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

Farhat L.C.; Vattimo E.F.Q.; Ramakrishnan D.Levine J.L.S.Johnson J.A.Artukoglu B.B.Landeros-Weisenberger A.Asbahr F.R.Cepeda S.L.Comer J.S.Fatori D.Franklin M.E.Freeman J.B.Geller D.A.Grant P.J.Goodman W.K.Heyman I.Ivarsson T.Lenhard F.Lewin A.B.Li F.Merlo L.J.Mohsenabadi H.Peris T.S.Piacentini J.Rosa-Alcazar A.I.Rosa-Alcazar A.Rozenman M.Sapyta J.J.Serlachius E.Shabani M.J.Shavitt R.G.Small B.J.Skarphedinsson G.Swedo S.E.Thomsen P.H.Turner C.Weidle B.Miguel E.C.Storch E.A.Mataix-Cols D.Bloch M.H.

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

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

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? 2021 American Academy of Child and Adolescent PsychiatryObjective: 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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《Journal of the American Academy of Child and Adolescent Psychiatry》 |2022年第4期|495-507|共13页
作者
Farhat L.C.; Vattimo E.F.Q.; Ramakrishnan D.Levine J.L.S.Johnson J.A.Artukoglu B.B.Landeros-Weisenberger A.Asbahr F.R.Cepeda S.L.Comer J.S.Fatori D.Franklin M.E.Freeman J.B.Geller D.A.Grant P.J.Goodman W.K.Heyman I.Ivarsson T.Lenhard F.Lewin A.B.Li F.Merlo L.J.Mohsenabadi H.Peris T.S.Piacentini J.Rosa-Alcazar A.I.Rosa-Alcazar A.Rozenman M.Sapyta J.J.Serlachius E.Shabani M.J.Shavitt R.G.Small B.J.Skarphedinsson G.Swedo S.E.Thomsen P.H.Turner C.Weidle B.Miguel E.C.Storch E.A.Mataix-Cols D.Bloch M.H.;
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作者单位

University of Florida;

Tehran Institute of Psychiatry Iran University of Medical Sciences;

Semel Institute for Neuroscience and Human Behavior University of California at Los AngelesUniversity of MurciaUniversity of DenverDuke University School of MedicineCentre for Psychiatry Research Karolinska Institutet Stockholm Health Care ServicesFaculdade de Medicina FMUSP Universidade de S?o PauloSchool of Aging Studies University of South FloridaFaculty of Psychology University of IcelandNational Institutes of HealthRegional Center for Child and Youth Mental Health and Child Welfare Faculty of Medicine and HealthBaylor College of MedicineYale Child Study Center Yale School of MedicineColumbia University New YorkSUNY Downstate Health Sciences UniversityCenter for Children and Families Florida International UniversityUniversity of PennsylvaniaWarren Alpert Medical School Brown UniversityMassachusetts General Hospital Harvard Medical SchoolGreat Ormond Street Hospital NHS Foundation TrustUniversity of South Florida;

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正文语种英语
中图分类精神病学;
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CY-BOCS; diagnostic test accuracy; meta-analysis; obsessive-compulsive disorder; randomized controlled trials;

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

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