9月21日，在《美国医学会杂志》刊发了一项研究，披露出那些在接受药物治疗中受益的罹患强迫症（OCD）的儿童和青少年会在添加认知行为疗法之后令其OCD症状显著减少。
大脑受OCD影响的区域
根据文章的背景资料：“50个人中会有1人受到强迫症的影响，这种疾病在整个的发育过程中都很明显。它与严重的功能障碍和精神科合并症有关。随机对照试验的发现支持5 - 羟色胺再摄取抑制剂（SRIs）药物治疗、认知行为治疗[CBT，包括接触加上反应预防]及联合治疗的功效。 然而，对儿科强迫症专业知识的缺乏阻止了大多数家庭获得接触加上反应预防或联合治疗。据此研究的背景信息介绍，仅仅使用可获得的最广泛使用的治疗—药物疗法的数据结果表明，通常得到的结果是不完整的治疗反应，而临床上显著的残留症状甚至在充分的治疗试验之后常常会持续存在。
费城宾州大学医学院的Martin E. Franklin, Ph.D.及其同事开展了一项研究，旨在检验CBT或一种简单形式的CBT及在药物治疗情况下施行CBT的指示以扩大SRIs的效应。 这一为期12周的设有对照的试验是在2004年至2009年期间在3个学术性医疗中心中开展的，其中包括124名年龄在7至17岁的以OCD作为主要诊断的门诊病人。 这些参与者被随机指派到3个治疗策略组中的一组（其治疗策略包括在12周中进行7次治疗）：42人被分在仅用药物治疗的小组，42人被分在药物加上CBT指导的小组，42人被分在药物加上CBT的小组，而最后一组包括做14次同时进行的CBT治疗。
研究人员发现，在12周的时候，其儿童的耶鲁-布朗强迫症量表基线评分至少下降30%的参与者的百分比在加上CBT小组中为68.6%、在CBT组加上指导的病人中为34.0%，在只用药物治疗组中为30.0%。 比较发现，加CBT的治疗策略要优于仅用药物治疗的策略及CBT加上指导的治疗策略。 在CBT策略中的加指导的做法与仅用药物治疗相比没有统计上的优越性。
研究人员补充说，这一研究及其它研究发现凸显了在社区的OCD儿科病人中传播CBT的重要性，使得患儿可有超越仅使用药物治疗策略的选择。 “此外，这一研究的发现表明，这些传播的做法应该聚焦于让完整的CBT规程能够在这些环境中更广泛地被病人使用，而不是尝试创建及传播这种有效治疗形式的缩减版本。为了达到这些目标，有关研究必须聚焦于超越学术医疗背景的研发、评估及比较不同的传播CBT的模式。”
生物探索推荐英文论文摘要：
Cognitive Behavior Therapy Augmentation of Pharmacotherapy in Pediatric Obsessive-Compulsive Disorder
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.
