Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder

被引：18

作者：

Farhat, Luis C. ^{[1
]}

Vattimo, Edoardo F. Q. ^{[1
]}

Ramakrishnan, Divya ^{[2
]}

Levine, Jessica L. S. ^{[2
]}

Johnson, Jessica A. ^{[3
,4
]}

Artukoglu, Bekir B. ^{[5
]}

Landeros-Weisenberger, Angeli ^{[2
]}

Asbahr, Fernando R. ^{[1
]}

Cepeda, Sandra L. ^{[6
]}

Comer, Jonathan S. ^{[7
]}

Fatori, Daniel ^{[1
]}

Franklin, Martin E. ^{[8
,9
]}

Freeman, Jennifer B. ^{[10
]}

Geller, Daniel A. ^{[11
]}

Grant, Paul J.

Goodman, Wayne K. ^{[6
]}

Heyman, Isobel ^{[12
]}

Ivarsson, Tord ^{[13
]}

Lenhard, Fabian ^{[15
,16
]}

Lewin, Adam B. ^{[17
]}

Li, Fenghua ^{[2
]}

Merlo, Lisa J. ^{[18
]}

Mohsenabadi, Hamid ^{[19
]}

Peris, Tara S. ^{[20
]}

Piacentini, John ^{[20
]}

Rosa-Alcazar, Ana, I ^{[21
]}

Rosa-Alcazar, Angel ^{[21
]}

Rozenman, Michelle ^{[22
]}

Sapyta, Jeffrey J. ^{[23
]}

Serlachius, Eva ^{[15
,16
]}

Shabani, Mohammad J. ^{[19
]}

Shavitt, Roseli G. ^{[1
]}

Small, Brent J. ^{[24
]}

Skarphedinsson, Gudmundur ^{[25
]}

Swedo, Susan E. ^{[26
]}

Thomsen, Per Hove ^{[13
,14
]}

Turner, Cynthia ^{[27
]}

Weidle, Bernhard ^{[13
]}

Miguel, Euripedes C. ^{[1
]}

Storch, Eric A. ^{[6
]}

Mataix-Cols, David ^{[15
,16
]}

Bloch, Michael H. ^{[2
]}

机构：

[1] Univ Sao Paulo, Fac Med FMUSP, Sao Paulo, Brazil

[2] Yale Sch Med, Yale Child Study Ctr, New Haven, CT USA

[3] Columbia Univ, New York, NY USA

[4] Columbia Sch Nursing, New York, NY USA

[5] SUNY Downstate Hlth Sci Univ, New York, NY USA

[6] Baylor Coll Med, Houston, TX 77030 USA

[7] Florida Int Univ, Ctr Children & Families, Miami, FL 33199 USA

[8] Univ Penn, Philadelphia, PA 19104 USA

[9] Rogers Mem Hosp, Oconomowoc, WI USA

[10] Brown Univ, Warren Alpert Med Sch, Providence, RI 02912 USA

[11] Harvard Med Sch, Massachusetts Gen Hosp, Boston, MA 02115 USA

[12] Great Ormond St Hosp NHS Fdn Trust, London, England

[13] Norwegian Univ Sci & Technol NTNU, Fac Med & Hlth Sci, Reg Ctr Child & Youth Mental Hlth & Child Welf, Trondheim, Norway

[14] Aarhus Univ Hosp, Skejby, Denmark

[15] Karolinska Inst, Ctr Psychiat Res, Stockholm, Sweden

[16] Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden

[17] Univ S Florida, Hillsborough Cty, FL USA

[18] Univ Florida, Miami, FL USA

[19] Iran Univ Med Sci, Tehran Inst Psychiat, Tehran, Iran

[20] Univ Calif Los Angeles, Semel Inst Neurosci & Human Behav, Los Angeles, CA 90024 USA

[21] Univ Murcia, Murcia, Spain

[22] Univ Denver, Denver, CO 80208 USA

[23] Duke Univ, Sch Med, Durham, NC USA

[24] Univ S Florida, Sch Aging Studies, Hillsborough Cty, FL USA

[25] Univ Iceland, Fac Psychol, Reykjavik, Iceland

[26] NIH, Bldg 10, Bethesda, MD 20892 USA

[27] Univ Queensland, Fac Med, Primary Care Clin Unit, Brisbane, Qld, Australia

来源：

JOURNAL OF THE AMERICAN ACADEMY OF CHILD AND ADOLESCENT PSYCHIATRY | 2022年 / 61卷 / 04期

关键词：

obsessive-compulsive disorder; randomized controlled trials; meta-analysis; diagnostic test accuracy; CY-BOCS; COGNITIVE-BEHAVIORAL THERAPY; RANDOMIZED CONTROLLED-TRIAL; D-CYCLOSERINE AUGMENTATION; SIGNAL-DETECTION ANALYSIS; PLACEBO-CONTROLLED TRIAL; FAMILY-BASED TREATMENT; YOUNG-CHILDREN; OCD TREATMENT; DOUBLE-BLIND; ADOLESCENTS;

D O I：

10.1016/j.jaac.2021.05.027

中图分类号：

B844 [发展心理学（人类心理学）];

学科分类号：

040202 ;

摘要：

Objective: A lack of universal definitions for response and remission in pediatric obsessive-compulsive disorder (OCD) has hampered the comparability of results across trials. To address this problem, we conducted an individual participant data diagnostic test accuracy meta-analysis to evaluate the discriminative ability of the Children's Yale Brown Obsessive-Compulsive Scale (CY-BOCS) in determining response and remission. We also aimed to generate empirically derived cutoffs on the CY-BOCS for these outcomes. Method: A systematic review of PubMed, PsycINFO, Embase and CENTRAL identified 5,401 references; 42 randomized controlled clinical trials were considered eligible, and 21 provided data for inclusion (N = 1,234). Scores of <= 2 in the Clinical Global Impressions Improvement and Severity scales were chosen to define response and remission, respectively. A 2-stage, random-effects meta-analysis model was established. The area under the curve (AUC) and the Youden Index were computed to indicate the discriminative ability of the CY-BOCS and to guide for the optimal cutoff, respectively. Results: The CY-BOCS had sufficient discriminative ability to determine response (AUC = 0.89) and remission (AUC = 0.92). The optimal cutoff for response was a >= 35% reduction from baseline to posttreatment (sensitivity = 83.9, 95% CI = 83.7-84.1; specificity = 81.7, 95% CI = 81.5-81.9). The optimal cutoff for remission was a posttreatment raw score of <= 12 (sensitivity = 82.0, 95% CI = 81.8-82.2; specificity = 84.6, 95% CI = 84.4-84.8). Conclusion: Meta-analysis identified empirically optimal cutoffs on the CY-BOCS to determine response and remission in pediatric OCD randomized controlled clinical trials. Systematic adoption of standardized operational definitions for response and remission will improve comparability across trials for pediatric OCD.

引用

页码：495 / 507

页数：13

共 65 条

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