0
September 1997, Vol 54, No. 9 >
Article | September 1997

A Clinical Psychotherapy Trial for Adolescent Depression Comparing Cognitive, Family, and Supportive Therapy

David A. Brent, MD; Diane Holder, MSW; David Kolko, PhD; Boris Birmaher, MD; Marianne Baugher, MA; Claudia Roth, MSW; Satish Iyengar, PhD; Barbara A. Johnson, MD
Arch Gen Psychiatry. 1997;54(9):877-885. doi:10.1001/archpsyc.1997.01830210125017
Text Size: A A A
Published online
Article
References
Comments

Background:  Previous studies in nonclinical samples have shown psychosocial treatments to be efficacious in the treatment of adolescent depression, but few psychotherapy treatment studies have been conducted in clinically referred, depressed adolescents.

Methods:  One hundred seven adolescent patients with DSM-III-R major depressive disorder (MDD) were randomly assigned to 1 of 3 treatments: individual cognitive behavior therapy, systemic behavior family therapy (SBFT), or individual nondirective supportive therapy (NST). Treatments were 12 to 16 sessions provided in as many weeks. Intent-to-treat analyses were conducted using all follow-up data.

Results:  Of the 107 patients enrolled in the study, 78 (72.9%) completed the study, 4 (3.7%) never initiated treatment, 10 (9.3%) had exclusionary criteria that were undetected at entry, 8 (7.5%) dropped out, and 7 (6.5%) were removed for clinical reasons. Cognitive behavior therapy showed a lower rate of MDD at the end of treatment compared with NST (17.1% vs 42.4%; P=.02), and resulted in a higher rate of remission (64.7%, defined as absence of MDD and at least 3 consecutive Beck Depression Inventory scores <9) than SBFT (37.9%; P=.03) or NST (39.4%; P=.04). Cognitive behavior therapy resulted in more rapid relief in interviewer-rated (vs both treatments, P=.03) and self-reported depression (vs SBFT, P=.02). All 3 treatments showed significant and similar reductions in suicidality and functional impairment. Parents' views of the credibility of cognitive behavior therapy improved compared with parents' views of both SBFT (P=.01) and NST (P=.05).

Conclusion:  Cognitive behavior therapy is more efficacious than SBFT or NST for adolescent MDD in clinical settings, resulting in more rapid and complete treatment response.

