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

Publication ,  Journal Article
Farhat, LC; Vattimo, EFQ; Ramakrishnan, D; Levine, JLS; Johnson, JA; Artukoglu, BB; Landeros-Weisenberger, A; Asbahr, FR; Cepeda, SL; Comer, JS ...
Published in: J Am Acad Child Adolesc Psychiatry
April 2022

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.

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Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

April 2022

Volume

61

Issue

4

Start / End Page

495 / 507

Location

United States

Related Subject Headings

  • Research Design
  • Obsessive-Compulsive Disorder
  • Humans
  • Developmental & Child Psychology
  • Child
  • 5201 Applied and developmental psychology
  • 3213 Paediatrics
  • 3202 Clinical sciences
  • 17 Psychology and Cognitive Sciences
  • 11 Medical and Health Sciences
 

Citation

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Farhat, L. C., Vattimo, E. F. Q., Ramakrishnan, D., Levine, J. L. S., Johnson, J. A., Artukoglu, B. B., … Bloch, M. H. (2022). Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry, 61(4), 495–507. https://doi.org/10.1016/j.jaac.2021.05.027
Farhat, Luis C., Edoardo F. Q. Vattimo, Divya Ramakrishnan, Jessica L. S. Levine, Jessica A. Johnson, Bekir B. Artukoglu, Angeli Landeros-Weisenberger, et al. “Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder.J Am Acad Child Adolesc Psychiatry 61, no. 4 (April 2022): 495–507. https://doi.org/10.1016/j.jaac.2021.05.027.
Farhat LC, Vattimo EFQ, Ramakrishnan D, Levine JLS, Johnson JA, Artukoglu BB, et al. Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry. 2022 Apr;61(4):495–507.
Farhat, Luis C., et al. “Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder.J Am Acad Child Adolesc Psychiatry, vol. 61, no. 4, Apr. 2022, pp. 495–507. Pubmed, doi:10.1016/j.jaac.2021.05.027.
Farhat LC, Vattimo EFQ, Ramakrishnan D, Levine JLS, Johnson JA, Artukoglu BB, Landeros-Weisenberger A, Asbahr FR, Cepeda SL, Comer JS, Fatori D, Franklin ME, Freeman JB, Geller DA, Grant PJ, Goodman WK, Heyman I, Ivarsson T, Lenhard F, Lewin AB, Li F, Merlo LJ, Mohsenabadi H, Peris TS, Piacentini J, Rosa-Alcázar AI, Rosa-Alcázar À, Rozenman M, Sapyta JJ, Serlachius E, Shabani MJ, Shavitt RG, Small BJ, Skarphedinsson G, Swedo SE, Thomsen PH, Turner C, Weidle B, Miguel EC, Storch EA, Mataix-Cols D, Bloch MH. Systematic Review and Meta-analysis: An Empirical Approach to Defining Treatment Response and Remission in Pediatric Obsessive-Compulsive Disorder. J Am Acad Child Adolesc Psychiatry. 2022 Apr;61(4):495–507.
Journal cover image

Published In

J Am Acad Child Adolesc Psychiatry

DOI

EISSN

1527-5418

Publication Date

April 2022

Volume

61

Issue

4

Start / End Page

495 / 507

Location

United States

Related Subject Headings

  • Research Design
  • Obsessive-Compulsive Disorder
  • Humans
  • Developmental & Child Psychology
  • Child
  • 5201 Applied and developmental psychology
  • 3213 Paediatrics
  • 3202 Clinical sciences
  • 17 Psychology and Cognitive Sciences
  • 11 Medical and Health Sciences