Symptom Trajectories of Early Responders and Remitters among Youth with OCD

Megan Rech; Saira Weinzimmer; Daniel Geller; Joseph F McGuire; Sophie C Schneider; Kevin C Patyk; Alessandro S De Nadai; Sandra C Cepeda; Brent J Small; Tanya K Murphy; Sabine Wilhelm; Eric A Storch

doi:10.1016/j.jocrd.2020.100580

Symptom Trajectories of Early Responders and Remitters among Youth with OCD

J Obsessive Compuls Relat Disord. 2020 Oct:27:100580. doi: 10.1016/j.jocrd.2020.100580. Epub 2020 Aug 29.

Authors

Affiliations

¹ Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.
² Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
³ Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, Maryland.
⁴ Department of Psychology, Texas State University, San Marcos, Texas.
⁵ University of South Florida School of Aging Studies, Tampa, Florida.
⁶ Department of Pediatrics, University of South Florida, Tampa, Florida.

Abstract

Objectives: This study examined the phenomenology and predictors of early response and remission among youth with obsessive-compulsive disorder (OCD) receiving cognitive-behavioral therapy (CBT).

Methods: 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.

Results: 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.

Conclusions: 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.

Keywords: Cognitive-behavioral therapy; Early response and remission; Pediatric OCD.

Abstract

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