REFERENCES

1 +
Lewinsohn PM, Hops H.  Adolescent psychopathology, I: prevalence and incidence of depression and other DSM-III-R disorders in high school students . J Abnorm Psychol . 1993;;102:133-144.
2 +
Kovacs M, Gatsonis C.  Secular trends in age at onset of major depressive disorder in a clinical sample of children . J Psychiatr Res . 1994;;28:319-329.
3 +
Ryan ND, Williamson DE, lyengar S, Orvaschel H, Reich T, Dahl RE, Puig-Antich J.  A secular increase in child and adolescent onset affective disorder . J Am Acad Child Adolesc Psychiatry . 1992;;31:600-605.
4 +
Harrington R, Fudge H, Rutter M, Pickles A, Hill J.  Adult outcomes of childhood and adolescent depression, I: psychiatric status . Arch Gen Psychiatry . 1990;;47:465-473.
5 +
Kandel DB, Davies M.  Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry . 1986;;43:255-262.
6 +
Kovacs M, Feinberg T, Crouse-Novak M, Paulauskas S, Pollock M, Finkelstein R.  Depressive disorders in childhood, II: a longitudinal study of the risk for a subsequent major depression . Arch Gen Psychiatry . 1984;;41:643-649.
7 +
Rohde P, Lewinsohn PM, Seeley JR.  Are adolescents changed by an episode of major depression? J Am Acad Child Adolesc Psychiatry . 1994;;33:1289-1298.
8 +
Andrews JA, Lewinsohn PM.  Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders . J Am Acad Child Adolesc Psychiatry . 1992;;31:655-662.
9 +
Brent DA, Perper JA, Moritz G, Allman C, Friend A, Roth C, Schweers J, Balach L, Baugher M.  Psychiatric risk factors for adolescent suicide: a case-control study . J Am Acad Child Adolesc Psychiatry . 1993;;32:521-529.
10 +
Fergusson DM, Lynskey MT.  Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders . J Am Acad Child Adolesc Psychiatry . 1995;;34:1308-1317.
11 +
Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M.  Psychiatric diagnosis in child and adolescent suicide . Arch Gen Psychiatry . 1996;;53:339-348.
12 +
Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, Rintelmann J.  A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression . Arch Gen Psychiatry . 1997;;54: In press.
13 +
Kramer AD, Feiguine RJ.  Clinical effects of amitriptyline in adolescent depression: a pilot study . J Am Acad Child Adolesc Psychiatry . 1981;;20:636-644.
14 +
Kye C, Waterman MD, Ryan N, Birmaher B, Williamson D, lyengar S, Dachille S.  A randomized, controlled trial of amitriptyline in the acute treatment of adolescent major depression . J Am Acad Child Adolesc Psychiatry . 1996;;35:1139-1144.
15 +
Kutcher S, Boulos C, Ward B, Marton P, Simeon J, Ferguson HB, Szalai J, Katic M, Roberts N, Dubois C, Reed K.  Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial . J Am Acad Child Adolesc Psychiatry . 1994;;33:686-694.
16 +
Geller B, Cooper MA, Graham DL, Marsteller FA, Bryant DM.  Double-blind placebo-controlled study of nortriptyline in depressed adolescents using a 'fixed plasma level' design . Psychopharmacol Bull . 1990;;26:85-90.
17 +
Simeon JG, Dinicola VF, Ferguson B, Copping W.  Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up . Prog Neuropsychopharmacol Biol Psychiatry . 1990;;14:791-795.
18 +
Garber J, Hilsman R.  Cognitions, stress, and depression in children and adolescents . Mood Disorders . 1992;;1:129-167.
19 +
Reynolds WM, Coates KI.  A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents . J Consult Clin Psychol . 1986;;54:653-660.
20 +
Lewinsohn PM, Clarke GN.  Cognitive-behavioral treatment for depressed adolescents . Behav Ther . 1990;;21:385-401.
21 +
Kahn JS, Kehle TJ, Jenson WR, Clark E.  Comparison of cognitive-behavioral relaxation, and self-modeling interventions for depression among middle-school students . School Psychol Rev . 1990;;19:196-211.
22 +
Wood A, Harrington R, Moore A.  Controlled trial of a brief cognitive-behavioral intervention in adolescent patients with depressive disorders . J Child Psychol Psychiatry . 1996;;37:737-746.
23 +
Diamond GS, Serrano AC, Dickey M, Sonis WA.  Current status of family-based outcome and process research . J Am Acad Child Adolesc Psychiatry . 1996;;35:6-16.
24 +
Asarnow JR, Goldstein MJ, Tompson M, Guthrie D.  One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion . J Child Psychol Psychiatry . 1993;;34:129-137.
25 +
Hollis C.  Depression, family environment, and adolescent suicidal behavior . J Am Acad Child Adolesc Psychiatry . 1996;;35:622-630.
26 +
Luborsky L, McLellan T, Woody GE, O'Brien CP, Auerbach A.  Therapist success and its determinants . Arch Gen Psychiatry . 1985;;42:602-611.
27 +
Burns DD, Nolen-Hoeksema S.  Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model . J Consult Clin Psychol . 1992;;60:441-449.
28 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987;.
29 +
Beck AT, Steer RA, Garbin MG.  Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation . Clin Psychol Rev . 1988;;8:77-100.
30 +
