Treatment of obsessive-compulsive disorder by U.S. psychiatrists

Objective: To examine the treatment of obsessive-compulsive disorder (OCD) by a nationally representative sample of psychiatrists. Method: The authors analyzed physician-reported data from the 1997 and 1999 American Psychiatric Institute for Research and Education Practice Research Network (PRN) Study of Psychiatric Patients and Treatments to describe demographic, clinical, and treatment characteristics of patients with a diagnosis of OCD (per DSM-IV and clinical features). On the basis of published studies, serotonin reuptake inhibitor (SRI) doses were predefined as low, intermediate, or high. Results: Sixty-five percent of patients received an SRI, but only 39.4% of the sample patients received an SRI at a dose thought to be most effective for OCD or were having their dose titrated. A total of 7.5% of patients in the sample received cognitive-behavioral therapy (CBT) with or without medication treatment. Prescription of benzodiazepines or antipsychotics was common, often in the absence of an SRI. Patients receiving CBT had on average the highest scores on the Global Assessment of Functioning Scale. No other demographic or treatment characteristics were associated with the type of treatment received by the patients. Conclusion: Despite important advances in the efficacy of pharmacologic and psychological treatments for OCD, psychiatric care of OCD continues to be an area with substantial opportunity for quality improvement.