Rech Megan, Weinzimmer Saira, Geller Daniel, McGuire Joseph F, Schneider Sophie C, Patyk Kevin C, De Nadai Alessandro S, Cepeda Sandra C, Small Brent J, Murphy Tanya K, Wilhelm Sabine, Storch Eric A
Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
J Obsessive Compuls Relat Disord. 2020 Oct;27. doi: 10.1016/j.jocrd.2020.100580. Epub 2020 Aug 29.
This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT).
One hundred and thirty-nine youth with a current primary diagnosis of OCD participated in this study. Participants received 10 sessions of CBT augmented by either placebo or d-cycloserine (DCS) as part of a randomized double-blind multi-site clinical trial. Early response and remission status were determined by clinician-rated global symptom improvement (CGI-I) and severity (CGI-S), respectively.
At the mid-treatment assessment, 45.3% of youth were early responders, and 28.1% were early remitters. At post-treatment assessment, 79.1% of youth were responders and 67.6% were remitters. Early response predicted a higher likelihood of post-treatment response and remission; early remission significantly predicted a higher likelihood of post-treatment remission. Bivariate logistic regressions showed that early response was predicted by lower baseline clinician-rated global severity (CGI-S) and lower depression severity; however, only depression severity remained a significant predictor in the multivariable logistic regression model. Furthermore, bivariate logistic regressions showed that early remission was predicted by lower baseline clinician-rated global severity (CGI-S), lower depression severity, and lower obsessive-compulsive symptom severity (CY-BOCS); however, only global severity remained a significant predictor in the multivariable logistic regression model.
Lower OCD and depression symptom severity predicted a greater likelihood of early treatment response and remission to CBT. Findings suggest that low OCD and depression symptom severity could serve as baseline characteristics to identify potential candidates for lower-intensity initial interventions in a stepped care approach. The modest predictive value of the variables examined suggests that additional factors could add to prediction of treatment response and remission.
本研究探讨了接受认知行为疗法（CBT）的强迫症（OCD）青少年早期反应和缓解的现象学及预测因素。
139名目前主要诊断为强迫症的青少年参与了本研究。作为一项随机双盲多中心临床试验的一部分，参与者接受了10次CBT治疗，并辅以安慰剂或d - 环丝氨酸（DCS）。早期反应和缓解状态分别由临床医生评定的整体症状改善（CGI - I）和严重程度（CGI - S）来确定。
在治疗中期评估时，45.3%的青少年为早期反应者，28.1%为早期缓解者。在治疗后评估时，79.1%的青少年为反应者，67.6%为缓解者。早期反应预示着治疗后反应和缓解的可能性更高；早期缓解显著预示着治疗后缓解的可能性更高。二元逻辑回归显示，早期反应可由较低的基线临床医生评定的整体严重程度（CGI - S）和较低的抑郁严重程度预测；然而，在多变量逻辑回归模型中，只有抑郁严重程度仍然是一个显著的预测因素。此外，二元逻辑回归显示，早期缓解可由较低的基线临床医生评定的整体严重程度（CGI - S）、较低的抑郁严重程度和较低的强迫症状严重程度（CY - BOCS）预测；然而，在多变量逻辑回归模型中，只有整体严重程度仍然是一个显著的预测因素。
较低的强迫症和抑郁症状严重程度预示着对CBT早期治疗反应和缓解的可能性更大。研究结果表明，低强迫症和抑郁症状严重程度可作为基线特征，以识别在阶梯式护理方法中可能适合较低强度初始干预的潜在候选人。所检查变量的预测价值有限，这表明其他因素可能有助于预测治疗反应和缓解情况。
