Department of Psyciatry, University of Pennsylvania, Philadelphia, USA.
J Clin Psychiatry. 2013 Jul;74(7):685-90. doi: 10.4088/JCP.12m07789.
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.
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).
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.
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.
Pooled data analyzed in this study were from 4 clinical trials, 3 of which are registered at ClinicalTrials.gov (identifiers: NCT00045903, NCT00389493, NCT00316316).
强迫症（OCD）的定义既包括侵入性的、不受欢迎的想法、图像或冲动，也包括重复的行为或心理行为，这些行为通常是为了减轻焦虑而进行的。强迫症治疗的最终目标是减轻症状，帮助患者达到“健康”。然而，目前还没有广泛接受的、有经验支持的确定 OCD 健康的标准。
基于先前的研究，本研究检查了耶鲁-布朗强迫症量表（Y-BOCS）评分，该评分最可靠地识别出对治疗有反应的患者、症状缓解的患者和达到健康的患者。本研究汇集了 4 项随机对照 OCD 治疗试验的数据（N=288），这些试验于 1990 年至 2011 年在 2 个学术地点进行。参与者（平均年龄=36.8 岁）有 DSM-IV-TR OCD 的主要诊断（平均 Y-BOCS 评分为 25.9）。
信号检测分析表明，Y-BOCS 从治疗前到治疗后的减少≥35%最能预测临床总体印象（CGI）改善量表定义的治疗反应。治疗后 Y-BOCS 评分为≤14 是症状缓解的最佳预测指标，而评分为≤12 是健康的最佳预测指标，健康的定义是症状缓解（由 CGI 严重程度量表定义）、生活质量良好（由生活质量享受和满意度问卷测量）和适应性功能水平高（由社会适应量表-自我报告评估）。由于效率（0.86）和特异性（0.88）在≤12 的截点处最高，因此将该截点得分确定为健康的最佳指标。
本研究结果支持 Y-BOCS 与其他幸福感衡量标准（生活质量、适应性功能）的收敛效度，并强调 Y-BOCS 评分≤12 作为幸福感的单一指标在结局研究中的效用。建议使用经验支持的 OCD 健康定义标准，以促进治疗结果研究之间的比较，并为临床治疗计划提供信息。
本研究分析的汇总数据来自 4 项临床试验，其中 3 项在 ClinicalTrials.gov 注册（标识符：NCT00045903、NCT00389493、NCT00316316）。
