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Gagnreynd þrepaskipt meðferð með dæmi af áráttu- og þráhyggjuröskun hjá börnum og unglingum

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Authors
Guðmundur Skarphéðinsson
Issue Date
2016

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Other Titles
Evidence-Based Sequential Treatments: Examples from Pediatric Obsessive- Compulsive Disorder
Citation
Sálfræðiritið 2016, 20-21:57–69
Abstract
Þó að gagnreyndum meðferðarúrræðum fyrir börn og unglinga með geðraskanir hafi fjölgað mikið á síðustu 30-40 árum, þá vantar enn mikið upp á reynslugögn fyrir framhaldsmeðferð. Margar geðraskanir eru langvinnar þar sem þörf er á meðferð, í einu eða öðru formi, í langan tíma. Í þessari grein er fjallað um nauðsyn þrepaskiptrar einstaklingsbundinnar meðferðar (sequential individualized treatment) svo hægt sé að ná betri meðferðarárangri, auka lífsgæði og starfshæfni til lengri tíma hjá fólki með langvinnar geðraskanir. Þrepaskipt meðferð má einnig kalla meðferðaráætlun sem er einstaklingsbundin og byggir á sjúklingaupplýsingum í upphafi meðferðar og á meðan meðferð stendur yfir. Þrepaskipt meðferð samræmist betur raunverulegum gangi sumra geðraskana, heldur en bráðameðferð sem á að leysa allan vanda sjúklings fyrir fullt og allt. Klínískar leiðbeiningar fjalla um þrepaskipta meðferð en það er sjaldgæft að reynslugögn um þrepaskipta meðferð búi að baki leiðbeiningunum. Í greininni eru tekin dæmi af áráttu- og þráhyggjuröskun hjá börnum og unglingum og ólíkum tilraunasniðum lýst. Sérstaklega verður fjallað um fjölþrepaslembivalsrannsókn (sequential multiple assignment randomized trials) eða SMART sem er afar gagnleg leið til þess að þróa og meta árangur meðferðaráætlunar fyrir þrepaskipta meðferð. Gagnlegum dæmum um óvissuatriði í klínískum leiðbeiningum verður lýst og fjallað um hvernig SMART tilraunasnið geti dregið úr slíkri óvissu. Einnig verður fjallað um atriði er varða afköst (power) í SMART tilraunasniði.
The status of evidence-based treatments for children with psychiatric disorders has improved significantly over the last 30-40 years. However, there is still a great need for evidence-based sequential treatments for patients with more chronic psychiatric disorders. In this paper, I discuss the necessity of sequential individualized treatments in order to obtain better treatment outcomes and increased quality of life over time for people with chronic psychiatric disorders. Sequential treatment is a form of treatment plan which is individualized and is based on patient characteristics at baseline and intermediate treatment outcomes. Sequential treatments may more accurately meet the needs of of more chronic psychatric disorders, compared to acute treatments that are supposed to cure the patient once and for all. Clinical guidelines discuss the need of sequential treatments but they are rarely evidence-based. The paper provides examples on how sequential treatments are needed for children and adolescents with obsessive-compulsive disorder. I present examples of appropriate research designs to evaluate sequential treatments for this group. Sequential multiple assignment randomized trials (SMART) will be discussed specifically. SMART is a very practical research design to develop and evaluate sequential treatments. I will describe specific examples of non-evidence-based sequential treatments recommended in clinical guidelines and present how a SMART design may be used to evaluate different treatment sequences. I will also discuss power issues when using the SMART design.
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Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn
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Icelandic Journal Articles (Peer Reviewed)

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