The adequacy of pharmacotherapy in outpatients with obsessive-compulsive disorder

Pharmacotherapy and behavioural treatment are the main treatment options for patients with obsessive-compulsive disorder (OCD). Nevertheless, studies on the appropriateness of these treatments are scarce. We aimed to assess the adequacy of treatment in general, and pharmacotherapy in particular, in patients with OCD. Three hundred and thirteen outpatients with OCD were interviewed on admission at the University Medical Center (UMC) Utrecht, The Netherlands. Patients were evaluated for demographic and clinical characteristics. Current treatment was assessed on admission and treatment history was appraised retrospectively. On admission, only one-half of the patients took appropriate medication, of which 7.6% were prescribed maximal effective doses, 11.8% mean effective doses, 15% minimal effective doses and 19.4% ineffective doses. Approximately 35% of patients were prescribed no drugs and 16% inappropriate drugs. Although the majority of the patients had been treated on average three times prior to their current treatment, 24% had never received a serotonin reuptake inhibitor (SRI) or behaviour therapy. For approximately 50% of the total sample, the maximal effective dose of SRIs had never been taken during the course of treatment history. A large proportion of patients with OCD fail to receive adequate treatment. Many patients were prescribed SRIs at doses below those recommended for the guidelines.