Obsessive-compulsive Severity Research Articles

Structured clinical interview for diagnosing obsessive-compulsive spectrum disorders.

BackgroundThere are several established structured diagnostic interviews that cover common mental disorders seen in general psychiatry clinics. The administration of more focused diagnostic interviews may be useful in specialty clinics, such as OCD clinics. A semi-structured clinician-administered interview for obsessive-compulsive spectrum disorders (SCID-OCSD) was developed and adapted for DSM-5/ICD-11 obsessive-compulsive and related disorders as well as other putative obsessive-compulsive spectrum conditions. ObjectiveTo introduce a semi-structured diagnostic interview for in-depth assessment of obsessive-compulsive spectrum disorders (OCSDs), and to report on its implementation in adults with primary OCD attending an OCD-specialized unit. MethodsPatients with primary OCD were interviewed using the SCID-OCSD. The SCID-OCSD assesses disorders drawn from several diagnostic categories that share some core features of obsessive-compulsive phenomenology and that are often comorbid in OCD (e.g., obsessive-compulsive related disorders, impulse-control disorders, and a spectrum of compulsive-impulsive conditions such as tics, eating disorders, non-suicidal self-injury, and behavioral addictions. Participants had to be at least moderately symptomatic on the Yale-Brown Obsessive-Compulsive Severity scale (YBOCS, i.e., a total score ≥ 14) to be included in the current study. ResultsOne hundred and one adult patients with current OCD (n = 101, 37 men and 64 women), took part in the study. Forty-two participants (n = 42) had OCD and one or more current or past comorbid OCSDs, with excoriation (skin-picking) disorder (n = 16) and body dysmorphic disorder (n = 14) being the most common. Nine (n = 9) participants reported a history of non-suicidal self-injury, and 6 participants reported a history of comorbid tics. ConclusionsIn OCD clinics, the SCID-OCSD may help diagnose the full range of putative OCSDs, and so facilitate treatment planning and research on these conditions.

Obsessive-compulsive severity, gender, and religiosity as predictors of personality trait scores

Obsessive-compulsive disorder (OCD) impacts 1%—4% of the United States population. Scrupulosity, or obsessions related to morality and religion, is the fifth most common obsession. Although clinicians and researchers may have ample assessment information about their clients, such as OCD severity, gender, and religious background, little research in the field has shown how these variables relate to personality factors. Using Amazon's Mechanical Turk, we recruited 230 participants to (a) determine if scrupulosity were predictive of openness and neuroticism while accounting for gender, OCD severity, and religiosity; (b) investigate whether religious identity interacted with scrupulosity when predicting openness and neuroticism; and (c) examine if gender identity contributed to openness and neuroticism. Using linear mixed models, we found that higher scrupulosity predicted lower levels of openness across all religious groups, and that higher scrupulosity was associated with higher negative emotionality for nonreligious individuals. Implications for practice and continued research are discussed.

Decision-making deficits in obsessive-compulsive disorder are associated with abnormality of recency and response consistency parameter in prospect valence learning model.

Patients with obsessive-compulsive disorder (OCD) have deficits in decision-making in the Iowa Gambling Task (IGT). However, no study has investigated the parameters of the prospect valence learning (PVL) model in the IGT for OCD. This study aimed to investigate deficits in decision-making in OCD using the PVL model and identify whether the parameters of the PVL model were associated with obsessive-compulsive severity. Forty-seven medication-free patients with OCD were compared with 47 healthy controls (HCs). Decision-making was measured using the total net and block net scores of the IGT. A PVL model with a decay-reinforcement learning rule (PVL-DecayRI) was used to investigate the parameters of the model. Correlation analysis was conducted between each parameter of the PVL-DecayRL and obsessive-compulsive symptoms. The total net score of patients with OCD was significantly lower than that of the HCs. The block net scores of the OCD group did not differ across the five blocks, whereas in the HCs, the fifth block net score was significantly higher than the block net scores of the first and second blocks. The values of the recency and response consistency parameters of the PVL-DecayRI in patients with OCD were significantly lower than those in HCs. The recency parameter positively correlated with the Y-BOCS obsessive score. Meanwhile, there was no correlation between consistency parameter values and symptom severity in OCD. Our detailed analysis of the decision-making deficit in OCD suggests that the most recent outcome has a small influence on the expectancy of prospect valence, as indicated by the lower recency parameter, and is characterized by more impulsive choices, as indicated by the lower consistency parameter.

Cyberchondria: An emerging entity in COVID-19 pandemic and thereafter

IntroductionCyberchondria is a pathological behaviour linked to excessive online searching of health information.It is frequently associated with health anxiety. It may be regarded as an compulsive behaviour secondary to obsessions about a real or an imagined illness. The coronavirus pandemic of 2019 has brought about a fear of getting infected. In the absence of a definitive cure, the focus largely lies on stringent preventive measures and early diagnosis. Known to present with diverse symptoms, fear of coronaviral infection makes affected individuals search for symptoms on internet for reassurance. Added misinformation further increases stress,anxiety and confusion.ObjectivesThe authors attempt to describe cyberchondria and highlight its increased prevalence during the coronavirus pandemic.Methods5 cases from different backgrounds were seen in the outpatient clinic during the months of April-July 2020.Consent was obtained from subjects before the study.They were clinically diagnosed with obsessive-compulsive disorder and exhibited cyberchondria in the background of the pandemic.ResultsAll of the described 5 cases had prominent fear of contracting or having contracted coronavirus disease-19.All of them were found to have significant scores rang on Yale-Brown Obsessive-Compulsive Severity Scale(ranging from 25-35) and improved after a trial of selective serotonin reuptake inhibitors.ConclusionsThe emergence of cyberchondria during the coronavirus -19 pandemic warrants further introspection.Changes in policy-making to prevent misinformation and present health information in a simple way to prevent confusion in the lay public is a necessity to tackle this problem in the near future.

Homework adherence predicts therapeutic improvement from behavior therapy in Tourette's disorder

Behavior therapy is a first-line intervention for Tourette's Disorder (TD), and a key component is the practice of therapeutic skills between treatment visits (i.e., homework). This study examined the relationship between homework adherence during behavior therapy for TD and therapeutic outcomes, and explored baseline predictors of homework adherence during treatment.Participants included 119 individuals with TD (70 youth, 49 adults) who received behavior therapy in a clinical trial. After a baseline assessment of tic severity and clinical characteristics, participants received 8 sessions of behavior therapy. Therapists recorded homework adherence at each therapy session. After treatment, tic severity was re-assessed by independent evaluators masked to treatment condition.Greater overall homework adherence predicted tic severity reductions and treatment response across participants. Early homework adherence predicted therapeutic improvement in youth, whereas late adherence predicted improvement in adults. Baseline predictors of greater homework adherence in youth included lower hyperactivity/impulsivity and caregiver strain. Meanwhile in adults, baseline predictors of increased homework adherence included younger age, lower hyperactivity/impulsivity, obsessive-compulsive severity, anger, and greater work-related disability.Homework adherence is an integral component of behavior therapy and linked to therapeutic improvement. Strategies that improve homework adherence may optimize the efficacy of behavioral treatments and improve treatment outcomes.

Obsessive belief and emotional appraisal correlates of symptom dimensions and impairment in obsessive-compulsive disorder.

Background:Obsessive–compulsive disorder (OCD) is a heterogeneous and debilitating illness. Symptom dimensions of OCD lend homogeneous avenues for research. Variations in one's appraisal of thoughts and emotions can influence symptom dimensions and impairment. However, little is known about the combined influence of these appraisals in OCD. A clear understanding of these relationships has putative treatment implications.Aim:The aim of the study is to examine the associations among obsessive beliefs, emotional appraisals, and OCD symptom dimensions in adults.Materials and Methods:We examined 50 drug-naïve/drug-free adults with active OCD. Symptom dimensions and impairment were assessed using the Dimensional Yale–Brown Obsessive–Compulsive Severity Scale. Obsessive beliefs and emotional appraisals were studied using the Obsessive Beliefs Questionnaire-44 and Perception of Threat from Emotion Questionnaire.Results:Tobit regression analysis showed the differential association of obsessive beliefs and symptom dimensions – perfectionism/certainty associated with contamination and responsibility/threat estimation associated with aggressive obsessions. Impairment was associated with dimensional symptom severities and with the perception of threat from anger. This association remained even after controlling for depression severity and obsessive beliefs.Conclusions:OCD symptom dimensions are heterogeneous in underlying obsessive beliefs. Emotional appraisals contribute significantly to impairment alongside symptom severity. Emotion-focused interventions must be included in the psychotherapeutic interventions for OCD.

