Evaluierte Behandlungsansätze in der Kinder- und Jugendpsychiatrie II
Abstract
Zusammenfassung:Fragestellung: Prinzip der evidenzbasierten Medizin ist es, bei klinischen Entscheidungen über die Behandlung von Patienten auch die Ergebnisse empirischer Untersuchungen einzubeziehen. Somit war es Ziel, das Evaluationsniveau psychotherapeutischer, psychopharmakologischer und kombinierter Behandlungsansätze bei verschiedenen psychiatrischen Störungsbildern im Kindes- und Jugendalter (schizophrene Störungen, affektive Störungen, phobische und andere Angststörungen, Zwangsstörung, posttraumatische Belastungsstörung, Anorexia nervosa und Bulimia nervosa) zu bestimmen. Methodik: Für psychotherapeutische sowie psychopharmakologische Behandlungsansätze wurden drei verschiedene Evaluationsniveaus definiert, nämlich A (≥ 2 kontrollierte, randomisierte Studien zur Überprüfung der Wirksamkeit), B (1 kontrollierte, randomisierte Studie) und C (offene Studien und Kasuistiken). Die mittels einer Literaturrecherche gefundenen empirischen Arbeiten wurden zur Bestimmung des Evaluationsniveaus der jeweiligen Behandlungsansätze herangezogen. Ergebnisse: Hier ist die Anzahl kontrollierter Studien im Kindes- und Jugendalter vergleichsweise gering, insbesondere bezüglich pharmakotherapeutischer Behandlungsansätze. Gut evaluiert ist die (kognitive) Verhaltenstherapie zur Behandlung depressiver Störungen, phobischer und Angststörungen und posttraumatischer Belastungsstörungen. Schlussfolgerungen: Hoher Evaluationsbedarf besteht bezüglich der medikamentösen Behandlung schizophrener und affektiver Störungen. Für psychotherapeutische Behandlungsansätze bei schizophrenen Störungen, Zwangsstörungen und Essstörungen erscheint eine Evaluation hinsichtlich spezifischer Aspekte des Kindes- und Jugendalters sehr wünschenswert. Insgesamt ist der am besten evaluierte psychotherapeutische Behandlungsansatz die (kognitive) Verhaltenstherapie.
Objectives: The principle of evidence-based medicine is to integrate data concerning the efficacy of interventions into clinical practice. This article assesses the level of evaluation of psychosocial, psychopharmacological and combined interventions for mental disorders in childhood and adolescence (schizophrenic disorders, affective disorders, phobias and anxiety disorders, obsessive-compulsive disorder, posttraumatic stress disorder, anorexia nervosa, and bulimia nervosa). Methods: Three different levels of evaluation were defined for both psychosocial and psychopharmacological interventions: A (≥ 2 randomized controlled studies), B (1 randomized controlled study), and C (open studies and case studies). The level of evaluation was judged on the basis of original papers found in a comprehensive literature search. Results: The number of controlled studies examining these disorders in children and adolescents is small, especially with regard to pharmacotherapy. However, the efficacy of (cognitive) behavior therapy for depressive disorders, phobias and anxiety disorders, as well as posttraumatic stress disorder has been demonstrated. Conclusions: There is still a considerable need to evaluate pharmacological treatment approaches for schizophrenic and affective disorders. Looking at psychosocial interventions in schizophrenic disorders, obsessive-compulsive disorder and eating disorders, specific aspects of treatment for young patients should be examined. Overall, the psychotherapy approach evaluated best is (cognitive) behavioral therapy.
Literatur
A multicenter comparison of cognitive-behavioral therapy and interpersonal psychotherapy for bulimia nervosa.. Archives of General Psychiatry, 57, 459– 466 (2000).
Multicenter open-label sertraline study in adolescent outpatients with major depression.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 566– 572 (1999).
Risperidone in adolescents with schizophrenia: an open pilot study.. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 694– 700 (1997).
Combination of antidepressants and psychological treatments for bulimia nervosa: a systematic review.. Acta Psychiatrica Scandinavica, 101, 256– 264 (2000).
Fluvoxamine for phobia of storms.. Acta Psychiatrica Scandinavica, 100, 244– 245 (1999).
Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders.. Journal of Clinical Child Psychology, 27, 459– 468 (1998).
The present status of operant conditioning for the treatment of anorexia nervosa.. Behavior Modification, 11, 432– 463 (1987).
