Defining Treatment Response and Remission in Obsessive-Compulsive Disorder: A Signal Detection Analysis of the Children's Yale-Brown Obsessive Compulsive Scale
ABSTRACT To examine the optimal Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) percent reduction cutoffs for predicting treatment response and clinical remission among children and adolescents with obsessive-compulsive disorder (OCD).
Youth with OCD (N = 109; range 7 to 19 years) received 14 sessions of weekly or intensive family-based CBT as part of previously published studies or through the standard clinical flow at our facility. Assessments were conducted before and after treatment and included the CY-BOCS, response and remission status on the Clinical Global Impressions Scale, and the Child Obsessive-Compulsive Impact Scale.
Maximally efficient CY-BOCS cutoffs were observed at a 25% reduction for treatment response, a 45% to 50% reduction for symptom remission, and a CY-BOCS score of 14 when considering raw scores. OCD-related impairment improved as a function of treatment response and symptom remission.
These data indicate that a CY-BOCS reduction of 25% appears to be optimal for determining treatment response, a reduction of 45% to 50% appears to be optimal for detecting symptom remission, and a CY-BOCS raw score of 14 best reflects remission after treatment. Clinical trials should employ a consistent definition of treatment response for cross-study comparability. Clinicians can use these values for treatment planning decisions.
- SourceAvailable from: Adam B. Lewin
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- "Multiple categorizations of treatment response and symptom remission were employed. Using the CGI, treatment response was defined by categorizations of " much better " or " very much better " on the CGI-I, and remission was defined by categorizing patients as having " mild symptoms " or less on the CGI-S, following research actuarial precedent (Lewin et al., 2011; Storch, Lewin, De Nadai, & Murphy, 2010). To provide comparison to other studies, we also considered remission outcome using CYBOCS scores of 12 at post-treatment reflecting symptom remission (mirroring criteria used by Freeman et al., 2008). "
ABSTRACT: Aims To examine the feasibility, acceptability and preliminary efficacy of family-based exposure/response prevention therapy (E/RP) versus treatment as usual (TAU) in a cohort of very young children with early onset obsessive-compulsive disorder (OCD). Methods Thirty-one children ages 3-8 years (M = 5.8 years) with a primary diagnosis of OCD were randomized to E/RP or TAU. The E/RP condition received 12 sessions of family-based E/RP twice weekly over 6 weeks. Families were assessed at baseline, post-treatment, 1-month and 3-month follow up. The Children’s Yale Brown Obsessive Compulsive Scale and Clinical Global Impression served as primary outcome measures. Results A large group effect emerged in favor of the E/RP group (d = 1.69). Sixty-five percent of the E/RP group was considered treatment responders as compared to 7% in the TAU group. Symptom remission was achieved in 35.2% of the E/RP group and 0% of the TAU group. There was no attrition and satisfaction was high; gains were maintained at 3 months. Conclusions Even amongst children as young as 3 years, developmentally tailored E/RP is efficacious and well-tolerated in reducing OCD symptoms. Key adaptations for younger children include extensive parent involvement, targeting family accommodation, and frequent meetings while delivering a full course of E/RP. ClinicalTrials.gov Identifier NCT01447966 http://clinicaltrials.gov/ct2/show/NCT01447966?term=ocd+and+st+petersburg&rank=1Behaviour Research and Therapy 05/2014; 56(1). DOI:10.1016/j.brat.2014.02.001 · 3.85 Impact Factor
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- "The definition of 10 as a cut-off score for clinical remission has been used in previous studies , however, it has recently been questioned by Storch et al. . Response to treatment may be defined differently via a wide range of CY-BOCS percent reductions. "
ABSTRACT: This paper describes and discusses the methodology of the Nordic long-term OCD-treatment study (NordLOTS). The purpose of this effectiveness study was to study treatment outcome of CBT, to identify CBT non- or partial responders and to investigate whether an increased number of CBT-sessions or sertraline treatment gives the best outcome; to identify treatment refractory patients and to investigate the outcome of aripiprazole augmentation; to study the outcome over a three year period for each responder including the risk of relapse, and finally to study predictors, moderators and mediators of treatment response. Step 1 was an open and uncontrolled clinical trial with CBT, step 2 was a controlled, randomised non-blinded study of CBT non-responders from step 1. Patients were randomized to receive either sertraline plus CBT-support or continued and modified CBT. In step 3 patients who did not respond to either CBT or sertraline were treated with aripiprazole augmentation to sertraline. This multicenter trial covering three Scandinavian countries is going to be the largest CBT-study for paediatric OCD to date. It is not funded by industry and tries in the short and long-term to answer the question whether further CBT or SSRI is better in CBT non-responders.Child and Adolescent Psychiatry and Mental Health 12/2013; 7(1):41. DOI:10.1186/1753-2000-7-41
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- "For researchers, these data provide empirically guided benchmarks for making decisions about study inclusion criteria and group stratification. Findings from this study complement recent findings that empirically evaluated the degree of obsessive-compulsive symptom change that constitutes treatment response (Lewin et al., 2011; Storch, Lewin, De Nadai, & Murphy, 2010). For clinicians, these data are valuable in that they provide a way to translate current best practice recommendations—largely rooted in assessment of symptom severity—into " real world " treatment planning. "
ABSTRACT: Despite extensive use of the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997), the lack of normative data impedes interpretation of individual CYBOCS scores. Consequently, psychometrics on CYBOCS severity scores from 815 treatment-seeking youth with obsessive-compulsive disorder (OCD) are presented, across age and sex, so that normative comparisons of obsessive, compulsive, and combined obsessive-compulsive severity could be calculated. Our findings suggest no evidence for marked age or sex differences. Further, obsessive-compulsive symptom severity scores (measured via the CYBOCS) appear consistent with global OCD syndrome severity (measured via the Clinician Global Impression-Severity scale [CGI-S; Guy, 1976]; r = .58). This study contributes the 1st empirically based guidelines for interpreting obsessive-compulsive symptom severity scores. After a diagnosis of OCD is determined, the CYBOCS can be used to determine severity of illness (however, categories of severity proposed by this article should not be used in the screening of OCD symptoms). Findings can facilitate clinicians' and investigators' ability to draw comparisons across obsessive-compulsive severity scores. (PsycINFO Database Record (c) 2013 APA, all rights reserved).Psychological Assessment 12/2013; 26(2). DOI:10.1037/a0035174 · 2.99 Impact Factor