Atferdsterapi og serotonin reopptakshemmere (SRIer) i behandling av tvangslidelse (OCD): Systematisk oversikt og metaanalyse av randomiserte kontrollerte studier med direkte sammenlikninger

Behavioral therapy and serotonin reuptake inhibitor pharmacotherapy in the treatment of obsessive-compulsive disorder: A systematic review and meta-analysis of head-to-head randomized controlled trials

Forfattere
Romanelli, R. J. Wu, F. M. Gamba, R. Mojtabai, R. Segal, J. B.
Årstall
2014
Tidsskrift
Depression and Anxiety
Volum
31
Sider
641-652
Background: Effective treatments for obsessive-compulsive disorder (OCD) include behavioral therapy (exposure and response/ritual prevention and cognitive behavioral therapy) and serotonin-reuptake inhibitors (SRIs); however, the relative efficacy of these treatments is not well established. We sought to review evidence from head-to-head randomized-controlled trials (RCTs) of behavioral therapy and SRIs in the treatment of OCD. Methods: A systematic search of multiple databases was conducted from first available date to June 30, 2012, for RCTs in the treatment of OCD among outpatients, comparing behavioral therapy and SRIs, alone or combined. Two independent reviewers evaluated studies for eligibility and risk of bias. The main outcome measure was posttreatment mean Yale-Brown Obsessive-Compulsive Scale (YBOCS) score. Results: We identified 2,186 unique articles. Fifteen articles were included, describing 13 RCTs. Pooled standardized mean difference (SMD; 95% confidence intervals) in YBOCS score significantly favored behavioral therapy over SRIs (0.37; 0.10, 0.64; P = .007), but not in a subset of trials that used selective SRIs (0.22; -0.02, 0.47; P = .070). Within individual trials, effect sizes significantly favored the combination of behavioral therapy plus an SRI over an SRI, but not behavioral therapy, alone. Conclusions: This review provides evidence that, among outpatients with OCD, behavioral therapy is more effective than SRIs, overall, but not selective SRIs. Furthermore, the combination of behavioral therapy plus an SRI is more effective than an SRI alone. These data may be used to inform the development of evidence-based treatment guidelines; however, more studies are also needed to further evaluate the relative efficacy of these interventions. (C) 2014 Wiley Periodicals, Inc.

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Tiltaksnivå

Behandling og hjelpetiltak

Tema

Psykiske vansker og lidelser

Angstproblematikk

Tvangsforstyrrelser (OCD)

Tiltak

Psykologiske behandlingsmetoder

Kognitiv atferdsterapi, atferdsterapi og kognitiv terapi

Medikamentell behandling

Antidepressiva

Aldersgruppe

Barn i skolealder (6-12 år)

Ungdom (13-18 år)

Uklar aldersgruppe

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