Week 7: CAMS & POTS

Question 1

CAMS

Answer 1

Major RCT for youth anxiety

Test efficacy of

1) SSRI
2) CBT
3) Combined

6 sites

488 youth with GAD, separation anxiety, social phobia

Diagnoses made using a semi-structured interview

Randomly assigned to receive:

• SSRI
• Pill Placebo
• CBT
• SSRI + CBT

Treated for 12 weeks

Clinician ratings of anxiety symptoms

Clinicians do not know what treatment group the child was in

Question 2

CAMS Results

Answer 2

Anxiety symptoms at 12 weeks

• Combined, CBT, SSRI > Placebo
• Combined > CBT, SSRI
• CBT = SSRI

All were better than placebo
CBT was equal to SSRI
Combined CBT and SSRI was the best

Follow up at 6 years
46.5 did not meet criteria

Question 3

CAMS moderator

Answer 3

Moderator: Anxiety diagnoses

Combined is associated with best outcomes across all three diagnoses

Social anxiety disorder: SSRI > CBT
DONE WITH THERAPISTS AND NOT PEERS

GAD: CBT > SSRI

Other is separation anxiety

Follow up at 6 years, 46.5% did not meet criteria

Question 4

POTS

Answer 4

Pediatric OCD Treatment Study (POTS)

112 youth with OCD
Randomly assigned to one of four groups
-SSRI
-Pill placebo
-CBT
-CBT + SSRI

Measured OCD symptoms
-Rated by an observer unaware of treatment condition

Question 5

POTS Results

Answer 5

In all three non-placebo conditions, symptoms decreased over the 12 weeks

Combined treatment > CBT, meds, placebo
CBT = Meds
CBT, Meds > Placebo

BUT ….

This study was done at two different sites

Question 6

POTS by site!

Answer 6

CBT vs Placebo was HUGE at Penn which is a center for excellence in OCD CBT

Much more so than at Penn

Combined vs. placebo looks like it is statistically similar BUT at Penn no difference between combined and CBT

Suggests that if CBT is really good, it is as good as CBT + meds (i.e. you do not need the meds)