Advertisement

Current Psychiatry Reports

, Volume 5, Issue 4, pp 252–265 | Cite as

Childhood anxiety disorders and developmental issues in anxiety

  • Paul Arnold
  • S. Preeya Banerjee
  • Rashmi Bhandari
  • Jennifer Ivey
  • Michelle Rose
  • David R. Rosenberg
Article

Abstract

Anxiety disorders are common disorders in childhood, and developmental differences must be considered when diagnosing and treating patients in this age group. Recent research has illuminated the course of childhood anxiety disorders, including how they can be precursors to continued anxiety and mood problems in adulthood. Recent studies of cognitive-behavioral therapy, the first-line psychosocial treatment for childhood anxiety, have focused on the following issues: the relative efficacy of group versus individual cognitive-behavioral therapy; the role of parent involvement; and the application of specific techniques to certain diagnostic groups (eg, social skills techniques in social phobia). Selective serotonin reuptake inhibitors have been associated with high acute response rates in controlled studies of children with anxiety disorders, and more recent evidence suggests they are efficacious and well tolerated when taken for longer periods. This article will review significant diagnostic and developmental issues, and highlight recent studies in psychosocial and pharmacologic therapies of pediatric anxiety disorders.

Keywords

Anxiety Disorder Generalize Anxiety Disorder Fluvoxamine Social Phobia Panic Disorder 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Verhulst F: Community and epidemiological aspects of anxiety disorders in children. In Anxiety Disorders in Children and Adolescents: Research, Assessment and Intervention. Edited by Silverman W, Treffers P. Cambridge: Cambridge University Press; 2001:273–292.Google Scholar
  2. 2.
    American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, edn 4, Text Revision. Washington, DC: American Psychiatric Association; 2000.Google Scholar
  3. 3.
    Gullone E: The development of normal fear: a century of research. Clin Psychol Rev 2000, 20:429–451.PubMedCrossRefGoogle Scholar
  4. 4.
    Freeman J, Garcia A, Leonard H: Anxiety disorders. In Child and Adolescent Psychiatry: A Comprehensive Textbook. Edited by Lewis M. Philadelphia: Lippincott Williams & Wilkins; 2002:821–834.Google Scholar
  5. 5.
    Masi G, Mucci M, Millepiedi S: Separation anxiety disorder in children and adolescents: epidemiology, diagnosis and management. CNS Drugs 2001, 15:93–104.PubMedCrossRefGoogle Scholar
  6. 6.
    Ost L-G, Treffers P: Onset, course and outcome for anxiety disorders in children. In Anxiety Disorders in Children and Adolescents: Research, Assessment and Intervention. Edited by Silverman W, Treffers P. Cambridge: Cambridge University Press; 2001.Google Scholar
  7. 7.
    Silove D, Manicavasagar V, Curtis J, Blaszczynski A: Is early separation anxiety a risk factor for adult panic disorder? A critical review. Compr Psychiatry 1996, 37:167–179.PubMedCrossRefGoogle Scholar
  8. 8.
    Pine DS, Klein RG, Coplan JD, et al.: Differential carbon dioxide sensitivity in childhood anxiety disorders and nonill comparison group. Arch Gen Psychiatry 2000, 57:960–967.PubMedCrossRefGoogle Scholar
  9. 9.
    Slattery MJ, Klein DF, Mannuzza S, et al.: Relationship between separation anxiety disorder, parental panic disorder, and atopic disorders in children: a controlled high-risk study. J Am Acad Child Adolesc Psychiatry 2002, 41947–954.Google Scholar
  10. 10.
