human
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obsessive-compulsive disorder ( OCD ) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates . There are few prospect i ve long-term follow-up studies . AIMS To follow up young people with OCD to clarify persistence rates and relevant predictors , presence of other psychiatric disorders , functional impairment , service utilisation and perceived treatment needs . METHOD All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic , Maudsley Hospital , London , were included . Sixty-one per cent ( 142 of 222 ) of all contactable young people and parents completed computerised diagnostic interviews and question naires . RESULTS We found a persistence rate of OCD of 41 % ; 40 % of participants had a psychiatric diagnosis other than OCD at follow-up . The main predictor for persistent OCD was duration of illness at assessment . High levels of baseline psychopathology predicted other psychiatric disorders at follow-up . Functional impairment and quality of life were mildly to moderately affected . Approximately 50 % of participants were still receiving treatment and about 50 % felt a need for further treatment . CONCLUSIONS This study confirms that paediatric OCD can be a chronic condition that persists into adulthood . Early recognition and treatment might prevent chronicity . Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services Expert guidelines recommend cognitive-behavior therapy ( CBT ) as a first-line treatment in pediatric obsessive – compulsive disorder ( OCD ) and the addition of selective serotonin reuptake inhibitors when CBT is not effective . However , the recommendations for CBT non-responders are not supported by empirical data . Our objective was to investigate the effectiveness of sertraline ( SRT ) versus continued CBT in children and adolescents that did not respond to an initial course of CBT . R and omized controlled trial conducted in five sites in Denmark , Sweden and Norway , 54 children and adolescents , age 7–17 years , with DSM-IV primary OCD were r and omized to SRT or continued CBT for 16 weeks . These participants had been classified as non-responders to CBT following 14 weekly sessions . Primary outcomes were the CY-BOCS total score and clinical response ( CY-BOCS < 16 ) . The study was a part of the Nordic Long-Term OCD Treatment Study ( NordLOTS ) . Intent-to-treat sample included 50 participants , mean age 14.0 ( SD = 2.7 ) and 48 % ( n = 24 ) males . Twenty-one of 28 participants ( 75 % ) completed continued CBT and 15 of 22 participants ( 69.2 % ) completed SRT . Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments ( p = .351 ) , the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group . The multivariate χ2 test suggested that there were no statistically significant differences between groups ( p = .727 ) . Within-group effect sizes were large and significant across both treatments . These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial . However , there was no significant between-group differences in SRT or continued CBT at post-treatment OBJECTIVE This article describes the long-term effects of augmenting serotonin reuptake inhibitors ( SRIs ) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder ( OCD ) . METHOD Between November 2000 and November 2006 , 111 OCD patients from 2 academic outpatient centers with partial SRI response were r and omized to the addition of exposure and ritual prevention or stress management training , delivered twice weekly for 8 weeks ( acute phase ) ; 108 began treatment . Responders ( 38 of 52 in the exposure and ritual prevention condition , 11 of 52 in the stress management training condition ) entered a 24-week maintenance phase . The Yale-Brown Obsessive Compulsive Scale ( YBOCS ) was the primary outcome measure . RESULTS After 24 weeks , patients r and omized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes ( mean YBOCS scores of 14.69 and 21.37 , respectively ; t = 2.88 , P = .005 ) , higher response rates ( decrease in YBOCS scores ≥ 25 % : 40.7 % vs 9.3 % , Fisher exact test P < .001 ) , and higher rates of excellent response ( YBOCS score ≤ 12 : 24.1 % vs 5.6 % , Fisher exact test P = .01 ) . During the maintenance phase , the slope of change in YBOCS scores was not significant in either condition ( all P values ≥ .55 ) , with no difference between exposure and ritual prevention and stress management training ( P > .74 ) . Better outcome was associated with baseline variables : lower YBOCS scores , higher quality of life , fewer comorbid Axis I diagnoses , and male sex . CONCLUSIONS Augmenting SRIs with exposure and ritual prevention versus stress management training leads to better outcome after acute treatment and 24 weeks later . Maintenance outcome , however , was primarily a function of OCD severity at entrance . Greater improvement during the acute phase influences how well patients maintain their gains , regardless of treatment condition Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD CONTEXT The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder ; however , empirical support for this assertion has been weaker for children and adolescents than for adults . OBJECTIVE To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder . DESIGN R and omized , double-blind , placebo-controlled trial . PATIENTS One hundred eighty-seven patients : 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years r and omized to receive either sertraline ( 53 children , 39 adolescents ) or placebo ( 54 children , 41 adolescents ) . SETTING Twelve US academic and community clinics with experience conducting r and omized controlled trials . INTERVENTION Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy , after which patients continued to receive this dosage of medication for 8 more weeks . Control patients received placebo . MAIN OUTCOME MEASURES The Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive Compulsive Scale ( NIMH GOCS ) , and the NIMH Clinical Global Impressions of Severity of Illness ( CGI-S ) and Improvement ( CGI-I ) rating scales . RESULTS In intent-to-treat analyses , patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS ( adjusted mean , -6.8vs -3.4 , respectively ; P=.005 ) , the NIMH GOCS ( -2.2 vs -1.3 , respectively ; P=.02 ) , and the CGI-I ( 2.7 vs 3.3 , respectively ; P=.002 ) scales . Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study . Based on CGI-I ratings at end point , 42 % of patients receiving sertraline and 26 % of patients receiving placebo were very much or much improved . Neither age nor sex predicted response to treatment . The incidence of insomnia , nausea , agitation , and tremor were significantly greater in patients receiving sertraline ; 12 ( 13 % ) of 92 sertraline-treated patients and 3 ( 3.2 % ) of 95 placebo-treated patients discontinued prematurely because of adverse medical events ( P=.02 ) . No clinical ly meaningful abnormalities were apparent on vital sign determinations , laboratory findings , or electrocardiographic measurements . CONCLUSION Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder OBJECTIVE To compare , via a pilot study , the effectiveness of behavior therapy and of drug treatment in children and adolescents with obsessive-compulsive disorder . METHOD Twenty-two children aged between 8 and 18 years were r and omly assigned to behavior therapy ( n = 12 ) or open clomipramine ( n = 10 ) in a parallel design lasting 12 weeks . Behavior therapy included exposure and response prevention administered in weekly sessions . The mean dosage of clomipramine was 2.5 mg/kg ( range = 1.4 - 3.3 mg/kg ) . The main outcome variables were the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Leyton Obsessional Inventory-Child Version ( LOI-CV ) . RESULTS Significant improvement was obtained in both treatment conditions . Behavior therapy produced stronger therapeutic changes than clomipramine on the CY-BOCS ( p < .05 ) , whereas on the LOI-CV no significant differences between the results of the two treatments were found . Five of the nine initial nonresponders showed significant changes after extension of treatment for another 12 weeks . CONCLUSION Behavior therapy is shown to be a good alternative for drug treatment and deserves further study in larger sample s of children with obsessive-compulsive disorder OBJECTIVE The efficacy of medications , consisting of serotonin partial and specific reuptake blockers , and behavior therapy , consisting of exposure and response prevention in addition to social skills training , cognitive therapy , and habit reversal , in the treatment of obsessive-compulsive disorder are well documented . The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy . METHODS Ten children/adolescents who had not previously responded to behavior therapy  were r and omly assigned to two groups : fluvoxamine alone or fluvoxamine with behavior therapy . All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year . RESULTS Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable , the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . According to the other measurements -National Institute of Mental Health-Global Obses-sive-Compulsive Scale , Clinical Global Impression-Improvement ( assessing level of im-provement from week to week ) , and Clinical Global Impression-Severity of Illness Scale ( as-sessing how ill the patient is from week to week)-improvement was not as evident . According to the CY-BOCS , those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication . At two-year follow-up , all patients continued to improve , with those in the combined approach improving more than those in the medication-alone group . CONCLUSIONS Future studies should determine the specific effect of each treatment group , combined and singularly . Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed . The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy , according to the CY-BOCS Concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid ( 5-HIAA ) , the dopamine metabolite homovanillic acid , and the noradrenaline metabolite 4-hydroxy-3-methoxyphenyl glycol were measured in CSF before and after three weeks ' treatment of severe obsessive-compulsive disorder with clomipramine hydrochloride . Patients who responded to  clomipramine treatment had significantly higher CSF levels of 5-HIAA before treatment . The amelioration of obsessive-comp 
    Output:
    
agent
Using the Cochrane methodology , and as measures of effect size mean difference and Hedge 's g , SRIs proved to be superior to drug placebo , with a modest effect size .