Concordance of assessment of insight by different measures in obsessive-compulsive disorder: An outpatient-based study from India.

Aims:This study aimed to examine the (a) prevalence of various levels of insight among patients with obsessive-compulsive disorder (OCD) and (b) correlation of insight specifier (Diagnostic and Statistical Manual [DSM]-5) and other established measures of insight in OCD.Methods:One hundred and twenty-five outpatients with a diagnosis of OCD were assessed by Brown Assessment of Beliefs Scale (BABS) and DSM-IV's insight specifier. The insight specifier of DSM-5 was determined by item one (“conviction”) of BABS. Dimensional Yale-Brown Obsessive-Compulsive Severity Scale was used to assess the frequency and severity of dimensional obsessive-compulsive (OC) symptoms.Results:The mean age of the participants was 31.2 (±11) years. Seventy-seven (61.6%) of the participants were men. There was a high correlation (r = 0.73) between the insight specifiers of DSM-5 and DSM-IV. Insight categories of DSM-5 had modest correlations with BABS total score and BABS-based insight categories. Significant associations were observed between the level of insight and comorbid psychotic illness, hoarding and symmetry dimensions of OC symptoms, severity of depressive, and OC symptoms. The first two associations were consistent across group comparisons (insight-groups based on DSM-IV and BABS) and correlation (with total BABS score).Conclusions:Majority of the patients with OCD have good insight and application of different tools influence the assessment of insight in OCD. The DSM-5 insight specifier has strong and significant correlation with the DSM-IV's insight classification and categorization of insight by BABS.

Comparison of temporary memory system and brain biochemical metabolites in patients with depressive obsessive-compulsive disorder and simple obsessive-compulsive disorder

Objective To investigate the difference of temporary memory system and brain biochemical metabolites between patients with depressive obsessive-compulsive disorder and simple obsessive-compulsive disorder. Methods From June 2017 to June 2018, 31 patients with simple obsessive-compulsive disorder, 33 patients with depressive obsessive-compulsive disorder and 25 healthy volunteers were selected as subjects. The temporary memory ability of the three groups was tested by n-back, Stoop color association test and digital breadth test. Three brain sublimation metabolites, N-acetylaspartate acid (NAA), choline complex (Cho) and creatine (Cr), were detected by proton magnetic resonance pop (1H-MRS) in bilateral prefrontal white matter, anterior cingulate cortex and anterior cingulate cortex. The ratio of NAA/Cr and Cho/Cr was calculated with Cr as reference material. Results The scores of Yale-brown obsessive-compulsive severity scale (Y-BOCS) and Hamilton depression rating scale 24 (HAMD24) in the patients with simple obsessive-compulsive disorder and depression obsessive-compulsive disorder group were significantly higher than those in the healthy control group, and the scores of HAMD24 in the patients with depression obsessive-compulsive disorder group were significantly higher than those in the patients with simple obsessive-compulsive disorder group, with statistically significant difference (P 0.05). Compared with the healthy control group, the NAA/Cr value of bilateral prefrontal white matter in the simple obsessive-compulsive group and the depression obsessive-compulsive group was significantly lower, and the difference was statistically significant (P<0.05). Conclusions Both patients with simple obsessive-compulsive disorder and depressive obsessive-compulsive disorder had speech memory impairment and bilateral prefrontal white matter nerve function decline, while depressive obsessive-compulsive disorder patients also had central executive memory impairment. Key words: Obsessive-compulsive disorder; Depressive disorder; Memory, short-term; N-acetylaspartate; Choline complex; Creatine

Development and psychometric evaluation of the Mandarin Chinese version of the Yale-Brown Obsessive-Compulsive Scale – Second Edition