Imipramine plus cognitive-behavioral therapy in the treatment of school refusal.. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 276– 283 (2000).
Clinical outcome after short-term psychotherapy for adolescents with major depressive disorder.. Archives of General Psychiatry, 57, 29– 36 (2000).
Randomized, controlled trial of amitriptyline versus placebo for adolescents with “treatment-resistant” mjaor depression.. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 527– 535 (1998).
Efficacy and safety of sertraline treatment of posttraumatic stress disorder: a randomized controlled trial.. Journal of the American Medical Association, 283, 1837– 1844 (2000).
Treatment of cognitive dysfunctions and behavioral deficits in schizophrenia.. Schizophrenia Bulletin, 18, 21– 26 (1992).
A clinical psychotherapy trial for adolescent depression comparing cognitive, family, and supportive therapy.. Archives of General Psychiatry, 54, 877– 885 (1997).
A variation of thought stopping in a twelve-year-old boy: A case report.. Journal of Behavior Therapy and Experimental Psychiatry, 4, 69– 70 (1973).
Pulse clomipramine for depressed adolescents.. American Journal of Psychiatry, 155, 995– (1998).
Is valproate pharmacotherapy associated with polycystic ovaries?. Annals of Pharmacotherapy, 33, 1211– 1216 (1999).
Cognitive-behavioral treatment of adolescent depression: efficacy of acute group treatment and booster sessions.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 272– 279 (1999).
Effects of psychoeducational intervention for married patients with bipolar disorder and their spouses.. Psychiatric Services, 49, 531– 533 (1998).
An auditory variant of eye movement desensitization in a case of childhood post-traumatic stress disorder.. Journal of Behavior Therapy and Experimental Psychiatry, 24, 373– 377 (1993).
A treatment outcome study for sexually abused preschool children: initial findings.. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 42– 50 (1996).
A treatment study for sexually abused preschool children: outcome during a one-year follow-up.. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1228– 1235 (1997).
The effectiveness of emotive imagery in the treatment of darkness phobia in children.. Behaviour Change, 9, 171– 177 (1997).
Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one-year follow-up.. Psychiatry Research, 49, 63– 75 (1993).
Behavior therapy versus clomipramine for the treatment of obsessive-compulsive disorder in children and adolescents.. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 1022– 1029 (1998).
Differential symptom reduction by drugs and psychotherapy in acute depression.. Archives of General Psychiatry, 36, 1450– 1456 (1979).
A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression.. Archives of General Psychiatry, 54, 1031– 1037 (1997).
Open fluoxetine treatment of mixed anxiety disorders in children and adolescents.. Journal of Child and Adolescent Psychopharmacology, 7, 17– 29 (1997).
Three psychological treatments for bulimia nervosa.. A comparative trial. Archives of General Psychiatry, 48, 463– 469 (1991).
Psychotherapy and bulimia nervosa. Longer-term effects of interpersonal psychotherapy, behavior therapy and cognitive behavior therapy.. Archives of General Psychiatry, 50, 419– 428 (1993).
A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments.. Archives of General Psychiatry, 52, 304– 312 (1995).
Family management in the prevention of morbidity of schizophrenia. Clinical outcome of a two-year longitudinal study.. Archives of General Psychiatry, 42, 887– 896 (1985).
Propanolol treatment for childhood posttraumatic stress disorder, acute type.. American Journal of Diseases of Children, 142, 1244– 1247 (1988).
Effect of decreasing afferent vagal activity with ondansetron on symptoms of bulimia nervosa: a randomised, double-blind trial.. Lancet, 355, 792– 797 (2000).
Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents.. Journal of Child and Adolescent Psychopharmacology, 8, 61– 67 (1998).
Risperidone augmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder.. Journal of Child and Adolescent Psychopharmacology, 9, 115– 123 (1999).
Clomipramine treatment of childhood obsessive-compulsive disorder. A double-blind controlled study.. Archives of General Psychiatry, 42, 977– 983 (1985).
Fluoxetine in the treatment of bulimia nervosa. A multicenter, placebo-controlled, double-blind trial.. Archives of General Psychiatry, 49, 139– 147 (1992).
Childhood obsessive-compulsive disorder: extinction of compulsive reassurance seeking.. Journal of Anxiety Disorders, 2, 361– 368 (1988).
Risperidone treatment for juvenile bipolar disorder: a retrospective chart review.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 960– 965 (1999).
Hypnotherapy with traumatized children.. International Journal of Clinical and Experimental Hypnosis, 39, 67– 81 (1991).
