The effect of fluvoxamine and behavior therapy on children and adolescents with obsessive-compulsive disorder
ABSTRACT The efficacy of medications, consisting of serotonin partial and specific reuptake blockers, and behavior therapy, consisting of exposure and response prevention in addition to social skills training, cognitive therapy, and habit reversal, in the treatment of obsessive-compulsive disorder are well documented. The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy.
Ten children/adolescents who had not previously responded to behavior therapy were randomly assigned to two groups: fluvoxamine alone or fluvoxamine with behavior therapy. All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year.
Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable, the Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS). According to the other measurements-National Institute of Mental Health-Global Obses-sive-Compulsive Scale, Clinical Global Impression-Improvement (assessing level of im-provement from week to week), and Clinical Global Impression-Severity of Illness Scale (as-sessing how ill the patient is from week to week)-improvement was not as evident. According to the CY-BOCS, those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication. At two-year follow-up, all patients continued to improve, with those in the combined approach improving more than those in the medication-alone group.
Future studies should determine the specific effect of each treatment group, combined and singularly. Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed. The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy, according to the CY-BOCS.
Full-textDOI: · Available from: Fugen Neziroglu, Jan 08, 2014
[Show abstract] [Hide abstract]
ABSTRACT: Unter Zwangsstörungen werden wiederkehrende und anhaltende Verhaltensweisen, Ideen, Gedanken und Impulse verstanden, die sich gegen in neren Widerstand aufdrängen und vom Patienten als unsinnig, übertrieben oder quälend erlebt werden. Zwangsstörungen lassen sich untergliedern in • Zwangsgedanken und/oder • Zwangshandlungen Bei den Zwangsgedanken handelt es sich um Ideen, Vorstellungen oder Impulse, die sich dem Erkrankten gegen seinen Willen aufdrängen und ihn immer wieder beschäftigen. Meist sind es zwanghafte Befürchtungen, die sich inhaltlich auf Verschmutzung, Bakterien, Infektionen, Symmetrie, Genauigkeit oder das Sammeln von Gegenständen beziehen können. Oder es sind Vorstellungen und Bilder aggressiver, sexueller oder religiöser Natur, die sich dem Bewusstsein aufdrängen.
[Show abstract] [Hide abstract]
ABSTRACT: The identification of efficacious psychological and psychiatric therapies is arguably one of the most significant achievements in the pediatric anxiety disorders field. Controlled trials have supported the usefulness of psychological and pharmacological monotherapies for pediatric obsessive–compulsive disorder, social anxiety disorder, panic disorder, agoraphobia, generalized anxiety disorder, specific phobia, posttraumatic stress disorder, and separation anxiety disorder (Compton et al., 2004; Feeney, Foa, Treadwell, & March, 2004; In-Albon & Schneider, 2007; Reinblatt & Riddle, 2007; Seidel & Walkup, 2006; Watson & Rees, 2008). Clinical practice guidelines, developed from a synthesis of research evidence and expert opinion, have recommended cognitive-behavioral therapy (CBT) as the first line psychotherapy and treatment of choice (American Academy of Child and Adolescent Psychiatry (AACAP), 2007; Canadian Psychiatric Association (CPA), 2006). The selective serotonin reuptake inhibitors (SSRIs) are the recommended first-line pharmacological agents for pediatric anxiety disorders. Second or third-line pharmacotherapy alternatives include noradrenergic antidepressants (tricyclic antidepressants (TCAs), venlafaxine), benzodiazepines, and buspirone.
Revista Brasileira de Psiquiatria 01/2007; 29(3). DOI:10.1590/S1516-44462006005000046 · 1.64 Impact Factor