David Baxter PhD
Late Founder
Effective OCD Treatments Largely Overlooked
by DEEANNA FRANKLIN, Associate Editor, Clinical Psychiatry News
Volume 34, Issue 9, Page 17 (September 2006)
Evidence-based treatments for obsessive-compulsive disorder appear to be highly underused in psychiatric practices, and the reasons for this are unclear, reported Dr. Carlos Blanco of the New York State Psychiatric Institute in New York City and his associates.
The researchers studied 123 adult outpatients diagnosed with obsessive-compulsive disorder (OCD) using data drawn from the American Psychiatric Institute for Research and Education's Practice Research Network Study of Psychiatric Patients and Treatments.
The study, conducted in 1997 and 1999, provided ?a nationally representative sample of patients? (J. Clin. Psychiatry 2006;67:946?51).
Study subjects were 96.6% white and 55.2% male; 80.5% were aged 18?64. Forty-one percent were privately insured, and 38.6% used a payment source described as ?other.? The length of treatment was a mean of 30 months, with psychiatric visits lasting a mean of 36 minutes.
In the study, 44.4% of participants had at least one comorbid Axis I disorder, while 42.1% had two or more. Patients were assessed using a Global Assessment of Functioning (GAF) scale score.
Participants were separated into three treatment groups: One group (39.4%) was taking either a high-dose serotonin reuptake inhibitor (SRI), such as clomipramine, or a selective serotonin reuptake inhibitor, such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft), without cognitive-behavioral therapy (CBT).
An additional group (53.2%) of patients was on lower-dose SRIs without CBT.
The third group (7.5%) received CBT with or without an SRI at any dosing level, the investigators said.
For treatment, 92.7% were prescribed at least one psychotropic medication, with 55.1% of patients taking two or more psychotropics.
There was a roughly even distribution of patients on low, intermediate, or high doses?35.5% were on benzodiazepines, and 23.1% got antipsychotics.
Only 40% of patients were prescribed higher-dose SRIs or were having their medication titrated, even though the higher doses are ?thought to be the most effective for OCD.?
Although 77% of patients received psychotherapy, only 7.5% of patients were receiving CBT, even though ?CBT is the only empirically supported psychotherapy for the treatment of OCD,? Dr. Blanco and his associates said. Only 4.2% were taking an SRI with CBT.
The only variable that differed across treatment groups was the GAF score, the researchers said.
Data showed that the mean GAF score for patients receiving CBT was 69.2, which was significantly greater than the mean GAF scores of the higher dose SRI group (59.8), and the lower dose SRI group (56.6).
Treatment selection by the psychiatrists may have been tied to the patient's overall level of functioning, as opposed to the patient's specific clinical characteristics, the investigators speculated.
The researchers attributed the limited use of CBT to clinician or patient factors, speculating that some psychiatrists were more familiar with medication treatments than they were with psychotherapies, or they may prefer pharmacotherapy over CBT.
Another factor may be patients' refusing ?to engage in CBT because the procedures (exposures and response prevention) may have generated an intolerable level of anxiety? in prior treatment experiences, the investigators said.
Additionally, psychiatrists may have substantial financial disincentives, such as problems with reimbursement, to provide psychotherapy, because treating CBT for OCD may require sessions longer than the traditional 30- to 45-minute visit.
The researchers concluded wider distribution of published practice guidelines might increase the use of appropriate treatments for OCD patients.
by DEEANNA FRANKLIN, Associate Editor, Clinical Psychiatry News
Volume 34, Issue 9, Page 17 (September 2006)
Evidence-based treatments for obsessive-compulsive disorder appear to be highly underused in psychiatric practices, and the reasons for this are unclear, reported Dr. Carlos Blanco of the New York State Psychiatric Institute in New York City and his associates.
The researchers studied 123 adult outpatients diagnosed with obsessive-compulsive disorder (OCD) using data drawn from the American Psychiatric Institute for Research and Education's Practice Research Network Study of Psychiatric Patients and Treatments.
The study, conducted in 1997 and 1999, provided ?a nationally representative sample of patients? (J. Clin. Psychiatry 2006;67:946?51).
Study subjects were 96.6% white and 55.2% male; 80.5% were aged 18?64. Forty-one percent were privately insured, and 38.6% used a payment source described as ?other.? The length of treatment was a mean of 30 months, with psychiatric visits lasting a mean of 36 minutes.
In the study, 44.4% of participants had at least one comorbid Axis I disorder, while 42.1% had two or more. Patients were assessed using a Global Assessment of Functioning (GAF) scale score.
Participants were separated into three treatment groups: One group (39.4%) was taking either a high-dose serotonin reuptake inhibitor (SRI), such as clomipramine, or a selective serotonin reuptake inhibitor, such as fluoxetine (Prozac), paroxetine (Paxil), or sertraline (Zoloft), without cognitive-behavioral therapy (CBT).
An additional group (53.2%) of patients was on lower-dose SRIs without CBT.
The third group (7.5%) received CBT with or without an SRI at any dosing level, the investigators said.
For treatment, 92.7% were prescribed at least one psychotropic medication, with 55.1% of patients taking two or more psychotropics.
There was a roughly even distribution of patients on low, intermediate, or high doses?35.5% were on benzodiazepines, and 23.1% got antipsychotics.
Only 40% of patients were prescribed higher-dose SRIs or were having their medication titrated, even though the higher doses are ?thought to be the most effective for OCD.?
Although 77% of patients received psychotherapy, only 7.5% of patients were receiving CBT, even though ?CBT is the only empirically supported psychotherapy for the treatment of OCD,? Dr. Blanco and his associates said. Only 4.2% were taking an SRI with CBT.
The only variable that differed across treatment groups was the GAF score, the researchers said.
Data showed that the mean GAF score for patients receiving CBT was 69.2, which was significantly greater than the mean GAF scores of the higher dose SRI group (59.8), and the lower dose SRI group (56.6).
Treatment selection by the psychiatrists may have been tied to the patient's overall level of functioning, as opposed to the patient's specific clinical characteristics, the investigators speculated.
The researchers attributed the limited use of CBT to clinician or patient factors, speculating that some psychiatrists were more familiar with medication treatments than they were with psychotherapies, or they may prefer pharmacotherapy over CBT.
Another factor may be patients' refusing ?to engage in CBT because the procedures (exposures and response prevention) may have generated an intolerable level of anxiety? in prior treatment experiences, the investigators said.
Additionally, psychiatrists may have substantial financial disincentives, such as problems with reimbursement, to provide psychotherapy, because treating CBT for OCD may require sessions longer than the traditional 30- to 45-minute visit.
The researchers concluded wider distribution of published practice guidelines might increase the use of appropriate treatments for OCD patients.
