Defining Treatment Response and Remission in Obsessive-Compulsive Disorder: A Signal Detection Analysis of the Children's Yale-Brown Obsessive Compulsive Scale

Department of Pediatrics, Rothman Center for Neuropsychiatry, University of South Florida, 800 6th Street South, 4th Floor, St. Petersburg, FL 33701, USA.
Journal of the American Academy of Child and Adolescent Psychiatry (Impact Factor: 7.26). 07/2010; 49(7):708-17. DOI: 10.1016/j.jaac.2010.04.005
Source: PubMed


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.

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    • "Consistent with previous methodology (e.g., Caporino et al. 2013; Storch et al. 2010, 2011; Tolin et al. 2005; Lewin et al. 2011), ROC analyses derived from signal detection theory were used to assess cut-offs on the PARS for identifying treatment response and remission based on gold standard criteria (ADIS-IV and CGI). Remission was defined as loss of primary anxiety diagnosis on the ADIS-IV, and mild or better symptoms on the CGI-S (B3). "
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    ABSTRACT: This study examined optimal guidelines to assess treatment response and remission for anxiety in youth with autism spectrum disorders (ASD) using the Pediatric Anxiety Rating Scale (PARS). Data was collected for 108 children aged 7-16 years with comorbid anxiety and ASD before and after receiving cognitive behavior therapy. Optimal cut-offs on the PARS were assessed using signal detection analyses using receiver operating characteristic methods. Maximum agreement with response criteria was achieved at 15 % reduction in symptoms on the PARS. Maximum agreement with remission criteria was achieved at 40 % reduction in symptoms, or at a score of 10 or below at post-treatment. Results have implications for standardizing criteria used in research trials and clinical practice.
    No preview · Article · Jun 2015 · Journal of Autism and Developmental Disorders
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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). "
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    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. Identifier NCT01447966
    Full-text · Article · May 2014 · Behaviour Research and Therapy
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    • "The definition of 10 as a cut-off score for clinical remission has been used in previous studies [28], however, it has recently been questioned by Storch et al. [71]. Response to treatment may be defined differently via a wide range of CY-BOCS percent reductions. "
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    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.
    Full-text · Article · Dec 2013 · Child and Adolescent Psychiatry and Mental Health
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