Chart Phase III Essay

Lumen Santos
Treatment for Late Life and Childhood Anxiety
Reference
(APA
Format)
Walkup,
J.T.,
Albano,
A.M.,
Piacentini J.,
Birmaher B.,
Compton
S.N., Sherrill
J.T., . . .
Kendall P.C.
(2008).
Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The
New
England
Journal of
Medicine,
359(26),
2753- 2766.

Rational/Prior
Findings


AD are common in children 

Effective treatment are CBT and SSRIs
(Sertraline)



approx.
40% -50% of children w/ AD do not have response for short term treatment with just
CBT or
SSRI alone



Lacks clinical trial control and results for
CBT, SSRI, or Subjects/
Participants


Children and adolescents 

ages 7 to 17 years who had separation or
GAD or social phobia - primary diagnosis from
DSM-IV-TR



IQ of 80 or more



ADHD, OCD, post-traumatic stress, oppositional defiant, and conduct disorders were also included, but only those who are taking stable doses of medication/ medical condition



excluded girls who are pregnant, or sexually active

Tests/Measures


Fourteen
60 min. of
CBTincluded
review, ratings of severity of subjects anxiety, treatment response, and adverse events. 

Therapy based on
Coping
Cat
Program



received regular site-level and crosssite supervisio n. pill counts and

Results


total of 3066 were potentially eligible were screened by phone, 761 signed consent forms, 524 eligible and completed baseline assessment, 488 went to randomization 

11 subjects stopped treatment, but were included in assessment (treatment & withdrawals), 46 stopped both treatment and assessment CBT group were less likely to withdraw from treatment than
Sertraline group



Discussions/
Conclusions


Combinati on therapy of CBT and Sertraline,
CBT alone, and Sertraline alone are effective for short term. 

Combinati on treatment had superior response rates no frequent report of physical, psychiatric
, or adverse events in sertraline group than



Lumen Santos combinatio n treatment

who are not using effective birth control 

medicatio n diaries


Anxiety
Disorders
Interview
Schedule
for DSMIV-TR child version were used on week
4, 8, and
12.



Week 12:
Global
Impressio nImprovem ent Scale, ranges 17- the lower the ranges, the better the improvem ent subjects and at least one parent provided written informed consent



used
PARS -



459 out of 488 completed at least 1 post baseline assessment, 396 completed all 4 assessments, and
440 completed the assessment at 12 week

in placebo group 

". . . suggests that among these effective therapies, combinatio n therapy provides best chance for a positive outcome." 

"Superiorit y outcome might be due to additive or synergistic effects of the two therapies." 

increased number of visit in the combinatio n therapy

Lumen Santos summary of six items assessing anxiety severity, frequency, distress, avoidance, and interferen ce during the previous weeks ranging 0
- 30, on the subjects.


Children's
Global
Assessme nt Scale ranges 1 100, 60 or below meant need for treatment and a score of
50 meant

increased opportuniti es for elicitations of adverse events. 

risk of some adverse events are lower in
CBT group than in sertraline group



sertraline is effective for children with social phobia, GAD, and separation anxiety disorder. 

study did not demonstrat e any risk of suicidal

Lumen Santos



Schuurmans,
J., Comijs
H.,
Emmelkamp
P.M.G.,
Weijnen
I.J.C, van den Hout M.,
& van Dyck
R. (2009).
Long-term



available studies shows that pharmacoth erapy have better average treatment effect than psychologi cal



84 adults aged 60 years and over with principle
DSM-IV-TR
diagnosis of GAD, panic disorder
(with or w/o agoraphobia),agor aphobia w/o history or panic





moderate impairme nt- used to overall impairme nt on life situations. Raters were high for anxiety severity (r
= 0.85) and diagnostic status (intraclass correlatio n coefficient = 0.82 0.88)
2
members of the research group

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