Chart Phase III Essay

Submitted By LumenSantos1
Words: 2919
Pages: 12

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