Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Studien

Therapie der Zwangsstörung im Kindes- und Jugendalter

Published Online:March 17, 2014https://doi.org/10.1026/0942-5403/a000137

Abstract

Die Therapie der kindlichen Zwangsstörung orientiert sich am Schweregrad der Zwangsstörung und an dem Vorhandensein von komorbiden Störungen. Eine evidenzbasierte Therapie bei Kindern und Jugendlichen beinhaltet Elemente der Psychoedukation, der kognitiv-behavioralen Psychotherapie (KVT) und eine pharmakologische Behandlung. Die am besten evaluierte Methode der KVT ist die Exposition mit Reaktionsmanagement. Randomisierte und kontrollierte Meta-Analysen zeigen, dass diese Therapiemethode hoch effektiv ist. Die Kombination von KVT und einer Medikation ist hierbei besonders wirksam. Selektive-Serotonin-Wiederaufnahme-Hemmer und Clomipramin zeigten sich in verschiedenen Meta-Analysen, die randomisierte und Placebo kontrollierte Studien von Kindern und Jugendlichen beinhalteten als besonders effektiv. Neuere kognitive und metakognitive Techniken fokussieren auf die Modifikation von Erwartungen und haben vielleicht das Potential, die Wirksamkeit der Behandlung zu verbessern.


Therapy of obsessive-compulsive disorder

The therapy of pediatric obsessive-compulsive disorder (OCD) is based on a thorough assessment of the severity of OCD and the presence of comorbid disorders. The evidence-based treatment of OCD in children and adolescents includes elements of psychoeducation, cognitive behavioral therapy (CBT), and pharmacological treatments. The most important behavioral therapeutic method within CBT is exposure and response management. The findings of meta-analyses of randomized controlled trials indicate that this type of treatment is highly effective. The combination of CBT and medication is particularly efficacious. Selective serotonin reuptake inhibitors (SSRI) and clomipramine were found to be significantly superior to placebo in different meta-analyses, including randomized and controlled pharmacological therapy in children and adolescents. More recent cognitive and metacognitive treatments focus on modifying expectations and may have the potential to improve treatment efficacy.

Literatur

  • AACAP Official Action (2012). Practice parameter for the assessment and treatment of children and adolescents with obsessive-compulsive disorder. Journal of the American Academy of Child and Adolescents Psychiatry, 51, 98 – 113. First citation in articleCrossref, Google Scholar

  • Abramowitz, J. S. (1997). Effectivness of psychological and pharmacological treatments for obsessive-compulsive disorder: A qualitative review. Journal Consult Clinical Psychology, 65, 44 – 52. First citation in articleCrossref, Google Scholar

  • Alaghband-Rad, J. , Hakimshooshtary, M. (2009). A randomized controlled clinical trial of Citalopram versus Fluoxetin in children and adolescents with obsessive-compulsive disorder. European Child and Adolescent Psychiatry, 18,131 – 135. First citation in articleCrossref, Google Scholar

  • Asbahr, F. R. , Castillo, A. R. , Ito, L. M. , Latorre, M. D. , Moreira, M. N. , Lotufo-Neto, F. (2006). Group cognitive-behavioral therapy versus sertraline for the treatment of children and adolescents with obsessive-compulsive disorder. Journal of American Academy of Child and Adolescent Psychiatry, 44, 1128 – 1136. First citation in articleCrossref, Google Scholar

  • Barrett, P. , Healy-Farell, L. , March, J. S. (2004). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: A controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 46 – 62. First citation in articleCrossref, Google Scholar

  • Barrett, P. , Farrell, L. , Dadds, M. & Boulter, N. (2005). Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: Long-term-up and predictors of outcome. Journal of the American Academy of Child and Adolescent Psychiatry, 44, 1005 – 1014. First citation in articleCrossref, Google Scholar

  • Bolton, D. , Perrin, S. (2008). Evaluation of exposure with response-prevention of obsessive-compulsive disorder in childhood and adloscence. Behavior Therapy and Experimental Psychiatry, 39, 11 – 22. First citation in articleCrossref, Google Scholar

  • Brezinka,V. (2012). Ricky, die Spinne–ein Computerspiel zur Unterstützung der Behandlung der Zwangserkrankung bei Kindern. Newsletter SGZ, 1, 5 – 8. First citation in articleGoogle Scholar

  • De Haan, E. , Hoogduin, K. A. , Buitelaar, J. K. & Keijsers, G. P. (1998). Behavior therapy versus clomipramine fort he treatment of obsessive-compulsive disorder in children and adolescents. Journal of American Academy of Child and Adolescent Psychiatry, 37, 1022 – 1029. First citation in articleCrossref, Google Scholar

  • Fleischhaker, C. , Sixt, B. & Schulz, E. (2010). DBT-A. Dialektisch-behaviorale Therapie für Jugendliche. Berlin: Springer. First citation in articleGoogle Scholar

  • Foa, E. B. , Steketee, G. S. , Grayson, G. B. , Turner, R. M. & Latimer, P. R. (1984). Deliberate exposure and blocking of obsessive-compulsive rituals: Immediate and long term effects. Behavior Therapy, 15, 450 – 472. First citation in articleCrossref, Google Scholar