Intermittent medication - an alternative?. Acta Psychiatrica Scandinavica, Suppl. 382, 33– 38 (1994).
Double-blind, placebo-controlled study of nortriptyline in depressed adolescents using a “fixed plasma level” design.. Psychopharmacology Bulletin, 26, 85– 90 (1990).
Pharmacokinetically designed double-blind placebo-controlled study of nortriptyline in 6- to 12-year-olds with major depressive disorder.. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 34– 44 (1992).
Double-blind and placebo-controlled study of lithium for adolescent bipolar disorders with secondary substance dependency.. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 171– 178 (1998).
Controlled imipramine treatment of school phobia.. Archives of General Psychiatry, 25, 204– 207 (1971).
Effectiveness of fluoxetine therapy in bulimia nervosa regardless of comorbid depression.. International Journal of Eating Disorders, 25, 19– 27 (1999).
Long-term fluoxetine treatment of bulimia nervosa. Fluoextine Bulimia Nervosa Research Group.. British Journal of Psychiatry, 166, 660– 666 (1995).
Clonazepam in childhood anxiety disorders.. Journal of the American Academy of Child and Adolescent Psychiatry, 33, 372– 376 (1994).
Family self-control instruction for children's nighttime rear reduction.. Journal of Consulting and Clinical Psychology, 48, 206– 213 (1980).
Behavioral treatment of “nightfears” in children: maintenance of improvement at 2½- to 3-year follow-up.. Journal of Consulting and Clinical Psychology, 50, 598– 599 (1982).
Clonidine for posttraumatic stress disorder in preschool children.. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1247– 1249 (1996).
Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study.. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 721– 726 (2000).
Family psychoeducation, social skills training, and maintenance chemotherapy in the aftercare treatment of schizophrenia. I. One-year effects of a controlled study on relapse and expressed emotion.. Archives of General Psychiatry, 43, 633– 642 (1986).
Combination of behaviour therapy with fluvoxamine in comparison with behaviour therapy and placebo. Results of a multicentre study.. British Journal of Psychiatry, Suppl. 35, 71– 78 (1999).
Psychoeducation in bipolar disorder: effect on expressed emotion.. Psychiatry Research, 72, 17– 22 (1997).
Guanfacine for PTSD nightmares.. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 975– 976 (1996).
Moclobemide in social phobia. A double-blind, placebo-controlled clinical study.. European Archives of Psychiatry and Clinical Neurosciences, 247, 71– 80 (1997).
Polycystic ovaries and hyperandrogenism in women taking valproate for epilepsy.. New England Journal of Medicine, 329, 1383– 1388 (1993).
Reduction of children's fear of the dark by competence-related and situational threat-related verbal cues.. Journal of Consulting and Clinical Psychology, 43, 251– 258 (1975).
Compliance therapy in psychotic patients: randomised controlled trial.. British Medical Journal, 312, 345– 349 (1996).
Randomined controlled trial of compliance therapy. 18-month follow-up.. British Journal of Psychiatry, 172, 413– 419 (1998).
Therapy for youths with anxiety disorders: a second randomized clinical trail.. Journal of Consulting and Clinical Psychology, 65, 366– 380 (1997).
Verhaltenstherapie schizophrener Jugendlicher.. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 27, 189– 197 (1999).
Treating sexually abused children with posttraumatic stress symptoms: a randomised clinical trial.. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1347– 1355 (2000).
Adolescent depression: controlled desipramine treatment and atypical features.. Depression and Anxiety, 7, 15– 31 (1998).
Zwangssyndrome im Kindes- und Jugendalter.. Vandenhoeck & Ruprecht, Göttingen (1987).
Effect size of lithium, divalproex sodium, and carbamazepine in children and adolescents with bipolar disorder.. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 713– 720 (2000).
Use of buspirone in an adolescent with overanxious disorder.. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 789– 790 (1988).
Childhood-onset schizophrenia. A double-blind clozapine-haloperidol comparison.. Archives of General Psychiatry, 53, 1090– 1097 (1996).
Childhood-onset schizophrenia: an open-label study of olanzapine in adolescents.. Journal of the American Academy of Child and Adolescent Psychiatry, 37, 377– 385 (1998).
Successful clonazepam treatment of adolescents with panic disorder.. Journal of Clinical Psychopharmacology, 8, 299– 301 (1988).
Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial.. Journal of the American Acedemy of Child and Adolescent Psychiatry, 33, 686– 694 (1994).