Objective:To examine the psychometric properties of the Chinese version of the Yale-Brown Obsessive Compulsive Scale – Second Edition (Y-BOCS-II).Method:A total of 86 adults with a primary diagnosis of obsessive-compulsive disorder (OCD), ranging in age from 15 to 78 years, participated in the study. Participants were administered the Y-BOCS-II by a trained clinician who also rated overall illness severity on two additional measures. Patients completed the Obsessive Compulsive Inventory-Revised and Depression Anxiety Stress Scale-21.Results:Results indicated high internal consistency and fair 1-week test retest reliability. The Y-BOCS-II scales correlated strongly with clinician-rated obsessive-compulsive severity and modestly with self-reported obsessive-compulsive symptom frequency and distress. The relationship between Y-BOCS-II total score and depressive and anxiety symptoms was strong, which may reflect high rates of comorbid conditions in this sample or the linkage between obsessive-compulsive symptom severity and distress. Factor analysis demonstrated a two-factor structure consisting of obsession and compulsion factors, with interference due to obsessions cross-loading.Conclusions:Overall, these results support the use of the Y-BOCS-II among individuals from China. Future study by an independent group is necessary to replicate these findings, as well as investigate interrater reliability and treatment sensitivity.

Kundalini Yoga Meditation Versus the Relaxation Response Meditation for Treating Adults With Obsessive-Compulsive Disorder: A Randomized Clinical Trial.

Background: Obsessive-compulsive disorder (OCD) is often a life-long disorder with high psychosocial impairment. Serotonin reuptake inhibitors (SRIs) are the only FDA approved drugs, and approximately 50% of patients are non-responders when using a criterion of 25% to 35% improvement with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). About 30% are non-responders to combined first-line therapies (SRIs and exposure and response prevention). Previous research (one open, one randomized clinical trial) has demonstrated that Kundalini Yoga (KY) meditation can lead to an improvement in symptoms of obsessive-compulsive severity. We expand here with a larger trial.Design: This trial compared two parallel run groups [KY vs. Relaxation Response meditation (RR)]. Patients were randomly allocated based on gender and Y-BOCS scores. They were told two different (unnamed) types of meditation would be compared, and informed if one showed greater benefits, the groups would merge for 12 months using the more effective intervention. Raters were blind in Phase One (0–4.5 months) to patient assignments, but not in Phase Two.Main Outcome Measures: Primary outcome variable, clinician-administered Y-BOCS. Secondary scales: Dimensional Yale-Brown Obsessive Compulsive Scale (clinician-administered), Profile of Mood Scales, Beck Anxiety Inventory, Beck Depression Inventory, Clinical Global Impression, Short Form 36 Health Survey.Results: Phase One: Baseline Y-BOCS scores: KY mean = 26.46 (SD 5.124; N = 24), RR mean = 26.79 (SD = 4.578; N = 24). An intent-to-treat analysis with the last observation carried forward for dropouts showed statistically greater improvement with KY compared to RR on the Y-BOCS, and statistically greater improvement on five of six secondary measures. For completers, the Y-BOCS showed 40.4% improvement for KY (N = 16), 17.9% for RR (N = 11); 31.3% in KY were judged to be in remission compared to 9.1% in RR. KY completers showed greater improvement on five of six secondary measures. At the end of Phase Two (12 months), patients, drawn from the initial groups, who elected to receive KY continued to show improvement in their Y-BOCS scores.Conclusion: KY shows promise as an add-on option for OCD patients unresponsive to first line therapies. Future studies will establish KY’s relative efficacy compared to Exposure and Response Prevention and/or medications, and the most effective treatment schedule.Clinical Trial Registration: www.ClinicalTrials.gov, identifier NCT01833442.

Intranasal carbetocin reduces hyperphagia in individuals with Prader-Willi syndrome.