    Kendler KS, Myers J, Prescott CA: The etiology of phobias: an evaluation of the stress-diathesis model. Arch Gen Psychiatry 2002, 59:242–248.PubMedCrossRefGoogle Scholar
  11. 11.
    Birmaher B, Ryan ND, Williamson DE, et al.: Childhood and adolescent depression: a review of the past 10 years: part I. J Am Acad Child Adolesc Psychiatry 1996, 35:1427–1439.PubMedCrossRefGoogle Scholar
  12. 12.
    Pine DS, Cohen P, Gurley D, et al.: The risk for early-adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 1998, 55:56–64.PubMedCrossRefGoogle Scholar
  13. 13.
    Axelson DA, Birmaher B: Relation between anxiety and depressive disorders in childhood and adolescence. Depress Anxiety 2001, 14:67–78.PubMedCrossRefGoogle Scholar
  14. 14.
    Schwartz CE, Snidman N, Kagan J: Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry 1999, 38:1008–1015.PubMedCrossRefGoogle Scholar
  15. 15.
    Goodwin RD, Hamilton SP: Early-onset fearful panic attack: a possible prodrome of early-onset severe psychopathology. Compr Psychiatry 2002, 43:22–27.PubMedCrossRefGoogle Scholar
  16. 16.
    Yule W: Posttraumatic stress disorder in the general population and in children. J Clin Psychiatry 2001, 62(suppl):23–28.PubMedGoogle Scholar
  17. 17.
    Terr L: Children’s symptoms in the wake of Challenger: a field study of distant-traumatic events and an outline of related conditions. Am J Psychiatry 1999, 156:1536–1544.PubMedGoogle Scholar
  18. 18.
    Geller D, Biederman J, Jones J, et al.: Obsessive-compulsive disorder in children and adolescents: a review. Harv Rev Psychiatry 1998, 5:260–273.PubMedGoogle Scholar
  19. 19.
    Eichstedt J, Arnold S: Childhood-onset obsessive-compulsive disorder: a tic-related subtype of OCD? Clin Psychol Rev 2001, 21:137–158.PubMedCrossRefGoogle Scholar
  20. 20.
    Geller D, Biederman J, Faraone S, et al.: Developmental aspects of obsessive-compulsive disorder: findings in children, adolescents, and adults. J Nerv Ment Dis 2001, 189:471–477.PubMedCrossRefGoogle Scholar
  21. 21.
    Asbahr FR, Negrao AB, Gentil V, et al.: Obsessive-compulsive and related symptoms in children and adolescents with rheumatic fever with and without chorea: a prospective 6-month study. Am J Psychiatry 1998, 155:1122–1124.PubMedGoogle Scholar
  22. 22.
    Swedo S: Immunology of neurodevelopmental disorders: pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). Mol Psychiatry 2001, 7:S24-S25.CrossRefGoogle Scholar
  23. 23.
    Murphy M, Pichichero M: Prospective identification and treatment of children with Pediatric Autoimmune Neuropsychiatric Disorder Associated with Group A Streptococcal Infection (PANDAS). Arch Pediatr Adolesc Med 2002, 156:356–361.PubMedGoogle Scholar
  24. 24.
    Lougee L, Perlmutter S, Nicolson R, et al.: Psychiatric disorders in first-degree relatives of children with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS). J Am Acad Child Adolesc Psychiatry 2000, 39:1120–1126.PubMedCrossRefGoogle Scholar
  25. 25.
    Dadds MR, Barrett PM: Practitioner review: psychological management of anxiety disorders in childhood. J Child Psychol Psychiatry 2001, 42:999–1011.PubMedCrossRefGoogle Scholar
  26. 26.
    Mendlowitz SL, Manassis K, Bradley S, et al.: Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement. J Am Acad Child Adolesc Psychiatry 1999, 38:1223–1229.PubMedCrossRefGoogle Scholar
  27. 27.
    Manassis K, Mendlowitz SL, Scapillato D, et al.: Group and individual cognitive-behavioral therapy for childhood anxiety disorders: a randomized trial. J Am Acad Child Adolesc Psychiatry 2002, 41:1423–1430.PubMedCrossRefGoogle Scholar
  28. 28.