A randomized, controlled trial of amitriptyline in the acute treatment of adolescent major depression.. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1139– 1144 (1996).
A controlled trial of social intervention in the families of schizophrenic patients: two year follow-up.. British Journal of Psychiatry, 146, 594– 600 (1985).
A double-blind desipramine substitution during long-term clomipramine treatment in children and adolescents with obsessive-compulsive disorder.. Archives of General Psychiatry, 48, 922– 927 (1991).
Treatment of obsessive-compulsive disorder with clomipramine and desipramine in children and adolescents. A double-blind crossover comparison.. Archives of General Psychiatry, 46, 1088– 1092 (1989).
Citalopram in the treatment of early-onset panic disorder and school phobia.. Pharmacopsychiatry, 29, 30– 32 (1996).
A comparison of behavior therapy techniques in the reduction of fearful avoidance behavior.. Behavior Therapy, 5, 648– 655 (1974).
Skills training versus psychosocial occupational therapy for persons with persistent schizophrenia.. American Journal of Psychiatry, 155, 1087– 1091 (1998).
Duration of psychosis and outcome in first-episode schizophrenia.. American Journal of Psychiatry, 149, 1183– 1188 (1992).
Carbamazepine for PTSD.. Journal of the American Academy of Child and Adolescent Psychiatry, 34, 703– 704 (1995).
Serotonergic agents in the treatment of social phobia in children and adolescents: a case series.. Depression and Anxiety, 10, 33– 39 (1999).
Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial.. Journal of the American Medical Association, 280, 1752– 1756 (1998).
Two-year outcome of social skills training and group psychotherapy for out-patients with schizophrenia.. American Journal of Psychiatry, 153, 1585– 1592 (1996).
Behaviour therapy for obsessive-compulsive disorder: a decade of progress.. Canadian Journal of Psychiatry, 42, 1021– 1027 (1997).
Schizophrenia - a follow-up study of results of treatment.. Archives of General Psychiatry, 33, 481– 486 (1976).
Pharmacokinetics, tolerability, and clinical effectiveness of quetiapine fumarate: an open-label trial in adolescents with psychotic disorders.. Journal of Clinical Psychiatry, 61, 252– 260 (2000).
Symptom-specific effects of fluoxetine in post-traumatic stress disorder.. International Clinical Psychopharmacology, 15, 227– 231 (2000).
Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1223– 1229 (1999).
A comparison of in vivo and vicarious exposure in the treatment of childhood water phobia.. Behaviour Research and Therapy, 31, 9– 15 (1993).
A comparison study of antidepressants and structured intensive group psychotherapy in the treatment of bulimia nervosa.. Archives of General Psychiatry, 47, 149– 157 (1990).
Interpersonal psychotherapy for depressed adolescents.. Journal of the American Academy of Child and Adolescent Psychiatry, 35, 1145– 1155 (1996).
Efficacy of interpersonal psychotherapy for depressed adolescents.. Archives of General Psychiatry, 56, 573– 579 (1999).
Eye movement desensitisation and reprocessing versus exposure in vivo. A single-session crossover study of spider-phobic children.. British Journal of Psychiatry, 171, 82– 86 (1997).
An open trial of plasma exchange in childhood-onset obsessive-compulsive disorder without poststreptococcal exacerbations.. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1313– 1315 (2000).
An open trial of paroxetine in the treatment of children and adolescents diagnosed with dysthymia.. Journal of Child and Adolescent Psychopharmacology, 10, 103– 109 (2000).
Treatment of a bodily injury phobia with implosive therapy.. Journal of Consulting and Clinical Psychology, 38, 389– 393 (1972).
Improvement of some schizophrenic deficit symptoms with low doses of amisulpride.. American Journal of Psychiatry, 152, 130– 134 (1995).
Therapeutic plasma exchange and intravenous immunoglobulin for obsessive-compulsive disorder and tic disorders in childhood.. Lancet, 354, 1153– 1158 (1999).
Imipramine in prepubertal major depressive disorders.. Archives of General Psychiatry, 44, 81– 89 (1987).
Treatment of primary dysthymia with group cognitive therapy and pharmacotherapy: clinical symptoms and functional impairments.. American Journal of Psychiatry, 156, 1608– 1617 (1999).
Paroxetine in children with major depressive disorder: an open trial.. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1443– 1447 (1997).