Prader-Willi syndrome (PWS) is a genetic neurodevelopmental disorder of life-threatening hyperphagia, obesity, intellectual deficits, compulsivity, and other behavioral problems. The efficacy and safety of i.n. carbetocin, an oxytocin analog, was evaluated in a prospective, randomized, double-blinded trial in adolescents with PWS. Eligible patients aged 10-18 years with genetically confirmed PWS were randomized (1:1) to i.n. carbetocin or placebo 3 times daily for 14 days. The primary efficacy endpoint was change in parent/caregiver-rated Hyperphagia in PWS Questionnaire-Responsiveness (HPWSQ-R) total score. Secondary efficacy endpoints included HPWSQ-R behavior, drive, and severity domains; clinician-rated HPWSQ; Children's Yale-Brown Obsessive-Compulsive Severity Scale; food domain of the Reiss Profile; and Clinical Global Impression-Improvement scale. Endpoints were assessed using analysis of covariance. Relationship between primary and secondary endpoints was assessed using Pearson correlation coefficients. Safety was assessed throughout the study. Demographics and clinical characteristics were similar between treatment groups (carbetocin, n = 17; placebo, n = 20). Patients receiving carbetocin had statistically significant reductions in HPWSQ-R total score at study end (-15.6) versus patients receiving placebo (-8.9; P = 0.029); several secondary efficacy endpoints also demonstrated significant differences (P < 0.05). Treatment effects for the primary and secondary endpoints were highly correlated (P ≤ 0.0001). Incidence of adverse events (AEs) was similar between treatment groups. I.n. carbetocin was well tolerated and improved hyperphagia and behavioral symptoms of PWS. ClinicalTrials.gov: NCT01968187FUNDING. The study was funded by Ferring Pharmaceuticals. Recruitment was aided by ongoing work in PWS performed through Eunice Kennedy Shriver National Institute of Child Health and Human Development grant U54 HD083211.

Predictors of Broad Dimensions of Psychopathology among Patients with Panic Disorder after Cognitive-Behavioral Therapy.

Background Many patients with panic disorder meet criteria for at least one other diagnosis, most commonly other anxiety or mood disorders. Cognitive-behavioral therapy is the best empirically supported psychotherapy for panic disorder. There is now evidence indicating that cognitive-behavioral therapy for panic disorder yields positive benefits upon comorbid disorders. Objectives The present study aimed to examine the predictors of broad dimensions of psychopathology in panic disorder after cognitive-behavioral therapy. Methods Two hundred patients affected by panic disorder were treated with manualized group cognitive-behavioral therapy. We examined if the baseline personality dimensions of NEO Five Factor Index predicted the subscales of Symptom Checklist-90 Revised at endpoint using multiple regression analysis based on the intention-to-treat principle. Results Conscientiousness score of NEO Five Factor Index at baseline was a predictor of four Symptom Checklist-90 Revised subscales including obsessive-compulsive (β = −0.15, P < 0.01), depression (β = −0.13, P < 0.05), phobic anxiety (β = −0.15, P < 0.05), and Global Severity Index (β = −0.13, P < 0.05). Conclusion Conscientiousness at baseline may predict several dimensions of psychopathology in patients with panic disorder after cognitive-behavioral therapy. For the purpose of improving a wide range of psychiatric symptoms with patients affected by panic disorder, it may be useful to pay more attention to this personal trait at baseline.

Dissecting the Yale-Brown Obsessive-Compulsive Scale severity scale to understand the routes for symptomatic improvement in obsessive-compulsive disorder.

We aimed to investigate which items of the Yale-Brown Obsessive-Compulsive Severity Scale best discriminate the reduction in total scores in obsessive-compulsive disorder patients after 4 and 12 weeks of pharmacological treatment. Data from 112 obsessive-compulsive disorder patients who received fluoxetine (⩽80 mg/day) for 12 weeks were included. Improvement indices were built for each Yale-Brown Obsessive-Compulsive Severity Scale item at two timeframes: from baseline to week 4 and from baseline to week 12. Indices for each item were correlated with the total scores for obsessions and compulsions and then ranked by correlation coefficient. A correlation coefficient ⩾0.7 was used to identify items that contributed significantly to reducing obsessive-compulsive disorder severity. At week 4, the distress items reached the threshold of 0.7 for improvement on the obsession and compulsion subscales although, contrary to our expectations, there was greater improvement in the control items than in the distress items. At week 12, there was greater improvement in the time, interference, and control items than in the distress items. The use of fluoxetine led first to reductions in distress and increases in control over symptoms before affecting the time spent on, and interference from, obsessions and compulsions. Resistance did not correlate with overall improvement. Understanding the pathway of improvement with pharmacological treatment in obsessive-compulsive disorder may provide clues about how to optimize the effects of medication.