Begg CB, Iglewicz B.  A treatment allocation procedure for sequencial clinical trials . Biometrics . 1980;;36:81-90.
31 +
Efron B.  Forcing a sequential experiment to be balanced . Biometrika . 1971;;58:403-417.
32 +
Brent DA, Poling K, McKain B, Baugher M.  A psychoeducational program for families of affectively ill children and adolescents . J Am Acad Child Adolesc Psychiatry . 1993;;32:770-774.
33 +
Brent DA, Roth C, Holder D, Kolko DJ, Birmaher B, Johnson BA, Schweers J.  Psychosocial interventions for treating adolescent depression: a comparison of three psychosocial interventions . In: Hibbs ED, Jensen PS, eds. Psychosocial Treatment for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice . Washington, DC: American Psychiatric Press Inc; 1996;:187-206.
34 +
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression . New York, NY: Guilford Press; 1979;.
35 +
Rotheram MJ.  Evaluation of imminent danger for suicide among youth . Am J Orthopsychiatry . 1987;;57:102-110.
36 +
Alexander J, Parsons BV. Functional Family Therapy . Pacific Grove, Calif: Brooks/ Cole Publishing Co; 1982;.
37 +
Robin AL, Foster SL. Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach . New York, NY: Guilford Press; 1989;.
38 +
Vallis TM, Shaw BF, Dobson KS.  The Cognitive Therapy Scale: psychometric properties . J Consult Clin Psychol . 1986;;54:381-385.
39 +
Piercy FP, Liard RA, Mohammed Z.  A Family Therapist Rating Scale . J Marital Fam Ther . 1983;;9:49-59.
40 +
Suh CS, Strupp HH, O'Malley SS.  The Vanderbilt Process Measures: the Psychotherapy Process Scale (VPPS) and the Negative Indications Scale (NIS) . In: Greenberg LS, Pinsof WM, eds. The Psychotherapeutic Process: A Research Hand-book . New York, NY: Guilford Press; 1986;:285-323.
41 +
Endicott J, Spitzer RL.  A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;;35:837-844.
42 +
Elkin I, Shea T, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB.  National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments . Arch Gen Psychiatry . 1989;;46:971-982.
43 +
Borkovec TD, Nau SD.  Credibility of analogue therapy rationales . J Behav Ther Exp Psychiatry . 1972;;3:257-260.
44 +
Chambers WJ, Puig-Antich J, Hirsch M, Paez P, Ambrosini PJ, Tabrizi MA, Davies M.  The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-age Children, Present Episode Version . Arch Gen Psychiatry . 1985;;42:696-702.
45 +
Orvaschel H, Puig-Antich J, Chambers W, Tabrizi MA, Johnson R.  Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E . J Am Acad Child Psychiatry . 1982;;21:392-397.
46 +
Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A.  Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents . J Am Acad Child Adolesc Psychiatry . 1991;;30:51-57.
47 +
Strober M, Green J, Carlson G.  Utility of the Beck Depression Inventory with psychiatrically hospitalized adolescents . J Consult Clin Psychol . 1981;;49:482-483.
48 +
Somoza E, Soutullo-Esperon L, Mossman D.  Evaluation and optimization of diagnostic tests using receiver operating characteristic analysis and information theory . Int J Biomed Comput . 1989;;24:153-189.
49 +
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia SA.  A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry . 1983;;40:1228-1231.
50 +
Pocock SJ. Clinical Trials: A Practical Approach . New York, NY: John Wiley & Sons Inc; 1983;:182.
51 +
Lavori PW.  Clinical trials in psychiatry: should protocol deviation censor patient data? Neuropsychopharmacology . 1992;;6:39-48.
52 +
Gibbons RD, Hedeker D, Elkin I, WaternauxC, Kraemer HC, Greenhouse JB, Shea T, Imber SD, Sotsky SM, Watkins JT.  Some conceptual and statistical issues in analysis of longitudinal psychiatric data: application to the NIMH Treatment of Depression Collaborative Research Program dataset . Arch Gen Psychiatry . 1993;;50:739-750.
53 +
Mantel N.  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;;50:163-170.
54 +
Beck AT, Weissman A, Lester D, Trexler L.  The measurement of pessimism: the Hopelessness Scale . J Consult Clin Psychol . 1974;;42:861-865.
55 +
Luborsky L, Singer B.  Comparative studies of psychotherapies: is it true that 'everyone has won and all must have prizes?' Arch Gen Psychiatry . 1975;;32:995-1008.
56 +
Weisz JR, Weiss B, Donenberg GR.  The lab versus the clinic: effects of child and adolescent psychotherapy . Am Psychol . 1992;;47:1578-1585.
57 +
Barrett PM, Dadds MR, Rapee RM.  Family treatment of childhood anxiety: a controlled trial . J Consult Clin Psychol . 1996;;64:333-342.
58 +
Puig-Antich J, Lukens E, Davies M, Goetz D, Brennan-Quattrock J, Todak G.  Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationship after sustained recovery from affective episode . Arch Gen Psychiatry . 1985;;42:511-517.
59 +
Kovacs M, Akiskal HS, Gatsonis C, Parrone PL.  Childhood-onset dysthymic disorder . Arch Gen Psychiatry . 1994;;51:365-374.