    Hettema JM, Neale MC, Kendler KS: A review and meta-analysis of the genetic epidemiology of anxiety disorders. Am J Psychiatry 2001, 158:1568–1578.PubMedCrossRefGoogle Scholar
  29. 29.
    Cobham VE, Dadds MR, Spence SH: The role of parental anxiety in the treatment of childhood anxiety. J Consult Clin Psychol 1998, 66:893–905.PubMedCrossRefGoogle Scholar
  30. 30.
    Hudson JL, Kendall PC: Showing you can do it: homework in therapy for children and adolescents with anxiety disorders. J Clin Psychol 2002, 58:525–534.PubMedCrossRefGoogle Scholar
  31. 31.
    Barrett PM: Treatment of childhood anxiety: developmental aspects. Clin Psychol Rev 2000, 20:479–494.PubMedCrossRefGoogle Scholar
  32. 32.
    King NJ, Tonge BJ, Heyne D, et al.: Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adolesc Psychiatry 1998, 37:395–403.PubMedCrossRefGoogle Scholar
  33. 33.
    Silverman WK, Kurtines WM, Ginsburg GS, et al.: Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. J Consult Clin Psychol 1999, 67:675–687.PubMedCrossRefGoogle Scholar
  34. 34.
    Leger E, Ladouceur R, Dugas MJ, Freeston MH: Cognitivebehavioral treatment of generalized anxiety disorder among adolescents: a case series. J Am Acad Child Adolesc Psychiatry 2003, 42:327–330.PubMedCrossRefGoogle Scholar
  35. 35.
    Hayward C, Varady S, Albano AM, et al.: Cognitive-behavioral group therapy for social phobia in female adolescents: results of a pilot study. J Am Acad Child Adolesc Psychiatry 2000, 39:721–726.PubMedCrossRefGoogle Scholar
  36. 36.
    Beidel DC, Turner SM, Morris TL: Behavioral treatment of childhood social phobia. J Consult Clin Psychol 2000, 68:1072–1080.PubMedCrossRefGoogle Scholar
  37. 37.
    Spence SH, Donovan C, Brechman-Toussaint M: The treatment of childhood social phobia: the effectiveness of a social skills training-based, cognitive-behavioral intervention, with and without parental involvement. J Child Psychol Psychiatry 2000, 41:713–726.PubMedCrossRefGoogle Scholar
  38. 38.
    Ollendick T: Cognitive-behavioral treatment of panic disorder with agoraphobia in adolescents: a multiple baseline design analysis. Behav Ther 1995, 26:517–531.CrossRefGoogle Scholar
  39. 39.
    Pine DS, Cohen JA: Trauma in children and adolescents: risk and treatment of psychiatric sequelae. Biol Psychiatry 2002, 51:519–531.PubMedCrossRefGoogle Scholar
  40. 40.
    March JS, Amaya-Jackson L, Murray MC, Schulte A: Cognitivebehavioral psychotherapy for children and adolescents with posttraumatic stress disorder after a single-incident stressor. J Am Acad Child Adolesc Psychiatry 1998, 37:585–593.PubMedCrossRefGoogle Scholar
  41. 41.
    March JS, Franklin M, Nelson A, Foa E: Cognitive-behavioral psychotherapy for pediatric obsessive-compulsive disorder. J Clin Child Psychol 2001, 30:8–18.PubMedCrossRefGoogle Scholar
  42. 42.
    Benazon NR, Ager J, Rosenberg DR: Cognitive behavior therapy in treatment-naive children and adolescents with obsessive-compulsive disorder: an open trial. Behav Res Ther 2002, 40:529–539.PubMedCrossRefGoogle Scholar
  43. 43.
    Franklin ME, Kozak MJ, Cashman LA, et al.: Cognitive-behavioral treatment of pediatric obsessive-compulsive disorder: an open clinical trial. J Am Acad Child Adolesc Psychiatry 1998, 37:412–419.PubMedCrossRefGoogle Scholar
  44. 44.
    March JS, Mulle K, Herbel B: Behavioral psychotherapy for children and adolescents with obsessive-compulsive disorder: an open trial of a new protocol-driven treatment package. J Am Acad Child Adolesc Psychiatry 1994, 33:333–341.PubMedCrossRefGoogle Scholar
  45. 45.
