Obsessive-compulsive spectrum disorders in primary care: the possibilities and the pitfalls

Although the serotonin selective reuptake inhibitors make the treatment of obsessive-compulsive spectrum disorders possible for primary care physicians, numerous obstacles to successful treatment in the primary care setting remain. Given the absence of studies of primary care patients in primary care settings, the generalizability of results from patients with obsessive-compulsive spectrum disorders in psychiatric settings is uncertain. The primary care physician must combat resistance and refusal by patients to accept psychiatric intervention. In addition, the primary care physician faces recognition problems--not only are patients reluctant to disclose such problems, but primary care physicians lack validated screening tools. The development of a new computerized compulsive-impulsive spectrum scale should assist primary care physicians in diagnosing and treating obsessive-compulsive spectrum disorders, which may occur at a rate of 10% in the primary care setting.