  • Franklin, M. E , Sapyta, J. , Freeman, J. B. , Khanna, M. , Compton, S. , Almirali, D. , Moore, P. , Choate-Summers, M. , Garcia, A. , Edson, A. L. , Foa, E. B. & March, J. S. (2012). Cognitive-behavior therapy augmentation of pharmacotherapy in pediatric obsessive compulsive disorder: The Pediatric OCD Treatment Study II (POTS II) randomized, controlled trial. Journal of the American Medical Association, 21, 1224 – 1232. First citation in articleGoogle Scholar

  • Freeman, J. , Garcia, A. , Frank, H. , Benito, K. , Conelea, C. , Walther, M. & Edmunds, J. (2013). Evidence-base update for psychosocial treatments for pediatric obsessive-compulsive disorder. Journal of Clinical Child and Adolescent Psychology, 0, 1 – 20. First citation in articleGoogle Scholar

  • Geller, D. A. , Biederman, J. , Stewart, S. E. , Mullin, B. , Martin, A. , Spencer, T. & Faraone, S. V. (2003). Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. American Journal of Psychiatry, 160, 1919 – 1928. First citation in articleCrossref, Google Scholar

  • Gentile, S. (2011). Efficaty of antidepressant medications in children and adolescents with obsessive-compulsive disorder: A systematic appraisal. Journal of Clinical Psychopharmacotherapy, 31, 625 – 632. First citation in articleCrossref, Google Scholar

  • Hayes, S. C. , Luoma, J. B. , Bond, F. W. , Masuda, A. & Lillis, J. (2006). Acceptance and commitment therapy: Model, processes and outcomes. Behavior Research and Therapy, 44, 1 – 25. First citation in articleCrossref, Google Scholar

  • Jans, T. , Wewetzer, Ch. , Klampfl, K. , Walitza, S. & Warnke, A. (2007). Phenomenologie and co-morbidity of childhood onset obsessive compulsive disorder. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 35, 41 – 50. First citation in articleLink, Google Scholar

  • Lakatos, A , Reinecker, H. (2007). Kognitive Verhaltenstherapie bei Zwangsstörungen (3. Aufl.). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • March, J. S. , Foa, E. , Gammon, P. , Christman, A. , Curry, J. , Fitzgerald, D. et al. (2004). Cognitive-behavior therapy, sertraline, and their combinations for children and adolescents with obsessive-compulsive disorder–the Pediatrie OCD Treatment Study (POTS) randomiszed controlled trial. Journal of American Medical Association, 296, 1969 – 1976. First citation in articleGoogle Scholar

  • Rufer, M. , Fricke, S. (2009). Der Zwang in meiner Nähe. Bern: Huber. First citation in articleGoogle Scholar

  • Simons, M. (2009). Zwangsstörung. In S. Schneider. & J. Margraf, J. (Hrsg.), Lehrbuch der Verhaltenstherapie (S. 629 – 647). Berlin: Springer. First citation in articleCrossref, Google Scholar

  • Vloet, T. D. , Simons, M. , Herpertz-Dahlmann, B. (2012). Psychotherapeutische und medikamentöse Behandlung der kindlichen Zwangsstörung. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 40, 29 – 39. First citation in articleLink, Google Scholar

  • Walitza, S. , Melfsen, S. , Jans, T. , Zellmann, H. , Wewetzer, C. , Warnke, A. (2011). Obsessive-compulsive disorder in children and adolescents. Deutsches Ärzteblatt, 108, 173 – 179. First citation in articleGoogle Scholar

  • Wells, A. , Papageorgiou, C. (1998). Relationships between worry, obsessive-compulsive symptoms and meta-cognitive beliefs. Behavior Research and Therapy, 39, 899 – 913. First citation in articleCrossref, Google Scholar

  • Wells, A. (2009). Metakognitve therapy for anxiety and depression. New York: Guilford Press. First citation in articleGoogle Scholar

  • Wewetzer, G. , Wewetzer, C. (2012). Zwangsstörungen bei Kindern und Jugendlichen. Ein Therapiemanual. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Wewetzer, G. , Wewetzer, C. (2014). Ratgeber Zwangsstörungen bei Kindern und Jugendlichen. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Wewetzer, C. , Walitza S., (2009). Zwangsstörungen im Kindes- und Jugendalter. In M. Gerlach, C. Mehler-Wex , S. Walitza, A. Warnke , C. Wewetzer, (Hrsg.), Neuro-Psychopharmakotherapie im Kindes- und Jugendalter. Wien: Springer First citation in articleCrossref, Google Scholar

  • White, M. , Epston, D. (1990). Die Zähmung der Monster: Literarische Mittel zu therapeutischen Zwecken. Heidelberg: Auer. First citation in articleGoogle Scholar

  • Williams, T. I. , Salkovskis, P. M. , Forrester, L. , Turner, S. , White, H. , Allsopp, M. A. (2010). A randomised controlled trial of cognitive behavioural treatment for obsessive compulsive disorder in children and adolescents. European Child and Adolescents Psychiatry, 19, 449 – 456. First citation in articleCrossref, Google Scholar

  • Zellmann, H. , Jans, T. , Irblich, B. , Hemminger, U. , Reinecker, H. , Sauer, C. et al. (2009). Kinder und Jugendliche mit Zwangsstörungen–Ein prospektive Verlaufsstudie. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 37,173 – 182. First citation in articleLink, Google Scholar