Double-blind, crossover trial of fluoxetine and placebo in children and adolescents with obsessive-compulsive disorder.. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1062– 1069 (1992).
Obsessive-compulsive disorder in children and adolescents.. British Journal of Psychiatry, 173 (suppl. 35), 91– 96 (1998).
The group desensitization of children's snake phobias using vicarious and contact desensitization procedures.. Behaviour Research and Therapy, 6, 1– 6 (1968).
A controlled comparison of family versus individual therapy for adolescents with anorexia nervosa.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1482– 1489 (1999).
Paroxetine open-label treatment of pediatric outpatients with obsessive-compulsive disorder.. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 1180– 1185 (1999).
The efficacy of cognitive-behavioral and interpersonal treatments for depression in Puerto Pican adolescents.. Journal of Consulting and Clinical Psychology, 67, 734– 745 (1999).
Pulse intravenous clomipramine for depressed adolescents: double-blind, controlled trial.. American Journal of Psychiatry, 154, 668– 673 (1997).
A randomized controlled trial of cognitive-behavioral therapy for persistent symptoms in schizophrenia resistant to medication.. Archives of General Psychiatry, 57, 165– 172 (2000).
Treating adolescent obsessive-compulsive disorder: applications of the cognitive theory.. Behaviour Research and Therapy, 36, 93– 97 (1998).
A comparison of graduated exposure, verbal coping skills, and their combination in the treatment of children's fear of the dark.. Child and Family Behavior Therapy, 4, 33– 45 (1983).
Treatment of childhood-onset schizophrenia with olanzapine.. Journal of Child and Adolescent Psychopharmacology, 10, 69– 78 (2000).
Alprazolam effects in children with anxiety disorders.. Canadian Journal of Psychiatry, 32, 570– 574 (1987).
Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorders.. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 29– 33 (1992).
Treatment of adolescent obsessive-compulsive disorder with a clomipramine-fluoxetine combination.. Psychopharmacology Bulletin, 26, 285– 290 (1990).
Bipolar disorder and family communication: effects of a psychoeducational treatment program.. Journal of Abnormal Psychology, 108, 588– 597 (1999).
Olanzapine in the treatment of adolescent acute mania: a report of seven cases.. Journal of Affective Disorders, 53, 279– 283 (1999).
The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioural intervention, with and without parental involvement.. Journal of Child Psychology and Psychiatry, 41, 713– 726 (2000).
Haloperidol in schizophrenic children: early findings from a study in progress.. Psychopharmacology Bulletin, 28, 183– 186 (1992).
Bipolar disorder in children and adolescents: current challenges.. Canadian Journal of Psychiatry, 42, 632– 636 (1997).
Relapse following discontinuation of lithium maintenance therapy in adolescents with bipolar I illness: a naturalistic disorder.. American Journal of Psychiatry, 147, 457– 461 (1990).
Pediatric autoimmune neuropsychiatric disorders associated with strepto-coccal infections: clinical description of the first 50 cases.. American Journal of Psychiatry, 155, 264– 271 (1998).
Randomised controlled trial of intensive cognitive behaviour therapy for patients with chronic schizophrenia.. British Medical Journal, 317, 303– 307 (1998).
Child and adolescent obsessive-compulsive disorder treated with citalopram: findings from an open trial of 23 cases.. Journal of Child and Adolescent Psychopharmacology, 7, 157– 166 (1997).
The reduction of anxiety in children: a comparison of the effects of “systematic desensitization in vitro” and “systematic desensitization in vivo”.. Behaviour Research and Therapy, 20, 61– 67 (1982).
Fluoxetine in posttraumatic stress disorder.. Journal of Clinical Psychiatry, 55, 517– 522 (1994).
Kognitive Remediation.. Nervenarzt, 71, 19– 29 (2000).
The long-term treatment of social phobia with moclobemide.. International Clinical Psychopharmacology, 11 (Suppl. 3), 83– 88 (1996).
Long-term outcome of antidepressant treatment for bulimia nervosa.. American Journal of Psychiatry, 148, 1206– 1212 (1991).
Medication and psychotherapy in the treatment of bulimia nervosa.. American Journal of Psychiatry, 154, 523– 531 (1997).
Open trial of fluoxetine in children and adolescents with dysthymic disorder or double depression.. Journal of Affective Disorders, 56, 227– 236 (1999).
Valproic acid for dysphoric mania in a mentally retarded adolescent.. Journal of Clinical Psychiatry, 56, 590– 591 (1995).