Abstract
Zur Behandlung der kindlichen Zwangsstörung werden kognitiv-verhaltenstherapeutische (KVT) und medikamentöse Interventionen eingesetzt. Insbesondere kombiniert sind diese Behandlungen gut wirksam, dennoch zeigen sich ca. 40 % der Behandelten auch nach der Therapie noch symptomatisch. Die am besten evaluierte Methode der KVT ist die Exposition mit Reaktionsverhinderung, die auf dem Prinzip der Habituation beruht. Neuere kognitive und metakognitive Techniken fokussieren auf die Modifikation von Erwartungen und haben vielleicht das Potential, die Wirksamkeit der Behandlung zu verbessern. Selektive Serotonin-Wiederaufnahme-Hemmer (selective serotonin reuptake inhibitors, SSRIs) stellen die Medikamente der ersten Wahl zur Behandlung der kindlichen Zwangsstörung dar. Wenn die Patienten bei ausreichend langer Gabe nicht auf die Medikation ansprechen, sollte ein Therapieversuch mit einem alternativen SSRI oder mit Clomipramin durchgeführt werden. Bei einem erneuten Scheitern der Behandlung kann eine Augmentation mit einer Kombination zweier SSRIs bzw. einem SSRI und Clomipramin oder einem SSRI und einem (atypischen) Neuroleptikum erfolgen. Nach einer erfolgreichen Behandlung sollte das Ausschleichen der Medikation sehr langsam erfolgen. Erste Studien zum Einsatz neuer Substanzen wie dem Glutamatantagonisten Riluzol liegen für das Kindes- und Jugendalter vor.
Cognitive-behavioral therapy (CBT) and pharmacological treatments are often applied in cases of pediatric obsessive-compulsive disorder (OCD). Especially in combination both methods are particularly efficacious; nonetheless, 40 % of all patients treated remain symptomatic. Exposure with response prevention, based on the principle of habituation, is the intervention with the best evidence. More recent cognitive and metacognitive treatments focus on modifying expectations and may have the potential to improve treatment efficacy. Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment in severe cases of OCD. With treatment resistance, the SSRI should be changed, or alternatively clomipramine can be employed. Augmentation strategies suggest the combination of two SSRIs, SSRI und clomipramin, or SSRI and (atypical) neuroleptics. Following successful treatment, medication should be reduced very slowly. Novel treatments in children and adolescent have been reported for antiglutamatergic agents as riluzole or D-cycloserine, a partial agonist of N-methyl-D-aspartic acid (NMDA).
Literatur
2008). The status of hoarding as a symptom of obsessive-compulsive disorder. Behaviour Research Therapy, 46, 1026–1033.
(2009). A randomized controlled clinical trial of citalopram versus fluoxetine in children and adolescents with obsessive-compulsive disorder (OCD). European Child and Adolescent Psychiatry, 18, 131–135.
(2000). Diagnostic and Statistical Manual of Mental Disorders. Text revision (DSM-IV-TR) (4th ed.). Washington, DC: Author.
. (2008). Inhibition of serotonin but not norepinephrine transport during development produces delayed, persistent perturbations of emotional behaviors in mice. Journal of Neuroscience, 28, 199–207.
(2006). Glutamate transporter gene SLC1A1 associated with obsessive-compulsive disorder. Archives of General Psychiatry, 3, 717–720.
(2006). Handbuch Psychopharmaka für das Kindes- und Jugendalter. Göttingen: Hogrefe.
(2006). A systematic review: Antipsychotic augmentation with treatment refractory obsessive-compulsive disorder. Molecular Psychiatry, 11, 622–632.
(2010). Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Molecular Psychiatry, 15, 850–855.
(2007). Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: A meta-analysis of randomized controlled trials. Journal of the American Medical Association, 297, 1683–1696.
(2002). Clinical, imaging, lesion, and genetic approaches toward a model of cognitive control. Developmental Psychobiology, 40, 237–254.
(2005). Early-onset obsessive-compulsive disorder: A subgroup with a specific clinical and familial pattern? Journal of Child Psychology and Psychiatry, 46, 881–887.
(2008). Optimizing inhibitory learning during exposure therapy. Behaviour Research and Therapy, 46, 5–27.
(1998). Combination treatment with Clomipramine and selective serotonin reuptake inhibitors for obsessive-compulsive disorder in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 8, 61–67.
