Treatment of Obsessive-Compulsive Disorder by U.S. Psychiatrists 

Carlos Blanco, M.D., Ph.D.; Mark Olfson, M.D., M.P.H.; Dan J. Stein, M.D., Ph.D.; Helen Blair Simpson, M.D., Ph.D.; Marc J. Gameroff, Ph.D.; and William H. Narrow, M.D., M.P.H.

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.

(J Clin Psychiatry 2006;67:946-951)

Received Jan. 4, 2005; accepted Nov. 28, 2005. From the Department of Psychiatry, Columbia University, and the New York State Psychiatric Institute, New York, N.Y. (Drs. Blanco, Olfson, Simpson, and Gameroff); the Department of Psychiatry, University of Stellenbosch, Capetown, South Africa (Dr. Stein); and the American Psychiatric Institute for Research and Education (APIRE), Arlington, Va. (Dr. Narrow).

Supported in part by a National Institute on Drug Abuse (NIDA) grant DA-00482, a National Alliance for Research on Schizophrenia and Depression (NARSAD) Young Investigator Award, and a grant from the Alcohol Beverage Medical Research Foundation (Dr. Blanco).

Dr. Olfson has received grant/research support from Bristol-Myers Squibb and Eli Lilly; has been a consultant for Bristol-Myers Squibb, Eli Lilly, and McNeil; and has been on the speakers or advisory board of Janssen. Dr. Stein has received grant/research support from and has been a consultant for AstraZeneca, Eli Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth. Drs. Blanco, Simpson, Gameroff, and Narrow report no additional financial or other relationships relevant to the subject of this article.

The authors thank the members of the Practice Research Network (PRN) who participated in the 1997 (Harold Alan Pincus, M.D., and Deborah A. Zarin, M.D., Co-Principal Investigators) and 1999 (Harold Alan Pincus, M.D., and Ivan Montoya, M.D., Co-Principal Investigators) APIRE PRN Study of Psychiatric Patients and Treatments, which was supported in part by the National Institute of Mental Health; the John D. and Catherine T. MacArthur Foundation; and the Center for Mental Health Services, Substance Abuse, and Mental Health Services Administration.

Corresponding author and reprints: Carlos Blanco, M.D., Ph.D., New York State Psychiatric Institute, 1051 Riverside Drive, Box 69, New York, NY 10032 (e-mail: cb255@columbia.edu).