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Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life
Psychotherapy and Psychosomatics ( IF 22.8 ) Pub Date : 2022-10-28 , DOI: 10.1159/000527115
David Mataix-Cols 1, 2 , Erik Andersson 1, 2 , Kristina Aspvall 1, 2 , Julia Boberg 1, 2 , James J Crowley 1, 3, 4 , Elles de Schipper 1, 2 , Lorena Fernández de la Cruz 1, 2 , Oskar Flygare 1, 2 , Ekaterina Ivanova 1, 2 , Fabian Lenhard 1 , Lina Lundström 1, 2 , Christian Rück 1, 2 , Eva Serlachius 1, 5 , Matti Cervin 5
Affiliation  

Introduction: The operational definitions of treatment response, partial response, and remission in obsessive-compulsive disorder (OCD) are widely used in clinical trials and regular practice. However, the clinimetric sensitivity of these definitions, that is, whether they identify patients that experience meaningful changes in their everyday life, remains unexplored. Objective: The objective was to examine the clinimetric sensitivity of the operational definitions of treatment response, partial response, and remission in children and adults with OCD. Methods: Pre- and post-treatment data from five clinical trials and three cohort studies of children and adults with OCD (n = 1,528; 55.3% children, 61.1% female) were pooled. We compared (1) responders, partial responders, and non-responders and (2) remitters and non-remitters on self-reported OCD symptoms, clinician-rated general functioning, and self-reported quality of life. Remission was also evaluated against post-treatment diagnostic interviews. Results: Responders and remitters experienced large improvements across validators. Responders had greater improvements than partial responders and non-responders on self-reported OCD symptoms (Cohen’s d 0.65–1.13), clinician-rated functioning (Cohen’s d 0.53–1.03), and self-reported quality of life (Cohen’s d 0.63–0.73). Few meaningful differences emerged between partial responders and non-responders. Remitters had better outcomes across most validators than non-remitters. Remission criteria corresponded well with absence of post-treatment diagnosis (sensitivity/specificity: 93%/83%). Using both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale yielded more conservative results and more robust changes across validators, compared to only using the Y-BOCS. Conclusions: The current definitions of treatment response and remission capture meaningful improvements in the everyday life of individuals with OCD, whereas the concept of partial response has dubious clinimetric sensitivity.
Psychother Psychosom


中文翻译:

强迫症治疗反应和缓解的操作定义捕捉了日常生活中有意义的改善

简介:强迫症 (OCD) 的治疗反应、部分反应和缓解的操作定义广泛用于临床试验和常规实践。然而,这些定义的临床敏感性,即它们是否能识别出在日常生活中经历有意义变化的患者,仍未得到探索。目的:目的是检查 OCD 儿童和成人的治疗反应、部分反应和缓解的操作定义的临床敏感性。方法:来自强迫症儿童和成人的五项临床试验和三项队列研究的治疗前和治疗后数据 ( n= 1,528;55.3% 的儿童,61.1% 的女性)被集中在一起。我们比较了 (1) 反应者、部分反应者和无反应者以及 (2) 缓解者和非缓解者自我报告的强迫症症状、临床医生评定的一般功能和自我报告的生活质量。还根据治疗后诊断面谈评估缓解情况。结果:响应者和汇款人在验证者之间经历了巨大的改进。在自我报告的强迫症症状 (Cohen's d 0.65–1.13)、临床医生评定的功能 (Cohen's d 0.53–1.03) 和自我报告的生活质量 (Cohen's d0.63–0.73)。部分响应者和非响应者之间几乎没有出现有意义的差异。与非汇款人相比,汇款人在大多数验证者中的结果更好。缓解标准与治疗后诊断的缺失相吻合(敏感性/特异性:93%/83%)。与仅使用 Y-BOCS 相比,同时使用 Yale-Brown 强迫症量表 (Y-BOCS) 和临床整体印象量表产生了更保守的结果和跨验证器的更稳健的变化。结论:目前对治疗反应和缓解的定义捕捉到了强迫症患者日常生活中有意义的改善,而部分反应的概念具有可疑的临床敏感性。
心理医生
更新日期:2022-10-28
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