From direct comparisons of CBT and SRI treatments , we conclude that CBT has the superior efficacy .
COMBO versus CBT shows that SRI treatment adds little to concomitant CBT , while COMBO shows favourable outcome versus SRI alone .
In pre-trial partial treatment responders , those who failed a SRI had better outcome from adding CBT as compared to continuing a SRI .
Those who failed CBT treatment did as well with continued CBT as with switching to a SRI .
***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Obsessive-compulsive disorder ( OCD ) often starts in childhood and adolescence and can be a chronic disorder with high persistence rates . There are few prospect i ve long-term follow-up studies . AIMS To follow up young people with OCD to clarify persistence rates and relevant predictors , presence of other psychiatric disorders , functional impairment , service utilisation and perceived treatment needs . METHOD All young people with OCD assessed over 9 years at the National and Specialist Paediatric OCD clinic , Maudsley Hospital , London , were included . Sixty-one per cent ( 142 of 222 ) of all contactable young people and parents completed computerised diagnostic interviews and question naires . RESULTS We found a persistence rate of OCD of 41 % ; 40 % of participants had a psychiatric diagnosis other than OCD at follow-up . The main predictor for persistent OCD was duration of illness at assessment . High levels of baseline psychopathology predicted other psychiatric disorders at follow-up . Functional impairment and quality of life were mildly to moderately affected . Approximately 50 % of participants were still receiving treatment and about 50 % felt a need for further treatment . CONCLUSIONS This study confirms that paediatric OCD can be a chronic condition that persists into adulthood . Early recognition and treatment might prevent chronicity . Important challenges for services are ensuring adequate treatment and a smooth transition from child to adult services Expert guidelines recommend cognitive-behavior therapy ( CBT ) as a first-line treatment in pediatric obsessive – compulsive disorder ( OCD ) and the addition of selective serotonin reuptake inhibitors when CBT is not effective . However , the recommendations for CBT non-responders are not supported by empirical data . Our objective was to investigate the effectiveness of sertraline ( SRT ) versus continued CBT in children and adolescents that did not respond to an initial course of CBT . R and omized controlled trial conducted in five sites in Denmark , Sweden and Norway , 54 children and adolescents , age 7–17 years , with DSM-IV primary OCD were r and omized to SRT or continued CBT for 16 weeks . These participants had been classified as non-responders to CBT following 14 weekly sessions . Primary outcomes were the CY-BOCS total score and clinical response ( CY-BOCS < 16 ) . The study was a part of the Nordic Long-Term OCD Treatment Study ( NordLOTS ) . Intent-to-treat sample included 50 participants , mean age 14.0 ( SD = 2.7 ) and 48 % ( n = 24 ) males . Twenty-one of 28 participants ( 75 % ) completed continued CBT and 15 of 22 participants ( 69.2 % ) completed SRT . Planned pairwise comparison of the CY-BOCS total score did not reveal a significant difference between the treatments ( p = .351 ) , the response rate was 50.0 % in the CBT group and 45.4 % in the SRT group . The multivariate χ2 test suggested that there were no statistically significant differences between groups ( p = .727 ) . Within-group effect sizes were large and significant across both treatments . These large within-group effect sizes suggest that continued treatment for CBT non-responders is beneficial . However , there was no significant between-group differences in SRT or continued CBT at post-treatment OBJECTIVE This article describes the long-term effects of augmenting serotonin reuptake inhibitors ( SRIs ) with exposure and ritual prevention or stress management training in patients with DSM-IV obsessive-compulsive disorder ( OCD ) . METHOD Between November 2000 and November 2006 , 111 OCD patients from 2 academic outpatient centers with partial SRI response were r and omized to the addition of exposure and ritual prevention or stress management training , delivered twice weekly for 8 weeks ( acute phase ) ; 108 began treatment . Responders ( 38 of 52 in the exposure and ritual prevention condition , 11 of 52 in the stress management training condition ) entered a 24-week maintenance phase . The Yale-Brown Obsessive Compulsive Scale ( YBOCS ) was the primary outcome measure . RESULTS After 24 weeks , patients r and omized to and receiving exposure and ritual prevention versus stress management training had significantly better outcomes ( mean YBOCS scores of 14.69 and 21.37 , respectively ; t = 2.88 , P = .005 ) , higher response rates ( decrease in YBOCS scores ≥ 25 % : 40.7 % vs 9.3 % , Fisher exact test P < .001 ) , and higher rates of excellent response ( YBOCS score ≤ 12 : 24.1 % vs 5.6 % , Fisher exact test P = .01 ) . During the maintenance phase , the slope of change in YBOCS scores was not significant in either condition ( all P values ≥ .55 ) , with no difference between exposure and ritual prevention and stress management training ( P > .74 ) . Better outcome was associated with baseline variables : lower YBOCS scores , higher quality of life , fewer comorbid Axis I diagnoses , and male sex . CONCLUSIONS Augmenting SRIs with exposure and ritual prevention versus stress management training leads to better outcome after acute treatment and 24 weeks later . Maintenance outcome , however , was primarily a function of OCD severity at entrance . Greater improvement during the acute phase influences how well patients maintain their gains , regardless of treatment condition Rigorously design ed clinical trials have demonstrated the efficacy and safety of fluoxetine in adults with major depressive disorder and obsessive-compulsive disorder ( OCD ) but not in patients below 18 years old . This report describes a r and omized , double-blind , placebo-controlled , fixed-dose ( 20 mg qd ) trial of fluoxetine in 14 children and adolescents with OCD , ages 8 to 15 years old ; the study was 20 weeks long with crossover at 8 weeks . Obsessive-compulsive symptom severity was measured on the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Clinician 's Global Impression-Obsessive Compulsive Disorder scale ( CGI-OCD ) . The CY-BOCS total score decreased 44 % ( N = 7 , p = .003 ) after the initial 8 weeks of fluoxetine treatment , compared with a 27 % decrease ( N = 6 , p = .13 ) after placebo . During the initial 8 weeks , the magnitude of improvement for the fluoxetine group significantly exceeded that for the placebo group as measured by the CGI-OCD ( p = .01 ) but not by the CY-BOCS ( p = .17 ) . The most common drug side effects were generally well tolerated . The results suggest that fluoxetine is a generally safe and effective short-term treatment for children with OCD CONTEXT The serotonin reuptake inhibitors are the treatment of choice for patients with obsessive-compulsive disorder ; however , empirical support for this assertion has been weaker for children and adolescents than for adults . OBJECTIVE To evaluate the safety and efficacy of the selective serotonin reuptake inhibitor sertraline hydrochloride in children and adolescents with obsessive-compulsive disorder . DESIGN R and omized , double-blind , placebo-controlled trial . PATIENTS One hundred eighty-seven patients : 107 children aged 6 to 12 years and 80 adolescents aged 13 to 17 years r and omized to receive either sertraline ( 53 children , 39 adolescents ) or placebo ( 54 children , 41 adolescents ) . SETTING Twelve US academic and community clinics with experience conducting r and omized controlled trials . INTERVENTION Sertraline hydrochloride was titrated to a maximum of 200 mg/d during the first 4 weeks of double-blind therapy , after which patients continued to receive this dosage of medication for 8 more weeks . Control patients received placebo . MAIN OUTCOME MEASURES The Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) , the National Institute of Mental Health Global Obsessive Compulsive Scale ( NIMH GOCS ) , and the NIMH Clinical Global Impressions of Severity of Illness ( CGI-S ) and Improvement ( CGI-I ) rating scales . RESULTS In intent-to-treat analyses , patients treated with sertraline showed significantly greater improvement than did placebo-treated patients on the CY-BOCS ( adjusted mean , -6.8vs -3.4 , respectively ; P=.005 ) , the NIMH GOCS ( -2.2 vs -1.3 , respectively ; P=.02 ) , and the CGI-I ( 2.7 vs 3.3 , respectively ; P=.002 ) scales . Significant differences in efficacy between sertraline and placebo emerged at week 3 and persisted for the duration of the study . Based on CGI-I ratings at end point , 42 % of patients receiving sertraline and 26 % of patients