Yale-Brown Obsessive-Compulsive Scale

Yale-Brown Obsessive-Compulsive Scale

Psychiatric Interview Components

One important component of the psychiatric interview is gathering the history of present illness (HPI) (Carlat, 2017). One piece of the HPI is gathering information on the current and premorbid level of functioning (Carlat, 2017). I find this component important because it establishes which symptoms of the illness may be interfering with the patient’s daily activities. For example, a patient may state that their anxiety has gotten to the point where they are no longer able to participate in family gatherings, which is something they once enjoyed. In addition, this establishes a baseline for the patient (Carlat, 2017). This information may establish treatment goals for the patient.

A second component of the psychiatric interview is obtaining a family psychiatric history (Carlat, 2017). I find this component of the interview important because oftentimes psychiatric illnesses, or risk of substance use disorders, have a familial tie. For example, for a patient presenting to the clinic with depressive symptoms that have a significant family history of bipolar, it may be pertinent to inquire about symptoms of mania that the patient may not recognize as symptoms of a psychiatric disorder.

A third component of the psychiatric interview is obtaining a psychiatric history (Carlat, 2017). I find this piece of the psychiatric interview important because it gathers information about past treatments and the age of onset of symptoms (Carlat, 2017). It is important for a clinician to know which treatments were already tried and whether or not they were successful.

Psychometric Properties

The rating scale that I was assigned to explore and discuss is the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS). Originally developed for adults, this is a ten-item scale that establishes the severity of Obsessive-Compulsive Disorder (OCD) after a formal diagnosis is made (Stanford Medicine, 2020). The scale was developed in 1989, it showed psychometric properties in measuring the effects of medication and psychotherapy for the treatment of OCD (Castro-Rodrigues et al., 2018). However, the original scale showed a weakness in measuring severe cases and inconsistently measuring resistance to obsessions (Castro-Rodrigues et al., 2018).

The scale was revised in 2000, now known as the Y-BOCS-II (Castro-Rodrigues et al., 2018). Items in the scale were rephrased and the order of assessments were changed; this is now used as the gold standard to measure the severity of OCD symptom (Castro-Rodrigues et al., 2018).

Rating Scale Used in Practice

As stated above, the Y-BOCS is not used to make a case for the diagnosis of OCD, but rather establish the severity of symptoms. A clinician may implement this assessment and then share it with their patient in an attempt to assist the patient in recognizing the severity of their symptoms, and which symptoms may be part of their illness (Standford Medicine, 2020). In addition, a response to treatment may be measured through a decrease in scoring on the sale (Stanford Medicine, 2020).The revised scale, Y-BOCS II, has been found to have excellent psychometric properties in the measurement of the severity of OCD symptoms (Castro-Rodrigues et al., 2018).

Since its creation in 1989 for use in adult patients, the scale has been modified to assess children and adolescents (Lopez-Pina et al., 2015). In addition to assessing the severity of symptoms in OCD, the scale is useful in measuring the severity of symptoms where compulsions are a symptom of the disorder; for example, such as eating disorders, gambling, etc. (Lopez-Pina et al., 2015).

References

Carlot, D. (2017).The psychiatric interview(4thed.). Wolters Kluwer.

Castro-Rodrigues, P., Camacho, M., Almeida, S., Marinho, M., Soares, S., Barahona-

Correa, J., & Oliveira-Maia, A. (2018). Criterion validity of the Yale-Brown Obsessive-Compulsive Scale second edition for the diagnosis of obsessive-compulsive disorder in adults.Frontiers in Psychiatry, 9,431. https://www.frontiers.org/articles/10.3389/fpsyt.2018.00431/full

Lopez-Pina, J., Sanchez-Meca, J., Lopez-Lopez, J., Marin-Martinez, F., Nunez-Nunez,

R., Rosa-Alcazar, A., … & Ferrer-Requena, J. (2015). The Yale-Brown Obsessive-Compulsive Scale: a reliability generalization meta-analysis.Assessment, 22(5), 619.628. https://www.researchgate.net/profile/Ja-Lopez-Pina/publication/266380252_The_Yale-Brown_Obessive_Compulsive_Scale/links/550090d70cf2de950a6ea031/The-Yale-Brown-Obsessive-Compulsive-Scale.pdf

Stanford Medicine. (2020). Obsessive-compulsive and related disorders.

https://med.stanford.edu/ocd/about/diagnosis.html

 

Discussion: The Psychiatric Evaluation and Evidence-Based Rating Scales

Assessment tools have two primary purposes: 1) to measure illness and diagnose clients, and 2) to measure a client’s response to treatment. Often, you will find that multiple assessment tools are designed to measure the same condition or response. Not all tools, however, are appropriate for use in all clinical situations. You must consider the strengths and weaknesses of each tool to select the appropriate assessment tool for your client. For this Discussion, as you examine the assessment tool assigned to you by the Course Instructor, consider its use in psychotherapy.

