Systematic Review and Meta-Analysis: Cognitive-Behavioral Therapy for Obsessive-Compulsive Disorder in Children and Adolescents - 24/12/19
, Valdemar Funch Uhre, MSc a, b, c, Nicole Nadine Lønfeldt, MSc, PhD a, Linea Pretzmann, MSc a, Signe Vangkilde, MSc, PhD a, d, Kerstin Jessica Plessen, MD, PhD e, Christian Gluud, MD, Dr Med Sci f, g, Janus Christian Jakobsen, MD, PhD f, h, Anne Katrine Pagsberg, MD, PhD a, bAbstract |
Objective |
To assess benefits and harms of cognitive-behavioral therapy (CBT) versus no intervention or versus other interventions for pediatric obsessive-compulsive disorder (OCD).
Method |
We searched for randomized clinical trials of CBT for pediatric OCD. Primary outcomes were OCD severity, serious adverse events, and level of functioning. Secondary outcomes were quality of life and adverse events. Remission from OCD was included as an exploratory outcome. We assessed risk of bias and evaluated the certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE).
Results |
Nine trials (N = 645) were included comparing CBT with no intervention and 3 trials (N = 146) comparing CBT with selective serotonin reuptake inhibitors (SSRIs). Compared with no intervention, CBT decreased OCD severity (mean difference [MD] = −8.51, 95% CI = −10.84 to −6.18, p < .00001, low certainty), improved level of functioning (patient-rated: standardized MD [SMD] = −0.90, 95% CI = −1.19 to −0.62, p < .00001, very low certainty; parent-rated: SMD = −0.68, 95% CI = −1.12 to −0.23, p = .003, very low certainty), had similar proportions of participants with adverse events (risk ratio = 1.06, 95% CI = 0.93−1.22, p = .39, GRADE: low certainty), and was associated with reduced risk of still having OCD (risk ratio = 0.50, 95% CI = 0.37−0.67, p < .00001, very low certainty). We had insufficient data to assess the effect of CBT versus no intervention on serious adverse events and quality of life. Compared with SSRIs, CBT led to similar decreases in OCD severity (MD = −0.75, 95% CI = −3.79 to 2.29, p = .63, GRADE: very low certainty), and was associated with similar risk of still having OCD (risk ratio = 0.85, 95% CI = 0.66−1.09, p = .20, very low certainty). We had insufficient data to assess the effect of CBT versus SSRIs on serious adverse events, level of functioning, quality of life, and adverse events.
Conclusion |
CBT may be more effective than no intervention and comparable to SSRIs for pediatric OCD, but we are very uncertain about the effect estimates.
Le texte complet de cet article est disponible en PDF.Key words : cognitive-behavioral therapy, obsessive-compulsive disorder, systematic review
Plan
| The authors have reported no funding for this work. |
|
| Authors’ contributions: CU and VU conceived the project, collected data, analyzed data, drafted and revised the manuscript. NL and LP collected data, analyzed data and revised the manuscript. SV collected data and revised the manuscript. CG and JJ conceived the project, analyzed data and revised the manuscript. AP and KP conceived the project and revised the manuscript. All authors approved the final version of the manuscript. |
|
| This article is part of a special series devoted to the subject of anxiety and OCD. The series covers current topics in anxiety and OCD, including epidemiology, translational neuroscience, and clinical care. The series was edited by Guest Editor Daniel A. Geller, MBBS, FRACP. |
|
| Ms. C.F. Uhre and Mr. V.F. Uhre are co-first authors of this article. |
|
| Drs. Gluud and Jakobsen served as the statistical experts for this research. |
|
| The authors thank Sarah Louise Klingenberg, CandScientDi, of the University Hospital of Copenhagen, for making the search strategy and conducting the search in databases. |
|
| Disclosure: Ms. Funch Uhre has received funding from the Lundbeck Foundation (R191-2015-922). Mr. Funch Uhre has received funding from the Mental Health Services, Capital Region, Denmark. Drs. Lønfeldt, Vangkilde, Plessen, Gluud, Jakobsen, and Pagsberg, and Ms. Pretzmann have reported no biomedical financial interests or potential conflicts of interest. |
Vol 59 - N° 1
P. 64-77 - janvier 2020 Retour au numéro
Article précédent
- Meta-Analysis: 13-Year Follow-up of Psychotherapy Effects on Youth Depression
- Dikla Eckshtain, Sofie Kuppens, Ana Ugueto, Mei Yi Ng, Rachel Vaughn-Coaxum, Katherine Corteselli, John R. Weisz
- Review: Exteroceptive Sensory Abnormalities in Childhood and Adolescent Anxiety and Obsessive-Compulsive Disorder: A Critical Review
- David C. Houghton, Dan J. Stein, Bernadette M. Cortese
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?