Treatment response, symptom remission, and wellness in obsessive-compulsive disorder

Samantha G. Farris, Carmen P. McLean, Page E. Van Meter, Helen Blair Simpson, Edna B. Foa

Research output: Contribution to journalArticlepeer-review

111 Scopus citations

Abstract

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. Method: 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-/V-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 (CGDImprovement scale. A posttreatmentY 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. Trial Registration: Pooled data analy7ed in this study were from 4 clinical trials, 3 of which are registered at ClinicalTrials.gov (identifiers: NCT00045903, NCT00389493, NCTOO3 16316).

Original languageEnglish (US)
Pages (from-to)685-690
Number of pages6
JournalJournal of Clinical Psychiatry
Volume74
Issue number7
DOIs
StatePublished - Jul 2013

All Science Journal Classification (ASJC) codes

  • Psychiatry and Mental health

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