| Cognitive behavior therapy augmentation of pharmacotherapy in pediatric obsessive-compulsive disorder: the Pediatric OCD Treatment Study II (POTS II) randomized controlled trial. | |
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MedLine Citation:
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PMID: 21934055 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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CONTEXT: The extant literature on the treatment of pediatric obsessive-compulsive disorder (OCD) indicates that partial response to serotonin reuptake inhibitors (SRIs) is the norm and that augmentation with short-term OCD-specific cognitive behavior therapy (CBT) may provide additional benefit. OBJECTIVE: To examine the effects of augmenting SRIs with CBT or a brief form of CBT, instructions in CBT delivered in the context of medication management. DESIGN, SETTING, AND PARTICIPANTS: A 12-week randomized controlled trial conducted at 3 academic medical centers between 2004 and 2009, involving 124 pediatric outpatients between the ages of 7 and 17 years with OCD as a primary diagnosis and a Children's Yale-Brown Obsessive Compulsive Scale score of 16 or higher despite an adequate SRI trial. INTERVENTIONS: Participants were randomly assigned to 1 of 3 treatment strategies that included 7 sessions over 12 weeks: 42 in the medication management only, 42 in the medication management plus instructions in CBT, and 42 in the medication management plus CBT; the last included 14 concurrent CBT sessions. MAIN OUTCOME MEASURES: Whether patients responded positively to treatment by improving their baseline obsessive-compulsive scale score by 30% or more and demonstrating a change in their continuous scores over 12 weeks. RESULTS: The medication management plus CBT strategy was superior to the other 2 strategies on all outcome measures. In the primary intention-to-treat analysis, 68.6% (95% CI, 53.9%-83.3%) in the plus CBT group were considered responders, which was significantly better than the 34.0% (95% CI, 18.0%-50.0%) in the plus instructions in CBT group, and 30.0% (95% CI, 14.9%-45.1%) in the medication management only group. The results were similar in pairwise comparisons with the plus CBT strategy being superior to the other 2 strategies (P < .01 for both). The plus instructions in CBT strategy was not statistically superior to medication management only (P = .72). The number needed-to-treat analysis with the plus CBT vs medication management only in order to see 1 additional patient at week 12, on average, was estimated as 3; for the plus CBT vs the plus instructions in CBT strategy, the number needed to treat was also estimated as 3; for the plus instructions in CBT vs medication management only the number needed to treat was estimated as 25. CONCLUSIONS: Among patients aged 7 to 17 years with OCD and partial response to SRI use, the addition of CBT to medication management compared with medication management alone resulted in a significantly greater response rate, whereas augmentation of medication management with the addition of instructions in CBT did not. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00074815. |
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Authors:
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Martin E Franklin; Jeffrey Sapyta; Jennifer B Freeman; Muniya Khanna; Scott Compton; Daniel Almirall; Phoebe Moore; Molly Choate-Summers; Abbe Garcia; Aubrey L Edson; Edna B Foa; John S March |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Randomized Controlled Trial; Research Support, N.I.H., Extramural |
Journal Detail:
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Title: JAMA : the journal of the American Medical Association Volume: 306 ISSN: 1538-3598 ISO Abbreviation: JAMA Publication Date: 2011 Sep |
Date Detail:
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Created Date: 2011-09-21 Completed Date: 2011-09-23 Revised Date: 2012-04-26 |
Medline Journal Info:
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Nlm Unique ID: 7501160 Medline TA: JAMA Country: United States |
Other Details:
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Languages: eng Pagination: 1224-32 Citation Subset: AIM; IM |
Affiliation:
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Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA 19104, USA. marty@mail.med.upenn.edu |
| Data Bank Information | |
Bank Name/Acc. No.:
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ClinicalTrials.gov/NCT00074815 |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adolescent Child Cognitive Therapy* Combined Modality Therapy Female Humans Male Obsessive-Compulsive Disorder / therapy* Serotonin Uptake Inhibitors / therapeutic use* Severity of Illness Index Treatment Outcome |
| Grant Support | |
ID/Acronym/Agency:
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1R01MH064188-01A2/MH/NIMH NIH HHS; 2R01MH055121-06A2/MH/NIMH NIH HHS; 2R01MH055126-08A2/MH/NIMH NIH HHS |
| Chemical | |
Reg. No./Substance:
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0/Serotonin Uptake Inhibitors |
| Comments/Corrections | |
Comment In:
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Evid Based Ment Health. 2012 Feb;15(1):22
[PMID:
22184638
]
JAMA. 2012 Feb 8;307(6):560; author reply 560-1 [PMID: 22318271 ] |
Erratum In:
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JAMA. 2012 Apr 25;307(16):1694 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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