Columbia University, Department of Psychiatry, College of Physicians and Surgeons, New York State Psychiatric Institute, New York, NY 10032, USA.
J Clin Psychiatry. 2010 Nov;71(11):1434-9. doi: 10.4088/JCP.09m05537blu.
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.
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.
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.
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.
探讨强迫症（OCD）治疗偏好。我们假设 OCD 患者会选择药物治疗和心理治疗相结合作为整体最优选。
作者使用 2 种健康经济学方法（强制选择和条件排序法）设计了治疗偏好调查，以了解主流治疗中可获得的 OCD 治疗（选择性 5-羟色胺再摄取抑制剂 [SSRIs]、暴露和反应预防 [EX/RP] 及其组合）和 OCD 研究诊所正在开发的新型治疗方法的偏好。该调查通过电话询问了 89 名于 2008 年 7 月至 2009 年 1 月期间致电纽约州精神病学研究所 OCD 研究诊所的 OCD 患者。OCD 的诊断基于改编自 DSM-IV 轴 I 障碍结构化临床访谈的电话筛查评估。
大多数参与者选择联合治疗（43%）或 EX/RP（42%）而不是 SRI 药物（16%）。参与者将研究性心理治疗列为最优选的新型治疗方法（48%的参与者认可），深部脑刺激列为最不优选的新型治疗方法（77%的参与者认可）。定性数据表明，先前的治疗经验、对药物的担忧以及对治疗方案的实际和实际问题会影响偏好。
OCD 患者有明确的治疗偏好。在本研究中，大多数患者更喜欢联合治疗或心理治疗。未来的研究应前瞻性地研究哪些因素会改变这些偏好以及这些偏好如何影响治疗结果。