First Page Preview

First page PDF preview

Figures

Tables

Interactive Graphics

Video

Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Lewinsohn PM, Hops H.  Adolescent psychopathology, I: prevalence and incidence of depression and other DSM-III-R disorders in high school students . J Abnorm Psychol . 1993;;102:133-144.
2 +
Kovacs M, Gatsonis C.  Secular trends in age at onset of major depressive disorder in a clinical sample of children . J Psychiatr Res . 1994;;28:319-329.
3 +
Ryan ND, Williamson DE, lyengar S, Orvaschel H, Reich T, Dahl RE, Puig-Antich J.  A secular increase in child and adolescent onset affective disorder . J Am Acad Child Adolesc Psychiatry . 1992;;31:600-605.
4 +
Harrington R, Fudge H, Rutter M, Pickles A, Hill J.  Adult outcomes of childhood and adolescent depression, I: psychiatric status . Arch Gen Psychiatry . 1990;;47:465-473.
5 +
Kandel DB, Davies M.  Adult sequelae of adolescent depressive symptoms . Arch Gen Psychiatry . 1986;;43:255-262.
6 +
Kovacs M, Feinberg T, Crouse-Novak M, Paulauskas S, Pollock M, Finkelstein R.  Depressive disorders in childhood, II: a longitudinal study of the risk for a subsequent major depression . Arch Gen Psychiatry . 1984;;41:643-649.
7 +
Rohde P, Lewinsohn PM, Seeley JR.  Are adolescents changed by an episode of major depression? J Am Acad Child Adolesc Psychiatry . 1994;;33:1289-1298.
8 +
Andrews JA, Lewinsohn PM.  Suicidal attempts among older adolescents: prevalence and co-occurrence with psychiatric disorders . J Am Acad Child Adolesc Psychiatry . 1992;;31:655-662.
9 +
Brent DA, Perper JA, Moritz G, Allman C, Friend A, Roth C, Schweers J, Balach L, Baugher M.  Psychiatric risk factors for adolescent suicide: a case-control study . J Am Acad Child Adolesc Psychiatry . 1993;;32:521-529.
10 +
Fergusson DM, Lynskey MT.  Suicide attempts and suicidal ideation in a birth cohort of 16-year-old New Zealanders . J Am Acad Child Adolesc Psychiatry . 1995;;34:1308-1317.
11 +
Shaffer D, Gould MS, Fisher P, Trautman P, Moreau D, Kleinman M, Flory M.  Psychiatric diagnosis in child and adolescent suicide . Arch Gen Psychiatry . 1996;;53:339-348.
12 +
Emslie GJ, Rush AJ, Weinberg WA, Kowatch RA, Hughes CW, Carmody T, Rintelmann J.  A double-blind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression . Arch Gen Psychiatry . 1997;;54: In press.
13 +
Kramer AD, Feiguine RJ.  Clinical effects of amitriptyline in adolescent depression: a pilot study . J Am Acad Child Adolesc Psychiatry . 1981;;20:636-644.
14 +
Kye C, Waterman MD, Ryan N, Birmaher B, Williamson D, lyengar S, Dachille S.  A randomized, controlled trial of amitriptyline in the acute treatment of adolescent major depression . J Am Acad Child Adolesc Psychiatry . 1996;;35:1139-1144.
15 +
Kutcher S, Boulos C, Ward B, Marton P, Simeon J, Ferguson HB, Szalai J, Katic M, Roberts N, Dubois C, Reed K.  Response to desipramine treatment in adolescent depression: a fixed-dose, placebo-controlled trial . J Am Acad Child Adolesc Psychiatry . 1994;;33:686-694.
16 +
Geller B, Cooper MA, Graham DL, Marsteller FA, Bryant DM.  Double-blind placebo-controlled study of nortriptyline in depressed adolescents using a 'fixed plasma level' design . Psychopharmacol Bull . 1990;;26:85-90.
17 +
Simeon JG, Dinicola VF, Ferguson B, Copping W.  Adolescent depression: a placebo-controlled fluoxetine treatment study and follow-up . Prog Neuropsychopharmacol Biol Psychiatry . 1990;;14:791-795.
18 +
Garber J, Hilsman R.  Cognitions, stress, and depression in children and adolescents . Mood Disorders . 1992;;1:129-167.
19 +
Reynolds WM, Coates KI.  A comparison of cognitive-behavioral therapy and relaxation training for the treatment of depression in adolescents . J Consult Clin Psychol . 1986;;54:653-660.
20 +
Lewinsohn PM, Clarke GN.  Cognitive-behavioral treatment for depressed adolescents . Behav Ther . 1990;;21:385-401.
21 +
Kahn JS, Kehle TJ, Jenson WR, Clark E.  Comparison of cognitive-behavioral relaxation, and self-modeling interventions for depression among middle-school students . School Psychol Rev . 1990;;19:196-211.
22 +
Wood A, Harrington R, Moore A.  Controlled trial of a brief cognitive-behavioral intervention in adolescent patients with depressive disorders . J Child Psychol Psychiatry . 1996;;37:737-746.
23 +
Diamond GS, Serrano AC, Dickey M, Sonis WA.  Current status of family-based outcome and process research . J Am Acad Child Adolesc Psychiatry . 1996;;35:6-16.
24 +
Asarnow JR, Goldstein MJ, Tompson M, Guthrie D.  One-year outcomes of depressive disorders in child psychiatric in-patients: evaluation of the prognostic power of a brief measure of expressed emotion . J Child Psychol Psychiatry . 1993;;34:129-137.
25 +
Hollis C.  Depression, family environment, and adolescent suicidal behavior . J Am Acad Child Adolesc Psychiatry . 1996;;35:622-630.
26 +
Luborsky L, McLellan T, Woody GE, O'Brien CP, Auerbach A.  Therapist success and its determinants . Arch Gen Psychiatry . 1985;;42:602-611.
27 +
Burns DD, Nolen-Hoeksema S.  Therapeutic empathy and recovery from depression in cognitive-behavioral therapy: a structural equation model . J Consult Clin Psychol . 1992;;60:441-449.
28 +
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised . Washington, DC: American Psychiatric Association; 1987;.
29 +
Beck AT, Steer RA, Garbin MG.  Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation . Clin Psychol Rev . 1988;;8:77-100.
30 +
Begg CB, Iglewicz B.  A treatment allocation procedure for sequencial clinical trials . Biometrics . 1980;;36:81-90.
31 +
Efron B.  Forcing a sequential experiment to be balanced . Biometrika . 1971;;58:403-417.
32 +
Brent DA, Poling K, McKain B, Baugher M.  A psychoeducational program for families of affectively ill children and adolescents . J Am Acad Child Adolesc Psychiatry . 1993;;32:770-774.
33 +
Brent DA, Roth C, Holder D, Kolko DJ, Birmaher B, Johnson BA, Schweers J.  Psychosocial interventions for treating adolescent depression: a comparison of three psychosocial interventions . In: Hibbs ED, Jensen PS, eds. Psychosocial Treatment for Child and Adolescent Disorders: Empirically Based Strategies for Clinical Practice . Washington, DC: American Psychiatric Press Inc; 1996;:187-206.
34 +
Beck AT, Rush AJ, Shaw BF, Emery G. Cognitive Therapy of Depression . New York, NY: Guilford Press; 1979;.
35 +
Rotheram MJ.  Evaluation of imminent danger for suicide among youth . Am J Orthopsychiatry . 1987;;57:102-110.
36 +
Alexander J, Parsons BV. Functional Family Therapy . Pacific Grove, Calif: Brooks/ Cole Publishing Co; 1982;.
37 +
Robin AL, Foster SL. Negotiating Parent-Adolescent Conflict: A Behavioral-Family Systems Approach . New York, NY: Guilford Press; 1989;.
38 +
Vallis TM, Shaw BF, Dobson KS.  The Cognitive Therapy Scale: psychometric properties . J Consult Clin Psychol . 1986;;54:381-385.
39 +
Piercy FP, Liard RA, Mohammed Z.  A Family Therapist Rating Scale . J Marital Fam Ther . 1983;;9:49-59.
40 +
Suh CS, Strupp HH, O'Malley SS.  The Vanderbilt Process Measures: the Psychotherapy Process Scale (VPPS) and the Negative Indications Scale (NIS) . In: Greenberg LS, Pinsof WM, eds. The Psychotherapeutic Process: A Research Hand-book . New York, NY: Guilford Press; 1986;:285-323.
41 +
Endicott J, Spitzer RL.  A diagnostic interview: the Schedule for Affective Disorders and Schizophrenia . Arch Gen Psychiatry . 1978;;35:837-844.
42 +
Elkin I, Shea T, Watkins JT, Imber SD, Sotsky SM, Collins JF, Glass DR, Pilkonis PA, Leber WR, Docherty JP, Fiester SJ, Parloff MB.  National Institute of Mental Health Treatment of Depression Collaborative Research Program: general effectiveness of treatments . Arch Gen Psychiatry . 1989;;46:971-982.
43 +
Borkovec TD, Nau SD.  Credibility of analogue therapy rationales . J Behav Ther Exp Psychiatry . 1972;;3:257-260.
44 +
Chambers WJ, Puig-Antich J, Hirsch M, Paez P, Ambrosini PJ, Tabrizi MA, Davies M.  The assessment of affective disorders in children and adolescents by semistructured interview: test-retest reliability of the Schedule for Affective Disorders and Schizophrenia for School-age Children, Present Episode Version . Arch Gen Psychiatry . 1985;;42:696-702.
45 +
Orvaschel H, Puig-Antich J, Chambers W, Tabrizi MA, Johnson R.  Retrospective assessment of prepubertal major depression with the Kiddie-SADS-E . J Am Acad Child Psychiatry . 1982;;21:392-397.
46 +
Ambrosini PJ, Metz C, Bianchi MD, Rabinovich H, Undie A.  Concurrent validity and psychometric properties of the Beck Depression Inventory in outpatient adolescents . J Am Acad Child Adolesc Psychiatry . 1991;;30:51-57.
47 +
Strober M, Green J, Carlson G.  Utility of the Beck Depression Inventory with psychiatrically hospitalized adolescents . J Consult Clin Psychol . 1981;;49:482-483.
48 +
Somoza E, Soutullo-Esperon L, Mossman D.  Evaluation and optimization of diagnostic tests using receiver operating characteristic analysis and information theory . Int J Biomed Comput . 1989;;24:153-189.
49 +
Shaffer D, Gould MS, Brasic J, Ambrosini P, Fisher P, Bird H, Aluwahlia SA.  A Children's Global Assessment Scale (CGAS) . Arch Gen Psychiatry . 1983;;40:1228-1231.
50 +
Pocock SJ. Clinical Trials: A Practical Approach . New York, NY: John Wiley & Sons Inc; 1983;:182.
51 +
Lavori PW.  Clinical trials in psychiatry: should protocol deviation censor patient data? Neuropsychopharmacology . 1992;;6:39-48.
52 +
Gibbons RD, Hedeker D, Elkin I, WaternauxC, Kraemer HC, Greenhouse JB, Shea T, Imber SD, Sotsky SM, Watkins JT.  Some conceptual and statistical issues in analysis of longitudinal psychiatric data: application to the NIMH Treatment of Depression Collaborative Research Program dataset . Arch Gen Psychiatry . 1993;;50:739-750.
53 +
Mantel N.  Evaluation of survival data and two new rank order statistics arising in its consideration . Cancer Chemother Rep . 1966;;50:163-170.
54 +
Beck AT, Weissman A, Lester D, Trexler L.  The measurement of pessimism: the Hopelessness Scale . J Consult Clin Psychol . 1974;;42:861-865.
55 +
Luborsky L, Singer B.  Comparative studies of psychotherapies: is it true that 'everyone has won and all must have prizes?' Arch Gen Psychiatry . 1975;;32:995-1008.
56 +
Weisz JR, Weiss B, Donenberg GR.  The lab versus the clinic: effects of child and adolescent psychotherapy . Am Psychol . 1992;;47:1578-1585.
57 +
Barrett PM, Dadds MR, Rapee RM.  Family treatment of childhood anxiety: a controlled trial . J Consult Clin Psychol . 1996;;64:333-342.
58 +
Puig-Antich J, Lukens E, Davies M, Goetz D, Brennan-Quattrock J, Todak G.  Psychosocial functioning in prepubertal major depressive disorders, II: interpersonal relationship after sustained recovery from affective episode . Arch Gen Psychiatry . 1985;;42:511-517.
59 +
Kovacs M, Akiskal HS, Gatsonis C, Parrone PL.  Childhood-onset dysthymic disorder . Arch Gen Psychiatry . 1994;;51:365-374.

Correspondence

Submit a Letter
CME Course for:


You need to register in order to view this quiz.


To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
To view and print your certificate and access a summary of your CME courses go to My CME.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s “Cited By” API will populate this tab (http://www.crossref.org/citedby.html).
Compression-Only CPR: Pushing the Science Forward
Cone
AAM 2010;304:1493-1495.
All you need to read in the other general journals
BMJ 2010;341:c5893-c1494.
Submit a Response

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging & repositioning the boxes below.

© 2012 American Medical Association. All Rights Reserved.
Powered bySilverchair Information Systems