Treatment for Late Life and Childhood Anxiety
J.T., . . .
Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. The
AD are common in children
Effective treatment are CBT and SSRIs
40% -50% of children w/ AD do not have response for short term treatment with just
Lacks clinical trial control and results for
CBT, SSRI, or Subjects/
Children and adolescents
ages 7 to 17 years who had separation or
GAD or social phobia - primary diagnosis from
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
60 min. of
review, ratings of severity of subjects anxiety, treatment response, and adverse events.
Therapy based on
received regular site-level and crosssite supervisio n. pill counts and
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
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
for DSMIV-TR child version were used on week
4, 8, and
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
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.
Assessme nt Scale ranges 1 100, 60 or below meant need for treatment and a score of
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
I.J.C, van den Hout M.,
& van Dyck
available studies shows that pharmacoth erapy have better average treatment effect than psychologi cal
84 adults aged 60 years and over with principle
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)
members of the research group