT or continued CBT for 16 weeks. These participants had been classified as non-responders to CBT following 14 weekly sessions. Primary outcomes were the CY-BOCS total score and clinical response (CY-BOCS <16). The study was a part of the Nordic Long-Term OCD Treatment Study (NordLOTS). Intent-to-treat sample included 50 participants, mean age 14.0 (SD = 2.7) and 48 (n = 24) males. Twenty-one of 28 participants (75%) completed continued CBT and 15 of 22 participants (69.2%) completed SRT. Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments (p = .351), the response rate was 50.0% in the CBT group and 45.4% in the SRT group. The multivariate χ (2) test suggested that there were no statistically significant differences between groups (p = .727). Within-group effect sizes were large and significant across both treatments. These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial. However, there was no significant between-group differences in SRT or continued CBT at post-treatment.

Show MeSH
Related in: MedlinePlus