title: Augmenting Cognitive Behavior Therapy for School Refusal with Fluoxetine: A Randomized Controlled Trial.
abstract: This study investigates whether the augmentation of cognitive behavior therapy (CBT) with fluoxetine improves outcomes in anxious school refusing adolescents (11-16.5 years). Sixty-two participants were randomly allocated to CBT alone, CBT + fluoxetine or CBT + placebo. All treatments were well tolerated; with one suicide-attempt in the CBT + placebo group. All groups improved significantly on primary (school attendance) and secondary outcome measures (anxiety, depression, self-efficacy and clinician-rated global functioning); with gains largely maintained at 6-months and 1-year. Few participants were anxiety disorder free after acute treatment. During the follow-up period anxiety and depressive disorders continued to decline whilst school attendance remained stable, at around 54 %. The only significant between-group difference was greater adolescent-reported treatment satisfaction in the CBT + fluoxetine group than the CBT alone group. These results indicate the chronicity of school refusal, and the need for future research into how to best improve school attendance rates.
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia. glenn.melvin@monash.edu.
authors.forename: Glenn A
authors.identifier: 0000-0002-6958-3908
authors.initials: GA
authors.lastname: Melvin
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Dudley
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.|Early in Life Mental Health Service, Monash Health, Clayton, VIC, 3168, Australia.
authors.forename: Michael S
authors.initials: MS
authors.lastname: Gordon
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Ester
authors.initials: E
authors.lastname: Klimkeit
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Eleonora
authors.initials: E
authors.lastname: Gullone
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Taffe
authors.affiliation: Centre for Developmental Psychiatry and Psychology, Department of Psychiatry, School of Clinical Sciences at Monash Health, Monash University, Notting Hill Campus, #1, 270 Ferntree Gully Road, Notting Hill, VIC, 3168, Australia.
authors.forename: Bruce J
authors.initials: BJ
authors.lastname: Tonge
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior / Q000187:drug effects / Q000523:psychology; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D003131:Combined Modality Therapy / Q000379:methods; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010698:Phobic Disorders / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D011615:Psychotherapy, Group / Q000379:methods*; D012574:Schools; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D005473:Fluoxetine; D017367:Selective Serotonin Reuptake Inhibitors
keywords: Anxiety disorders; Cognitive behavior therapy; Fluoxetine; School refusal