Predictors of Comorbid Psychological Symptoms among Patients with Social Anxiety Disorder after Cognitive-Behavioral Therapy

Aim: The present study aimed to examine the predictors of comorbid psychological symptoms in social anxiety disorder (SAD) after cognitive-behavioral therapy (CBT). Methods: One hundred fourteen SAD patients completed manualized group CBT. We examined associations between the personality dimensions of NEO Five Factor Index (NEO-FFI) and the subscales of Symptom Checklist-90 Revised (SCL-90-R) in SAD patients after CBT using multiple regression analysis. Results: High levels of conscientiousness at baseline predicted symptom reduction on 4 SCL-90-R scales, including somatization, obsessive-compulsive, anxiety and global severity index in patients with SAD after CBT. And high levels of agreeableness predicted symptom reduction on 2 SCL-90-R scales, including Hostility and Paranoid Ideation. High levels of openness predicted psychoticism. Conclusion: The present study suggested that high levels of three NEO-FFI dimensions (openness, agreeableness, conscientiousness) might predict comorbid psychological symptoms reduction in SAD patients after CBT. For the purpose of improving comorbid psychological symptoms with SAD patients, it might be useful to pay more attention to these dimensions of NEO-FFI at baseline.

Alterations in psychosocial health of people affected by asbestos poisoning

OBJECTIVE To analyze the state of psychosocial and mental health of professionals affected by asbestos.METHODS A cross-sectional study was conducted with 110 professionals working in the Ferrolterra region of Spain, who were affected by asbestos poisoning. This group was compared with a group of 70 shipyard workers with no manifestation of work-related diseases. All the participants were male with a mean age of 67 years. This study was conducted in 2013, between January and June, and used the SCL-90 questionnaire by Derogatis as its primary measure for research. This questionnaire consists of 9 variables that measure psychosomatic symptoms. In addition, an overall index of psychosomatic gravity was calculated. The participants were also asked two questions concerning their overall perception of feeling good. Data were analyzed by ANOVA and logistic regression.RESULTS Participants affected by asbestos poisoning showed high occurrence rates of psychological health variables such as somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation, psychoticism, and global severity index.CONCLUSIONS Social interaction as a differentiating factor between workers affected by work-related chronic syndromes as compared to healthy participants will possibly aid in the development of intervention programs by improving the social network of affected individuals.

Self-Regulation and Other Executive Functions Relationship to Pediatric OCD Severity and Treatment Outcome

The intersection of obsessive-compulsive disorder (OCD) and executive functioning (EF) in children and adolescents is an emerging topic in the current literature. Spurred by the consistent association between increased EF deficits and higher adult obsessive-compulsive severity, a few initial studies have replicated this relationship in pediatric OCD samples and also have found preliminary evidence that EF deficits are associated with worse response to first-line psychotherapeutic or psychopharmacological treatments for pediatric OCD. This study aimed to extend the literature by providing the first comprehensive investigation of how multiple EF domains, measured repeatedly over the course of treatment, impact pediatric obsessive-compulsive severity and response to multimodal treatment. Multi-level modeling results found that deficits in shifting, inhibition, emotional control, planning/organizing, monitoring and initiating all predicted higher average obsessive compulsive severity across treatment. Interestingly, out of the eight domains of EF investigated, only emotional control moderated treatment outcome such that those with worse emotional control experienced less of a reduction in obsessive-compulsive severity during treatment. The findings generally align with previous theories for the link between EF and OCD and indicate that emotional control has important implications in the treatment of pediatric OCD. In fact, emotional control may provide one explanation for why factors such as disgust sensitivity, oppositional behavior, and third-wave behavioral treatment techniques have all been linked to pediatric OCD treatment outcome. Future research should investigate augmentation strategies that target emotional control in children and adolescents.

Defining clinical severity in pediatric obsessive-compulsive disorder.

Despite extensive use of the Children's Yale Brown Obsessive Compulsive Scale (CYBOCS; Scahill et al., 1997), the lack of normative data impedes interpretation of individual CYBOCS scores. Consequently, psychometrics on CYBOCS severity scores from 815 treatment-seeking youth with obsessive-compulsive disorder (OCD) are presented, across age and sex, so that normative comparisons of obsessive, compulsive, and combined obsessive-compulsive severity could be calculated. Our findings suggest no evidence for marked age or sex differences. Further, obsessive-compulsive symptom severity scores (measured via the CYBOCS) appear consistent with global OCD syndrome severity (measured via the Clinician Global Impression-Severity scale [CGI-S; Guy, 1976]; r = .58). This study contributes the 1st empirically based guidelines for interpreting obsessive-compulsive symptom severity scores. After a diagnosis of OCD is determined, the CYBOCS can be used to determine severity of illness (however, categories of severity proposed by this article should not be used in the screening of OCD symptoms). Findings can facilitate clinicians' and investigators' ability to draw comparisons across obsessive-compulsive severity scores.

Prospective Relationship Between Obsessive–Compulsive and Depressive Symptoms During Multimodal Treatment in Pediatric Obsessive–Compulsive Disorder

The present study examined the prospective relationship between obsessive-compulsive and depressive symptoms during a multimodal treatment study involving youth with obsessive-compulsive disorder (OCD). Participants included fifty-six youth, aged 7-17 years (M = 12.16 years) who were enrolled in a two-site randomized controlled pharmacological and cognitive behavioral therapy treatment trial. Obsessive-compulsive severity was measured using the Children's Yale-Brown Obsessive-Compulsive Scale, and depressive symptoms were rated using the Children's Depression Rating Scale-Revised. Multi-level modeling analyses indicated that, on average over the course of treatment, variable and less severe obsessive-compulsive symptoms significantly predicted a decrease in depressive symptoms. Additionally, week-to-week fluctuations in OCD severity did not significantly predict weekly changes in depressive symptom severity. Level of baseline depressive symptom severity did not moderate these relationships. Findings suggest that when treating youth with OCD with co-occurring depression, therapists should begin by treating obsessive-compulsive symptoms, as when these are targeted effectively, depressive symptoms diminish as well.

Validation of the Yale-Brown Obsessive-Compulsive Severity Scale in African Americans with obsessive-compulsive disorder

The Yale-Brown Obsessive Compulsive Scale (Y-BOCS) is widely used in the assessment of obsessive-compulsive disorder (OCD), but the psychometric properties of the instrument have not been examined in African Americans with OCD. Therefore, the purpose of this study is to explore the properties of the Y-BOCS severity scale in this population. Participants were 75 African American adults with a lifetime diagnosis of OCD. They completed the Y-BOCS, the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II), and the Multigroup Ethnic Identity Measure (MEIM). Evaluators rated OCD severity using the Clinical Global Impression Scale (CGI) and their global assessment of functioning (GAF). The Y-BOCS was significantly correlated with both the CGI and GAF, indicating convergent validity. It also demonstrated good internal consistency (α=0.83) and divergent validity when compared to the BAI and BDI-II. Confirmatory factor analyses tested five previously reported models and supported a three-factor solution, although no model exhibited excellent fit. An exploratory factor analysis was conducted, supporting a three-factor solution. A linear regression was conducted, predicting CGI from the three factors of the Y-BOCS and the MEIM, and the model was significant. The Y-BOCS appears to be a valid measure for African American populations.

Dysregulation in pediatric obsessive compulsive disorder

Although obsessive compulsive disorder (OCD) and common co-occurring conditions share deficits in self-regulatory abilities, there has been minimal examination of impaired self-regulation (dysregulation) in youth with OCD. This study examined the association of dysregulation with symptom severity, impairment, and treatment outcome in pediatric OCD. Clinicians assessed obsessive-compulsive severity, family accommodation and global severity in 144 youth with OCD. Youth completed self-report severity ratings of anxiety and depressive symptoms. Parents completed the Child Behavior Checklist (CBCL), and both children and parents completed parallel ratings of obsessive-compulsive impairment. Ninety-seven youth received cognitive behavioral therapy (CBT) and were re-assessed after treatment. Dysregulation was assessed using the CBCL-Dysregulation Profile. Before treatment, dysregulated youth exhibited greater obsessive-compulsive symptom severity, depressive mood, family accommodation, and impairment than non-dysregulated youth. The magnitude of dysregulation directly predicted child-rated impairment, parent-rated impairment, and family accommodation, beyond obsessive-compulsive severity. The magnitude of pretreatment dysregulation predicted treatment discontinuation but not treatment response. Obsessive-compulsive symptom severity and dysregulation level significantly decreased after CBT. Dysregulated youth with OCD presented as more clinically severe than their non-dysregulated counterparts, and may require more individualized interventions to reduce dysregulated behavior to prevent CBT attrition. For treatment completers, CBT was associated with a decrease in dysregulation level.