(2007). Sustained response versus relapse: The pharmacotherapeutic goal for obsessive-compulsive disorder. International Clinical Psychopharmacology, 22, 313–322.
(1988). Obsessive compulsive disorder in adolescence: An epidemiological study. Journal of the American Academy of Child and Adolescent Psychiatry, 27, 764–771.
(2010). Behavior Therapy, 41, 121–132.
(2010). Predictors and moderators of treatment outcome in the Pediatric Obsessive Compulsive Treatment Study (POTS I). Journal of the American Academy of Child and Adolescent Psychiatry, 49, 1024–1033.
(2001) Disentangling chronological age from age of onset in children and adolescents with obsessive compulsive disorder. International Journal of Neuropsychopharmacology, 4, 169–178.
(2003). Which SSRI? A meta-analysis of pharmacotherapy trials in pediatric obsessive-compulsive disorder. American Journal of Psychiatry, 160, 1919–1928.
(2004). Paroxetine treatment in children and adolescents with obsessive-compulsive disorder: A randomized, multicenter, double-blind, placebo-controlled trial. Journal of the American Academy of Child and Adolescent Psychiatry, 43, 1387–1396.
(2008). Pediatric obsessive-compulsive disorder: Management in primary care. Current Opinion in Pediatrics, 20, 544–550.
(1999). Pharmacotherapy in children and adolescents with obsessive-compulsive disorder. Child and Adolescent Psychiatric Clinics of North America, 8, 617–634.
(2007). An open-label trial of riluzole, a glutamate antagonist, in children with treatment-resistant obsessive-compulsive disorder. Journal of Child Adolescent Psychopharmacology, 17, 761–767.
(2010). Review of the use of the glutamate antagonist riluzole in psychiatric disorders and a description of recent use in childhood obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology, 20, 309–315.
E. (2005). Familial and sporadic subtypes of early-onset Obsessive-Compulsive disorder. Biological Psychiatry, 57, 895–900.
(2009). Memantine as an augmenting agent for severe pediatric OCD. American Journal of Psychiatry, 166, 237.
E. (2009). Cross-cutting issues and future directions for the OCD spectrum. Psychiatry Research, 170, 3–6.
(2010). Quality of life outcomes in patients with obsessive-compulsive disorder: Relationship to treatment response and symptom relapse. Journal of Clinical Psychiatry, 71, 784–792.
(2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 593–602.
(2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62, 617–627.
(1998). Behavioral versus pharmacological treatments of obsessive compulsive disorder: A meta-analysis. Psychopharmacology (Berl), 136, 205–216.
(1993). A 2- to 7-year follow-up study of 54 obsessive-compulsive children and adolescents. Archives of General Psychiatry, 50, 429–439.
(2010). Treatment of pediatric obsessive-compulsive disorder: A review. Journal of Child and Adolescent Psychopharmacology, 20, 299–308.
(2004). Cognitive-behavior therapy, sertraline, and their combination for children and adolescents with obsessive-compulsive disorder: The Pediatric OCD Treatment Study (POTS) randomized controlled trial. Journal of the American Medical Association, 292, 1969–1976.
(2007). Tics moderate treatment outcome with sertraline but not cognitive-behavior therapy in pediatric obsessive-compulsive disorder. Biological Psychiatry, 61, 344–347.
(2004). Age effects of antidepressant-induced manic conversion. Archives of Paediatric and Adolescent Medicine, 158, 773–780.
(2006). Comorbidity of obsessive-compulsive disorder and attention-deficit/hyperactivity disorder in referred children and adolescents. Comprehensive Psychiatry, 47, 42–47.
(2000). A double-blind placebo-controlled study of risperidone addition in serotonin-reuptake inhibitor-refractory obsessive-compulsive disorder. Archives of General Psychiatry, 57, 794–801.
(2010). Long-term outcomes of obsessive-compulsive disorder: Follow-up of 142 children and adolescents. British Journal of Psychiatry, 197, 128–134.
(2008). A meta-analysis of D-cycloserine and the facilitation of fear extinction and exposure therapy. Biological Psychiatry, 63, 1118–1126.
(2008). Compulsive hoarding: OCD symptom, distinct clinical syndrome, or both? American Journal of Psychiatry, 165, 1289–1298.