    Piacentini J, Bergman RL, Jacobs C, et al.: Open trial of cognitive behavior therapy for childhood obsessive-compulsive disorder. J Anxiety Disord 2002, 16:207–219.PubMedCrossRefGoogle Scholar
  46. 46.
    Wever C, Rey JM: Juvenile obsessive-compulsive disorder. Aust N Z J Psychiatry 1997, 31:105–113.PubMedGoogle Scholar
  47. 47.
    Thienemann M, Martin J, Cregger B, et al.: Manual-driven group cognitive-behavioral therapy for adolescents with obsessive-compulsive disorder: a pilot study. J Am Acad Child Adolesc Psychiatry 2001, 40:1254–1260.PubMedCrossRefGoogle Scholar
  48. 48.
    Waters TL, Barrett PM, March JS: Cognitive-behavioral family treatment of childhood obsessive-compulsive disorder: preliminary findings. Am J Psychother 2001, 55:372–387.PubMedGoogle Scholar
  49. 49.
    Barrett PM, Healy LJ: An examination of the cognitive processes involved in childhood obsessive-compulsive disorder. Behav Res Ther 2003, 41:285–299.PubMedCrossRefGoogle Scholar
  50. 50.
    Muratori F, Picchi L, Bruni G, et al.: A two-year follow-up of psychodynamic psychotherapy for internalizing disorders in children. J Am Acad Child Adolesc Psychiatry 2003, 42:331–339.PubMedCrossRefGoogle Scholar
  51. 51.
    Rosenberg D: Selective serotonin reuptake inhibitors. In Pharmacotherapy for Child and Adolescent Psychiatric Disorders. Edited by Rosenberg D, Davanzo P, Gershon S. New York: Marcel Dekker; 2002:223–296.Google Scholar
  52. 52.
    Research Unit on Pediatric Psychopharmacology Anxiety Study Group: Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 2001, 344:1279–1285. This study of fluvoxamine treatment in 128 subjects diagnosed with GAD, SAD, or social phobia represents the first multicenter randomized controlled trial of a pharmacologic treatment in children with these anxiety disorders. Using sound methodology, the study authors demonstrated fluvoxamine as a highly efficacious (76% response rate) and well-tolerated treatment.CrossRefGoogle Scholar
  53. 53.
    Borzo G: Fluvoxamine treats anxiety in children, teens. Clin Psychiatry News 2000, 28:10.Google Scholar
  54. 54.
    Walkup J, Labellarte M, Riddle MA, et al.: Treatment of pediatric anxiety disorders: an open-label extension of the research units on pediatric psychopharmacology anxiety study. J Child Adolesc Psychopharmacol 2002, 12:175–188.PubMedCrossRefGoogle Scholar
  55. 55.
    Walkup JT, Labellarte MJ, Riddle MA, et al.: Searching for moderators and mediators of pharmacological treatment effects in children and adolescents with anxiety disorders. J Am Acad Child Adolesc Psychiatry 2003, 42:13–21. This report describes moderators and mediators of treatment effects in the Research Unit on Pediatric Psychopharmacology study [52]. Predictors of positive response included decreased levels of depression, whereas negative response was predicted by presence of social phobia and increased illness severity. A better understanding of predictors of response will help clinicians in deciding the treatment option that is best suited to an individual patient.PubMedCrossRefGoogle Scholar
  56. 56.
    Rynn MA, Siqueland L, Rickels K: Placebo-controlled trial of sertraline in the treatment of children with generalized anxiety disorder. Am J Psychiatry 2001, 158:2008–2014.PubMedCrossRefGoogle Scholar
  57. 57.
    Rynn M, Kunz N, Lamm L, et al.: Venlafaxine XR for treatment of GAD in children and adolescents. Scientific proceedings of the 49th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. San Francisco: American Academy of Child and Adolescent Psychiatry; 2002:91.Google Scholar
  58. 58.
