Treatment response, symptom remission, and wellness in obsessive-compulsive disorder.
BACKGROUND
Obsessive-compulsive disorder (OCD) is defined both by intrusive, unwanted thoughts, images, or impulses and by repetitive behavioral or mental acts that are often performed to try to alleviate anxiety. The ultimate goal of treatment for OCD is to reduce the symptoms as well as help patients achieve "wellness." Currently, however, there are no widely accepted, empirically supported criteria for determining wellness in OCD.


METHODS
Building on previous research, the current study examined the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score that most reliably identified patients who responded to treatment, those who achieved symptom remission, and those who achieved wellness. The current study pooled data from 4 randomized controlled OCD treatment trials (N = 288), which took place between 1990 and 2011 at 2 academic sites. Participants (mean age = 36.8 years) had a primary diagnosis of DSM-IV-TR OCD (mean Y-BOCS score = 25.9).


RESULTS
Signal detection analyses showed that a pretreatment-to-posttreatment reduction of ≥ 35% on the Y-BOCS was most predictive of treatment response as defined by the Clinical Global Impressions (CGI)-Improvement scale. A posttreatment Y-BOCS score of ≤ 14 was the best predictor of symptom remission, whereas a score of ≤ 12 was the best predictor of wellness, as defined by symptom remission (defined by the CGI-Severity scale), good quality of life (as measured by the Quality of Life Enjoyment and Satisfaction Questionnaire), and a high level of adaptive functioning (as assessed by the Social Adjustment Scale-Self-Report). Because efficiency (0.86) and specificity (0.88) were highest at the cutoff of ≤ 12, this cutoff score was determined to be the best indicator of wellness.


CONCLUSIONS
The present findings support the convergent validity of the Y-BOCS with other measures of well-being (quality of life, adaptive functioning) and highlight the utility of a Y-BOCS score ≤ 12 as a solo indicator of wellness in outcome studies. The use of empirically supported criteria for defining wellness in OCD is recommended to facilitate comparisons across treatment outcome studies and to inform clinical treatment planning.


BACKGROUND
Pooled data analyzed in this study were from 4 clinical trials, 3 of which are registered at ClinicalTrials.gov (identifiers: NCT00045903, NCT00389493, NCT00316316).
Department of Psyciatry, University of Pennsylvania, Philadelphia, USA. sgfarris@uh.edu
Samantha G
SG
Farris
Carmen P
CP
McLean
Page E
PE
Van Meter
Helen Blair
HB
Simpson
Edna B
EB
Foa
D000223:Adaptation, Psychological; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D011619:Psychotropic Drugs / Q000627:therapeutic use*; D011788:Quality of Life / Q000523:psychology; D012074:Remission Induction / Q000379:methods; D015203:Reproducibility of Results; D012107:Research Design; D012680:Sensitivity and Specificity; D016896:Treatment Outcome
D011619:Psychotropic Drugs