Photo Credit: [shironosov]/[iStock / Getty Images Plus]/Getty Images

To Prepare:

  • Review this week’s Learning Resources and reflect on the insights they provide regarding psychiatric assessment and diagnosis.
  • Consider the elements of the psychiatric interview, history, and examination.
  • Consider the assessment tool assigned to you by the Course Instructor.
By Day 3 of Week 2

Post a brief explanation of three important components of the psychiatric interview and why you consider these elements important. Explain the psychometric properties of the rating scale you were assigned. Explain when it is appropriate to use this rating scale with clients during the psychiatric interview and how the scale is helpful to a nurse practitioner’s psychiatric assessment. Support your approach with evidence-based literature.

Read
 a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on 2 different days by comparing your assessment tool to theirs.

Note: For this Discussion, you are required to complete your initial post before you will be able to view and respond to your colleagues’ postings. Begin by clicking on the “Post to Discussion Question” link, and then select “Create Thread” to complete your initial post. Remember, once you click on Submit, you cannot delete or edit your own posts, and you cannot post anonymously. Please check your post carefully before clicking on Submit!

 

Responses

Thank you for your very educational post.  I enjoyed reading yours and our colleagues’ posts this week because I am learning a lot in terms of various evidence-based rating scales.  I admit I am only familiar with a very few and those that we use in the hospital for our interviews and assessments with patients.

Your post caught my attention because I have never heard of the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS).  This is one scale that we do not normally use in our hospital setting as clinicians.  Upon further research, I found out that The YBOCS was developed in the late 1980s by Drs Wayne Goodman and Dennis Charney to measure the severity of symptoms in OCD (Yale School of Medicine, n.d.).  As you mentioned, it has ten items rated based on a semistructured interview. The first five items concern obsessions: the amount of time that they consume, the degree to which they interfere with normal functioning, the distress that they cause, the patient’s attempts to resist them, and the patient’s ability to control them. The remaining five items ask parallel questions about compulsions (Sadock et al., 2015).  This scale is considered the gold standard to evaluate OCD.  According to Rector and Arnold (2016), the Y-BOCS was designed to measure and compare the efficacy of treatments, initial medical treatment, and then CBT in the field of OCD.  Sadock et al., (2015), added that the YBOCS has become the standard instrument for assessing OCD severity and is used in virtually every drug trial. It may also be used clinically to monitor treatment response.  This scale has been used in the first clinical trials demonstrating the efficacy of the medications that are now standard treatments for the disorder – the SSRIs and the neuroleptics.

References

Rector, N., & Arnold, P. (2016, March). Yale-Brown Obsessive Compulsive Scale. Retrieved December 10, 2020, from https://www.sciencedirect.com/topics/medicine-and-dentistry/yale-brown-obsessive-compulsive-scale

Sadock, B. J., Ruiz, P., & Sadock, V. A. (2015). Kaplan et Sadocks synopsis of psychiatry: Behavioral sciences, clinical psychiatry (11th ed.). Philadelphia: Wolters Kluwer.

Yale School of Medicine. (n.d.). History of the Clinic. Retrieved December 10, 2020, from https://medicine.yale.edu/psychiatry/ocd/aboutus/history/

 

 

 

Thanks for your post!

When comparing the Hamilton Anxiety Rating Scale to the Yale-Brown Obsessive-Compulsive Scale, similarities become quickly apparent. Because Obsessive-Compulsive disorder is a specific type of anxiety disorder, it makes sense the two scales would address some of the same symptoms (Storch, et al., 2010). Like the HAM-A, the Y-BOCS is used to establish the severity of symptoms, but not as a tool for diagnosis. Both scales are subjective and require the provider to observe clinical presentation in addition to the scale results themselves, and then to interpret accordingly. Though the Y-BOCS is directed at a more specific subset of symptoms, they are very comparable in their purpose.

References

Hamilton, M. (n.d.). Hamilton anxiety rating scale (HAM-A). Br J Med Psychol 1959; 32:50–55. Retrieved from https://dcf.psychiatry.ufl.edu/files/2011/05/HAMILTON-ANXIETY.pdf

Storch, E. A., Rasmussen, S. A., Price, L. H., Larson, M. J., Murphy, T. K., & Goodman, W. K. (2010). Yale-Brown Obsessive-Compulsive Scale–Second Edition. Psychological Assessment, 22(2), 223–232.

 

 

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