    Compton SN, Grant PJ, Chrisman AK, et al.: Sertraline in children and adolescents with social anxiety disorder: an open trial. J Am Acad Child Adolesc Psychiatry 2001, 40:564–571.PubMedCrossRefGoogle Scholar
  59. 59.
    Chavira DA, Stein MB: Combined psychoeducation and treatment with selective serotonin reuptake inhibitors for youth with generalized social anxiety disorder. J Child Adolesc Psychopharmacol 2002, 12:47–54.PubMedCrossRefGoogle Scholar
  60. 60.
    Wagner K, Stein M, Berard R, et al.: Efficacy of paroxetine in childhood and adolescent social anxiety disorder. Scientific proceedings of the 49th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. San Francisco: American Academy of Child and Adolescent Psychiatry; 2002:95.Google Scholar
  61. 61.
    Masi G, Toni C, Mucci M, et al.: Paroxetine in children and adolescent outpatients with panic disorder. J Child Adolesc Psychopharmacol 2001, 11:151–157.PubMedCrossRefGoogle Scholar
  62. 62.
    Cohen JA, Mannarino AP, Rogal S: Treatment practices for childhood posttraumatic stress disorder. Child Abuse Negl 2001, 25:123–135.PubMedCrossRefGoogle Scholar
  63. 63.
    Seedat S, Stein DJ, Ziervogel C, et al.: Comparison of response to a selective serotonin reuptake inhibitor in children, adolescents, and adults with posttraumatic stress disorder. J Child Adolesc Psychopharmacol 2002, 12:37–46.PubMedCrossRefGoogle Scholar
  64. 64.
    March J, Frances A, Carpenter D, et al.: Treatment of obsessivecompulsive disorder: the Expert Consensus Panel for obsessive-compulsive disorder. J Clin Psychiatry 1997, 58(suppl):2–72.Google Scholar
  65. 65.
    Cartwright C, Hollander E: SSRIs in the treatment of obsessive-compulsive disorder. Depress Anxiety 1998, 8(suppl):105–113.PubMedCrossRefGoogle Scholar
  66. 66.
    Ivey J, Rosenberg DR: Clomipramine use in obsessive-compulsive disorder. Expert Rev Neurotherapeutics 2002, 2:783–790.CrossRefGoogle Scholar
  67. 67.
    Riddle MA, Reeve EA, Yaryura-Tobias JA, et al.: Fluvoxamine for children and adolescents with obsessive-compulsive disorder: a randomized, controlled, multicenter trial. J Am Acad Child Adolesc Psychiatry 2001, 40:222–229.PubMedCrossRefGoogle Scholar
  68. 68.
    March JS, Biederman J, Wolkow R, et al.: Sertraline in children and adolescents with obsessive-compulsive disorder: a multicenter randomized controlled trial. JAMA 1998, 280:1752–1756.PubMedCrossRefGoogle Scholar
  69. 69.
    Geller DA, Hoog SL, Heiligenstein JH, et al.: Fluoxetine treatment for obsessive-compulsive disorder in children and adolescents: a placebo-controlled clinical trial. J Am Acad Child Adolesc Psychiatry 2001, 40:773–779.PubMedCrossRefGoogle Scholar
  70. 70.
    Geller D, Wagner K, Emslie G, et al.: Efficacy of paroxetine in pediatric OCD: results of a multicenter study. Scientific proceedings of the 49th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. San Francisco: American Academy of Child and Adolescent Psychiatry; 2002:117.Google Scholar
  71. 71.
    Thomsen PH, Ebbesen C, Persson C: Long-term experience with citalopram in the treatment of adolescent OCD. J Am Acad Child Adolesc Psychiatry 2001, 40:895–902.PubMedCrossRefGoogle Scholar
  72. 72.
    Greist J, Chouinard G, DuBoff E, et al.: Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry 1995, 52:289–295.PubMedGoogle Scholar
  73. 73.
    Findling RL, Reed MD, Myers C, et al.: Paroxetine pharmacokinetics in depressed children and adolescents. J Am Acad Child Adolesc Psychiatry 1999, 38:952–959.PubMedCrossRefGoogle Scholar
  74. 74.
