Patient Preferences for Obsessive-Compulsive Disorder Treatment

Objective: To explore preferences for the treatment of obsessive-compulsive disorder (OCD). We hypothesized that OCD patients will select a combination of medication and psychotherapy as their most preferred choice overall.

Method: The authors designed a treatment-preference survey using 2 health economics methods, forced-choice and contingent-ranking methods, to elicit preferences for OCD treatment available in mainstream care (serotonin reuptake inhibitors [SRIs], exposure and response prevention [EX/RP], and their combination) and for novel treatments under development at OCD research clinics. This survey was given by telephone to 89 individuals with OCD who called the OCD research clinic at the New York State Psychiatric Institute between July 2008 and January 2009. Diagnosis of OCD was based on a telephone screening evaluation adapted from the Structured Clinical Interview for DSM-IV Axis I Disorders.

Results: Most participants chose combination treatment (43%) or EX/RP (42%) over SRI medication (16%). Participants ranked investigational psychotherapy as their most-preferred novel treatment (endorsed by 48% of participants) and deep brain stimulation as their least-preferred novel treatment (endorsed by 77% of participants). Qualitative data suggest that prior treatment experience, concerns about medications, and logistical and practical concerns about treatment regimens affect preferences.

Conclusions: Patients with OCD have identifiable treatment preferences. In this sample of convenience, most preferred either combination treatment or psychotherapy. Future studies should investigate prospectively what modifies these preferences and how these preferences affect treatment outcome.

J Clin Psychiatry 2010;71(11):1434-1439

Submitted: July 17, 2009; accepted November 3, 2009 (doi:10.4088/JCP.09m05537blu).

Corresponding author: Sapana R. Patel, PhD, New York Psychiatric Institute and Columbia University, 1051 Riverside Dr, Unit 69, New York, NY 10032 (sp2309@columbia.edu).