title: Intensive residential treatment for severe obsessive-compulsive disorder: characterizing treatment course and predictors of response.
abstract: BACKGROUND
  Intensive residential treatment (IRT) is effective for severe, treatment-resistant obsessive-compulsive disorder (OCD). We sought to characterize predictors and course of response to IRT.
  
  
  METHODS
  Admission, monthly, and discharge data were collected on individuals receiving IRT. We examined the association between baseline characteristics and percent change in OCD symptoms as measured by the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) using linear regression. We compared baseline characteristics of IRT responders (≥35% reduction in Y-BOCS) versus non-responders, and of patients who did versus those who did not achieve wellness (Y-BOCS ≤ 12) using non-parametric tests. To examine the course of OCD severity over time, we used linear mixed-effects models with randomly varying intercepts and slopes.
  
  
  RESULTS
  We evaluated 281 individuals admitted to an IRT program. Greater baseline Y-BOCS scores were associated with a significantly greater percent reduction in Y-BOCS scores (β = -1.49 ([95% confidence interval: -2.06 to -0.93]; P < .001)). IRT responders showed significantly greater baseline Y-BOCS scores than non-responders (mean (SD) 28 (5.2) vs. 25.6 (5.8); P = .003) and lower past-year alcohol use scores than non-responders (1.4 (1.9) vs. 2.1 (2.2); P = .01). Participants who achieved wellness displayed lower hoarding factor scores than those who did not (5 (4.6) vs. 9.53 (6.3); P = .03). OCD symptoms declined rapidly over the first month but more slowly over the remaining two months.
  
  
  CONCLUSIONS
  Higher baseline OCD severity, lower past-year alcohol use, and fewer hoarding symptoms predicted better response to IRT. IRT yielded an initial rapid reduction in OCD symptoms, followed by a slower decline after the first month.
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA, USA; Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA. Electronic address: bbrennan@partners.org.
authors.forename: Brian P
authors.initials: BP
authors.lastname: Brennan
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lee
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Jason A
authors.initials: JA
authors.lastname: Elias
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.
authors.forename: Jesse M
authors.initials: JM
authors.lastname: Crosby
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.
authors.forename: Brittany M
authors.initials: BM
authors.lastname: Mathes
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA; Psychology Department, Suffolk University, Boston, MA, USA.
authors.forename: Marie-Christine
authors.initials: MC
authors.lastname: Andre
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA.
authors.forename: Christina M
authors.initials: CM
authors.lastname: Gironda
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Harrison G
authors.initials: HG
authors.lastname: Pope
authors.affiliation: Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Jenike
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, MA, USA; Laboratory for Psychiatric Biostatistics, McLean Hospital, Belmont, MA, USA.
authors.forename: Garrett M
authors.initials: GM
authors.lastname: Fitzmaurice
authors.affiliation: Biological Psychiatry Laboratory, McLean Hospital, Belmont, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA.
authors.forename: James I
authors.initials: JI
authors.lastname: Hudson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000428:Alcohol Drinking; D005260:Female; D000067836:Hoarding Disorder / Q000175:diagnosis / Q000628:therapy; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D009771:Obsessive-Compulsive Disorder / Q000175:diagnosis / Q000628:therapy*; D011569:Psychiatric Status Rating Scales; D012114:Residential Treatment; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Hoarding; IRT; Intensive residential treatment; OCD; Obsessive-compulsive disorder; Predictors