    McDougle CJ, Epperson CN, Pelton GH, et al.: A double-blind, placebo-controlled study of risperidone addition in serotonin reuptake inhibitor-refractory obsessive-compulsive disorder. Arch Gen Psychiatry 2000, 57:794–801.PubMedCrossRefGoogle Scholar
  75. 75.
    Fitzgerald KD, Stewart CM, Tawile V, Rosenberg DR: Risperidone augmentation of serotonin reuptake inhibitor treatment of pediatric obsessive compulsive disorder. J Child Adolesc Psychopharmacol 1999, 9:115–123.PubMedGoogle Scholar
  76. 76.
    Crocq M, Leclerq P, Guillon M, Bailey P: Open-label olanzapine in obsessive-compulsive disorder refractory to antidepressant treatment. Eur Psychiatry 2002, 17:296–297.PubMedCrossRefGoogle Scholar
  77. 77.
    McDougle CJ, Goodman WK, Leckman JF, et al.: Haloperidol addition in fluvoxamine-refractory obsessive-compulsive disorder: a double-blind, placebo-controlled study in patients with and without tics. Arch Gen Psychiatry 1994, 51:302–308.PubMedGoogle Scholar
  78. 78.
    Figueroa Y, Rosenberg DR, Birmaher B, Keshavan MS: Combination treatment with clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. J Child Adolesc Psychopharmacol 1998, 8:61–67.PubMedCrossRefGoogle Scholar
  79. 79.
    Pigott T, Sheay S: Pharmacotherapy of obsessive-compulsive disorder: overview and treatment-refractory strategies. In Obsessive-compulsive Disorder: Contemporary Issues in Treatment. Edited by Goodman W, Rudorfer M, Maser J. Mahwah: Lawrence Erlbaum Associates; 2000:277–302.Google Scholar
  80. 80.
    Rosenberg D, MacMaster F, Keshavan M, et al.: Decrease in caudate glutamatergic concentrations in pediatric obsessivecompulsive disorder patients taking paroxetine. J Am Acad Child Adolesc Psychiatry 2000, 39:1096–1103.PubMedCrossRefGoogle Scholar
  81. 81.
    Rosenberg D: Toward a neuroodevelopmental model of obsessive-compulsive disorder. Biol Psychiatry 1998, 43:623–640.PubMedCrossRefGoogle Scholar
  82. 82.
    Arnold P, Mundo E, Richter M, et al.: Are NMDA genes linked to early onset obsessive-compulsive disorder? Scientific proceedings of the 49th Annual Meeting of the American Academy of Child and Adolescent Psychiatry. San Francisco: American Academy of Child and Adolescent Psychiatry; 2002:118.Google Scholar
  83. 83.
    Rosenberg D, Hanna G: Genetic and imaging strategies in obsessive-compulsive disorder: potential implications for treatment development. Biol Psychiatry 2000, 48:1210–1222.PubMedCrossRefGoogle Scholar
  84. 84.
    Garvey M, Perlmutter S, Allen A, et al.: A pilot study of penicillin prophylaxis for neuropsychiatric exacerbations triggered by streptococcal infections. Biol Psychiatry 1999, 45:1564–1571.PubMedCrossRefGoogle Scholar
  85. 85.
    Arnold P, Richter M: Is obsessive-compulsive disorder an autoimmune disease? Can J Psychiatry 2001, 165:1353–1358.Google Scholar
  86. 86.
    Perlmutter S, Leitman S, Garvey M, et al.: Therapeutic plasma exchange and intravenous immunoglobulin for obsessivecompulsive disorder and tic disorders in childhood. Lancet 1999, 354:1153–1158.PubMedCrossRefGoogle Scholar
  87. 87.
    Nicolson R, Swedo S, Lenane M, et al.: An open trial of plasma exchange in childhood-onset obsessive-compulsive disorder without post-streptococcal exacerbations. J Am Acad Child Adolesc Psychiatry 2000, 39:1313–1315.PubMedCrossRefGoogle Scholar
  88. 88.