receiving placebo were very much or much improved . Neither age nor sex predicted response to treatment . The incidence of insomnia , nausea , agitation , and tremor were significantly greater in patients receiving sertraline ; 12 ( 13 % ) of 92 sertraline-treated patients and 3 ( 3.2 % ) of 95 placebo-treated patients discontinued prematurely because of adverse medical events ( P=.02 ) . No clinical ly meaningful abnormalities were apparent on vital sign determinations , laboratory findings , or electrocardiographic measurements . CONCLUSION Sertraline appears to be a safe and effective short-term treatment for children and adolescents with obsessive-compulsive disorder OBJECTIVE To compare , via a pilot study , the effectiveness of behavior therapy and of drug treatment in children and adolescents with obsessive-compulsive disorder . METHOD Twenty-two children aged between 8 and 18 years were r and omly assigned to behavior therapy ( n = 12 ) or open clomipramine ( n = 10 ) in a parallel design lasting 12 weeks . Behavior therapy included exposure and response prevention administered in weekly sessions . The mean dosage of clomipramine was 2.5 mg/kg ( range = 1.4 - 3.3 mg/kg ) . The main outcome variables were the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) and the Leyton Obsessional Inventory-Child Version ( LOI-CV ) . RESULTS Significant improvement was obtained in both treatment conditions . Behavior therapy produced stronger therapeutic changes than clomipramine on the CY-BOCS ( p < .05 ) , whereas on the LOI-CV no significant differences between the results of the two treatments were found . Five of the nine initial nonresponders showed significant changes after extension of treatment for another 12 weeks . CONCLUSION Behavior therapy is shown to be a good alternative for drug treatment and deserves further study in larger sample s of children with obsessive-compulsive disorder OBJECTIVE The efficacy of medications , consisting of serotonin partial and specific reuptake blockers , and behavior therapy , consisting of exposure and response prevention in addition to social skills training , cognitive therapy , and habit reversal , in the treatment of obsessive-compulsive disorder are well documented . The purpose of the study was to explore if adding behavior therapy to medication would enhance treatment efficacy . METHODS Ten children/adolescents who had not previously responded to behavior therapy  were r and omly assigned to two groups : fluvoxamine alone or fluvoxamine with behavior therapy . All 10 patients received fluvoxamine for 10 weeks-five continued solely on fluvoxamine for one year and five engaged in behavior therapy for 20 sessions along with fluvoxamine and then continued solely on medication until the end of the year . RESULTS Eight of 10 patients improved significantly on fluvoxamine at week 10 on the primary outcome variable , the Children 's Yale-Brown Obsessive Compulsive Scale ( CY-BOCS ) . According to the other measurements -National Institute of Mental Health-Global Obses-sive-Compulsive Scale , Clinical Global Impression-Improvement ( assessing level of im-provement from week to week ) , and Clinical Global Impression-Severity of Illness Scale ( as-sessing how ill the patient is from week to week)-improvement was not as evident . According to the CY-BOCS , those who received a combination of fluvoxamine and exposure with response prevention showed significantly more improvement than those who only took medication . At two-year follow-up , all patients continued to improve , with those in the combined approach improving more than those in the medication-alone group . CONCLUSIONS Future studies should determine the specific effect of each treatment group , combined and singularly . Reasons for discrepancy in improvement ratings as noted by the different instruments are discussed . The addition of behavior therapy to fluvoxamine seems to enhance treatment efficacy , according to the CY-BOCS Concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid ( 5-HIAA ) , the dopamine metabolite homovanillic acid , and the noradrenaline metabolite 4-hydroxy-3-methoxyphenyl glycol were measured in CSF before and after three weeks ' treatment of severe obsessive-compulsive disorder with clomipramine hydrochloride . Patients who responded to  clomipramine treatment had significantly higher CSF levels of 5-HIAA before treatment . The amelioration of obsessive-comp 
    Output:
    