(2003). Functional impairment in children and adolescents with obsessive-compulsive disorder. Journal of Child and Adolescent Psychopharmacology, 13, S61–S69.
(2006). Multiaxiales Klassifikationsschema für psychische Störungen des Kindes- und Jugendalter nach ICD-10 der WHO (5. Aufl.). Bern: Huber.
(2001). Fluvoxamine for children and adolescents with obsessive-compulsive disorder: A randomized, controlled, multicenter trial. Journal of the American Academy of Child and Adolescent Psychiatry, 40, 222–229.
(2003). Diagnostisches und Statistisches Manual Psychischer Störungen DSM-IV (4. Aufl.). Göttingen: Hogrefe.
(1997). Children’s Yale-Brown Obsessive Compulsive Scale: Reliability and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 844–852.
(2009). Streptococcal infection, Tourette syndrome, and OCD: Is there a connection? Neurology, 73, 1256–1263.
(2003). Psychotherapie der Zwangsstörung bei Kindern und Jugendlichen – eine Übersicht. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 31, 213–221.
(2006). Metacognitive therapy versus exposure and response prevention for pediatric obsessive-compulsive disorder. A case series with randomized allocation. Psychotherapy and Psychosomatics, 75, 257–264.
(2010). Should OCD be classified as an anxiety disorder in DSM-V? Depression and Anxiety, 27, 495–506.
(2010). A single-blinded case-control study of memantine in severe obsessive-compulsive disorder. Journal of Clinical Psychopharmacology, 30, 34–39.
(2008). Where does obsessive-compulsive disorder belong in DSM-V? Depression and Anxiety, 25, 336–347.
(2010). Defining treatment response and remission in obsessive-compulsive disorder: A signal detection analysis of the Children’s Yale-Brown Obsessive Compulsive Scale. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 708–717.
(2010). The role of comorbid disruptive behavior in the clinical expression of pediatric obsessive-compulsive disorder. Behaviour Research Therapy, 48, 1204–1210.
(2010). A preliminary study of D-cycloserine augmentation of cognitive-behavioral therapy in pediatric obsessive-compulsive disorder. Biological Psychiatry, 68, 1073–1076.
(2011). The Leyton Obsessional Inventory-Child Version Survey Form does not demonstrate adequate psychometric properties in American youth with pediatric obsessive-compulsive disorder. Journal of Anxiety Disorders, 25, 574–578.
(1998). Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections: Clinical description of the first 50 cases. American Journal of Psychiatry, 155, 264–271.
(1995). Diagnostisches Inventar bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS). Berlin: Springer.
(2006). Bildgebungsbefunde bei Kindern und Jugendlichen mit ADHS, Tic-Störungen und Zwangserkrankungen. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 34, 343–355.
(2009). Obsessive compulsive disorder: Cognitive behaviour therapy with children and young people. Hove: Routledge.
(2011). Obsessive-compulsive disorder in children and adolescents. Deutsches Ärzteblatt International, 108, 173–179.
(2008). Meta-analysis of randomized, controlled treatment trials for pediatric obsessive-compulsive disorder. Journal of Child Psychology and Psychiatry, 49, 489–498.
(1997). Cognitive therapy of anxiety disorders: A practice manual and conceptual guide. Chichester, UK: Wiley.
(2011). Metakognitive Therapie bei Angststörungen und Depression. Weinheim: Beltz.
(2001). Long-term outcome and prognosis of obsessive-compulsive disorder with onset in childhood or adolescence. European Child and Adolescent Psychiatry, 10, 37–46.
(2003). Pharmakotherapie von Zwangsstörungen im Kindes- und Jugendalter. Zeitschrift für Kinder- und Jugendpsychiatrie und Psychotherapie, 31, 223–230.
(2008). Zwangsstörungen. In , Entwicklungspsychiatrie (2. Aufl., S. 719–743). Stuttgart: Schattauer.
(2008). Augmentation of behavior therapy with D-cycloserine for obsessive-compulsive disorder. American Journal of Psychiatry, 165, 335–341.
(2011). Myth of the pure obsessional type in obsessive-compulsive disorder. Depression and Anxiety, 28, 495–500.
(2005, January). Mental health: Facing the challenges, building solutions. Paper read at Report from the WHO European Ministerial Conference, Helsinki.
. (