    Cook EH, Wagner KD, March JS, et al.: Long-term sertraline treatment of children and adolescents with obsessivecompulsive disorder. J Am Acad Child Adolesc Psychiatry 2001, 40:1175–1181. The efficacy and tolerability of sertraline was studied over a 1-year period in 137 children or adolescents with OCD after completion of a controlled trial. Significant improvement was observed during the extension period in responders to the acute trial, and 43% of individuals who did not respond in the 12 week trial were classified as responders at the end of 1 year. Long-term effects of SSRIs are becoming an increasingly important question as more children are treated for longer periods with these medications.PubMedCrossRefGoogle Scholar
  89. 89.
    Wagner K, Cook E, Chugn H, et al.: Remission status after long-term sertraline treatment of pediatric OCD. J Child Adolesc Psychopharmacol 2003, in press.Google Scholar
  90. 90.
    Gallagher D, Gardiner C, Carpenter D: Interim results: long-term safety of paroxetine in pediatric patients. New Research Program and Abstract presented at the 155th Annual Meeting of the American Psychiatric Association. Philadelphia, PA; May 10–14, 2002.Google Scholar
  91. 91.
    Weintrob N, Cohen D, Klipper-Aurbach Y, et al.: Decreased growth during therapy with selective serotonin reuptake inhibitors. Arch Pediatr Adolesc Med 2002, 156:696–701.PubMedGoogle Scholar
  92. 92.
    Rosenberg D: Anxiolytics. In Pharmacotherapy for Child and Adolescent Psychiatric Disorders. Edited by Rosenberg D, Davanzo P, Gershon S. New York: Marcel Dekker; 2002:489–541.Google Scholar
  93. 93.
    Rosenberg D: Tricyclic antidepressants. In Pharmacotherapy for Child and Adolescent Psychiatric Disorders. Edited by Rosenberg D, Davanzo P, Gershon S. New York: Marcel Dekker, 2002:169–222.Google Scholar
  94. 94.
    Bernstein GA, Borchardt CM, Perwien AR, et al.: Imipramine plus cognitive-behavioral therapy in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry 2000, 39:276–283. In this randomized controlled trial, 63 children meeting criteria for major depressive disorder and one or more anxiety disorders were randomized to receive CBT with placebo or CBT with imipramine. Significant improvement in school attendance was demonstrated in the imipramine plus CBT group, but not in the CBT plus placebo group, whereas anxiety and depression decreased in the groups. Application of study findings are limited by the use of tricyclic antidepressants, now considered second-line agents in child anxiety disorders; however, it remains important because it is the only published randomized controlled trial demonstrating the increased benefits of combining CBT with pharmacotherapy.PubMedCrossRefGoogle Scholar
  95. 95.
    Layne A, Bernstein G, Egan E, Kushner M: Predictors of treatment response in anxious-depressed adolescents with school refusal. J Am Acad Child Adolesc Psychiatry 2003, 42:319–326. This report of predictors of treatment response in the Bernstein et al. study [94] indicated that positive response to treatment was predicted by use of imipramine and improved attendance at baseline. Predictors of poor response include the presence of SAD or avoidant disorder. This study provides further confirmation of the additive benefits of medication when combined with CBT, and is also important in providing the clinician with predictors of response that will potentially help clinicians to determine the treatment option that is best suited to an individual patient.PubMedCrossRefGoogle Scholar

Copyright information

© Current Science Inc. 2003

Authors and Affiliations

  • Paul Arnold
    • 1
  • S. Preeya Banerjee
  • Rashmi Bhandari
  • Jennifer Ivey
  • Michelle Rose
  • David R. Rosenberg
  1. 1.Department of PsychiatryCentre for Addiction and Mental Health and the University of TorontoTorontoCanada

Personalised recommendations