OBJECTIVE This study evaluated the long-term outcomes of a stepped care treatment for pediatric obsessive-compulsive disorder (OCD) and investigated whether response to first-step cognitive-behavioral therapy (CBT) is an important indicator of 3-year outcomes. METHOD This study is a part of the Nordic Long-term OCD Treatment Study (NordLOTS), in which 269 children and adolescents were treated with CBT. Nonresponders to CBT were randomized to extended treatment with continued CBT or pharmacotherapy with sertraline. Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) scores no higher than 15 and no higher than 10 were defined as treatment response and remission, respectively. Participants were assessed 2 and 3 years after first-step CBT. Linear mixed-effects models were used to analyze the outcomes. RESULTS Intent-to-treat analyses showed a significant decrease in CY-BOCS total score from baseline (24.6) to 3-year follow-up (5.0; p = .001), with a mean decrease of 5.9 from after treatment to 3-year follow-up. Three years after treatment, 90% (n = 242) of participants were rated as responders and 73% were in clinical remission. The duration of treatment did not influence the symptom level at 3-year follow-up (p = .998) and no significant difference was found (p = .169) between the extended treatment conditions. CONCLUSION The results suggest that evidence-based treatment for pediatric OCD has long-term positive effects, whether a first step of manual-based CBT or extended treatment with CBT or sertraline. The improvements were maintained, and the symptoms decreased further during follow-up and were, after 3 years, similarly independent of treatment duration and form of extended treatment. CLINICAL TRIAL REGISTRATION INFORMATION Nordic Long-term Obsessive-Compulsive Disorder (OCD) Treatment Study; www.controlled-trials.com; ISRCTN66385119.

中文翻译：

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小儿强迫症的治疗效果是可持续的：NordLOTS 的三年随访。

目的 本研究评估了儿童强迫症 (OCD) 阶梯式护理治疗的长期结果，并调查对第一步认知行为治疗 (CBT) 的反应是否是 3 年结果的重要指标。方法 本研究是北欧长期强迫症治疗研究 (NordLOTS) 的一部分，其中 269 名儿童和青少年接受了 CBT 治疗。对 CBT 无反应者被随机分配到继续 CBT 延长治疗或舍曲林药物治疗。儿童耶鲁-布朗强迫症量表 (CY-BOCS) 得分不高于 15 分和不高于 10 分分别定义为治疗反应和缓解。在第一步 CBT 后 2 年和 3 年对参与者进行评估。线性混合效应模型用于分析结果。结果 意向治疗分析显示 CY-BOCS 总分从基线 (24.6) 到 3 年随访 (5.0; p = .001) 显着下降，从治疗后到 3- 平均下降 5.9年随访。治疗三年后，90% (n = 242) 的参与者被评为有反应者，73% 的参与者处于临床缓解状态。治疗持续时间不影响 3 年随访时的症状水平 (p = .998)，延长治疗条件之间未发现显着差异 (p = .169)。结论 结果表明，无论是手动 CBT 的第一步，还是 CBT 或舍曲林的扩展治疗，儿童强迫症的循证治疗都具有长期的积极作用。改善得以维持，并且在随访期间症状进一步减轻，并且在 3 年后，同样独立于治疗持续时间和延长治疗的形式。临床试验注册信息北欧长期强迫症（OCD）治疗研究；www.control-trials.com；ISRCTN66385119。