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Gagnreynd meðferð við áráttu- og þráhyggjuröskun hjá börnum og unglingum: Yfirlitsgrein

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Authors
Guðmundur Skarphéðinsson
Bertrand Lauth
Urður Njarðvík
Tord Ivarsson
Issue Date
2016-04

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Other Titles
A Review and Recommendations of Evidence-Based Treatments for Pediatric Obsessive-Compulsive Disorder
Citation
Læknablaðið 2016, 102(04):179-185
Abstract
Áráttu- og þráhyggjuröskun (ÁÞR) hjá börnum og unglingum einkennist af þráhyggjukenndum hugsunum og áráttukenndri hegðun eða hugsun. Í þessari yfirlitsgrein er lýst gagnreyndri meðferð við ÁÞR meðal barna og unglinga. Leitað var í PubMED að öllum samanburðarrannsóknum, yfirlitsgreinum og klínískum leiðbeiningum. Hugræn atferlismeðferð (HAM) og sérhæfð serótónín-endurupptökuhamlandi lyf (SSRI) eru áhrifarík með- ferðarform fyrir börn og unglinga sem koma fyrsta sinn í meðferð. Í samanburðarrannsóknum hefur HAM vinninginn. Rannsóknir á börnum sem svara fyrstu meðferð illa eru takmarkaðar en benda þó til þess að áframhaldandi HAM og SSRI séu áhrifarík úrræði fyrir þá sem ekki svara HAM en HAM+SSRI sé áhrifaríkasta úrræðið fyrir þá sem ekki svara SSRI og hafa aldrei verið meðhöndlaðir með HAM. Fyrri rannsóknir eru í samræmi við klínískar leiðbeiningar þar sem fyrsta úrræði er HAM þegar aðgengi að kunnáttumönnum í HAM er til staðar. HAM er einnig jafn árangursríkt og SSRI hjá þeim sem enn hafa talsverð einkenni eftir 14 vikur. Niðurstöður bentu ekki til þess að HAM+SSRI sé áhrifaríkara en HAM veitt af sérfræðingum. HA
Pediatric obsessive-compulsive disorder (OCD) is characterized by recurrent obsessions and compulsions. In this review we depict evidence- -based treatments for pediatric OCD patients. We searched PubMed for relevant publications including randomized controlled trials, reviews, and expert guidelines. Substantial evidence for cognitive behavior therapy (CBT) and specific serotonin reuptake inhibitors (SSRIs) among treatment-naïve patients shows that both treatments are effective. CBT is significantly more effective than SSRI based on head-to-head trials. The evidence for CBT- or SSRI-resistant patients is limited but indicates that CBT and SSRI are effective treatments for CBT non-responders while a combination of CBT and SSRI is the most effective treatment for SSRI non-responders with no prior exposure to CBT. The current data support clinical guidelines indicating that when CBT expertise is present, one can successfully treat patients with CBT. CBT is also as effective as SSRI in non-responders after 14 weeks of CBT. The results did not indicate that combined treatment of CBT and SSRI is more effective than CBT delivered by experts. However, combined treatment is more effective than SSRI in SSRI non-responders
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To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.
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http://www.laeknabladid.is
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Icelandic Journal Articles (Peer Reviewed)

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