CY-BOCS Follow Up

Date *

Date

Patient Name *

First Name Last Name

Obsession Rating Scale

Select appropriate score

Note: Scores should reflect the composite effect of all the patient's obsessive compulsive symptoms. Rate the average occurrence of each item during the prior week up to and including the time of interview.

QUESTIONS ON OBSESSIONS (ITEMS 1-5)

"I am now going to ask you questions about the thoughts you cannot stop thinking about."

(Review for the informant(s) the Target Symptoms and refer to them while asking questions 1-5).

1. Time Occupied by Obsessive Thoughts (Be *

0 - None 1 - Mild: Less than 1 hr/day or occasional intrusion 2 - Moderate: 1-3 hrs/day or frequent intrusion 3 - Severe: Greater than 3 and up to 8 hrs/day or very frequent intrusion 4 - Extreme: Greater than 8 hrs/day or near constant intrusion

2. Interference Due to Obsessive Thoughts (How much do these thoughts get in the way of school or doing things with friends? Is there anything that you don't do because of them? {If currently not in school, determine how much performance would be affected if patient were in school}) *

0 - None 1 - Mild: Slight interference with social or school activities, but overall performance not impaired 2 - Moderate: Definite interference with social or school performance, but still manageable 3 - Severe: Causes substantial impairment in social or school performance 4 - Extreme: Incapacitating

3. Distress Associated with Obsessive Thoughts: *

0 - None 1 - Mild: Infrequent and not too disturbing 2 - Moderate: Frequent and disturbing, but still manageable 3 - Severe: Very frequent, and very disturbing 4 - Extreme: Near constant, and disabling distress/frustration

4. Resistance Against Obsessions: (How hard do you try to stop the thoughts or ignore them? {Only rate effort made to resist, not success or failure in actually controlling the obsessions. If the obsessions are minimal, the patient may not feel the need to resist them. In such cases, a rating of "0" should be given}) *

0 - None: Makes an effort to always resist, or symptoms so minimal doesn't need to actively resist 1 - Mild: Tries to resist most of the time 2 - Moderate: Makes some effort to resist 3 - Severe: Yields to all obsessions without attempting to control them, but does so with some reluctance 4 - Extreme: Completely and willingly yields to all obsessions

5. Degree of Control Over Obsessive Thoughts: *

0 - Complete Control 1 - Much Control: Usually able to stop or divert obsessions with some effort and concentration 2 - Moderate Control: Sometimes able to stop or divert obsessions 3 - Little Control: Rarely successful in stopping obsessions, can only divert attention with difficulty 4 - No Control: Experienced as completely involuntary, rarely able to even momentarily divert thinking

Obsession Subtotal (add items 1-5):

Is there anything in this section that you would like to bring to the attention of your provider?

QUESTIONS ON OBSESSIONS (ITEMS 6-10)

"I am now going to ask you questions about the habits you can't stop."

(Review for the informant(s) the Target Symptoms and refer to them while asking questions 6-10).

6. Time Spent Performing Compulsive Behaviors: *

0 - None 1 - Mild: Less than 1 hour/day 2 - Moderate: 1 to 3 hours/day 3 - Severe: Greater than 3 and up to 8 hours/day 4 - Extreme: Greater than 8 hours/day

7. Interference Due to Compulsive Behaviors (How much do these habits get in the way of school or doing things with friends? Is there anything you don't do because of them? {If currently not in school, determine how much performance would be affected if patient were in school}): *

0 - None 1 - Mild: Slight interference with social or school performance, but still manageable 2 - Moderate: Definite interference with social or school performance, but still manageable 3 - Severe: Causes substantial impairment in social or school performance 4 - Extreme: Incapacitating

8. Distress Associated with Compulsive Behavior (How would you feel if prevented from carrying out your habits? How upset would you become?): *

0 - None 1 - Mild: Only slightly anxious if compulsions prevented 2 - Moderate: anxiety would mount but remain manageable if compulsions prevented 3 - Severe: Prominent and very disturbing increase in anxiety if compulsions interrupted 4 - Extreme: Incapacitating anxiety from any intervention aimed at modifying activity

9. Resistance Against Compulsions (How much do you try to fight the habits? {Only rate effort made to resist, not success or failure in actually controlling the compulsions}): *

0 - None: Makes an effort to always resist, or symptoms so minimal doesn't need to actively resist 1 - Mild: Tries to resist most of the time 2 - Moderate: Makes some effort to resist 3 - Severe: Yields to all obsessions without attempting to control them, but does so with some reluctance 4 - Extreme: Completely and willingly yields to all obsessions

10. Degree of Control Over Compulsive Thoughts (How strong is the feeling that you have to carry out the habit{s}? When you try to fight them, what happens?): *

0 - Complete Control 1 - Much Control: Experiences pressure to perform the behavior, but usually able to exercise voluntary control over it 2 - Moderate Control: Moderate control, strong pressure to perform behavior, can control it only with difficulty 3 - Little Control: Little control, very strong drive to perform behavior, must be carried to completion, can only delay with difficulty 4 - No Control: No control, drive to perform behavior experienced as completely involuntary and overpowering, rarely able to delay activity (even momentarily)

Compulsion Subtotal (add items 6-10):

CY-BOCS Total (add items 1-10):

Total CY-BOCS Score: Range of severity for patients who have both obsessions and compulsions

0-7 Subclinical

8-15 Mild

16-23 Moderate

24-31 Severe

32-40 Extreme

Is there anything in this section that you would like to bring to the attention of your provider?

Provider Notes: