Defining Response in Clinical Trials for Obsessive-Compulsive Disorder: A Signal Detection Analysis of the Yale-Brown Obsessive Compulsive Scale
J Clin Psychiatry 2005;66(12):1549-1557
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Many studies of the treatment
of obsessive-compulsive disorder (OCD) have used percent reduction cutoffs on the Yale-Brown
Obsessive Compulsive Scale (YBOCS) to classify patients as treatment responders. However,
reduction criteria have varied from 20% to 50%,
with studies of cognitive-behavioral therapy (CBT) using a more stringent criterion than studies
of pharmacotherapy. The aim of this retrospective investigation was to determine optimal
YBOCS reduction criteria for classifying patients as
Method: Data from 87 adult clinic and
research outpatients meeting DSM-IV-TR criteria for OCD according to structured interview
were examined, comparing the percent YBOCS reduction from pretreatment to posttreatment with
2 "gold standard" criteria from the Clinical
Global Impressions (CGI) scale: much or very much
improved and mild illness or better. Signal
detection analyses were used to determine the
sensitivity, specificity, predictive value of a positive test,
predictive value of a negative test, and efficiency
of various YBOCS reduction cutoffs.
Results: A YBOCS reduction cutoff of
30% was optimal for predicting improvement on the CGI. The 20% cutoff used by many
pharmacologic studies resulted in a high number of
false positives, whereas the 50% cutoff used by
most CBT studies resulted in a high number of
false negatives. For predicting mild illness or better
at posttreatment, a YBOCS reduction cutoff of 40% to 50% was optimal.
Conclusions: A YBOCS reduction criterion
of 30% appears to be optimal for determining clinical improvement, whereas a 40% to 50%
reduction criterion is appropriate for predicting
mild illness at posttreatment. Future studies
should employ a standard definition of treatment
response in order to facilitate cross-study