New York State Psychiatric Institute and Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University, New York City (Senter, Patel, Dixon, Simpson); New York State Office of Mental Health, Albany (Myers). Editor Emeritus Howard H. Goldman, M.D., Ph.D., was decision editor on the manuscript.
Psychiatr Serv. 2021 Jul 1;72(7):784-793. doi: 10.1176/appi.ps.202000296. Epub 2021 May 7.
Obsessive-compulsive disorder (OCD) can be a chronic and disabling illness with a lifetime prevalence of 2%, twice that of schizophrenia. Although effective treatments exist, OCD often remains underdetected and undertreated.
The authors performed a scoping review of the literature (of articles in PubMed and PsycINFO published from January 1, 2000, to February 1, 2020) to define gaps in OCD diagnosis and treatment among U.S. adults. Interventions at the patient, clinician, and health care system levels used to address these gaps are described, and promising approaches from around the world are highlighted.
Of 102 potential studies identified in the search, 27 (including five non-U.S. studies) were included. The studies revealed that lack of clinician and patient knowledge about OCD and misdiagnosis contributes to its underdetection. Suboptimal prescribing of selective serotonin reuptake inhibitor medications and limited use of exposure and response prevention, as a first-line psychotherapy, contribute to OCD undertreatment. Digital health technologies show promise in increasing OCD detection and delivery of evidence-based care and in ensuring continuity of care (including during the COVID-19 pandemic).
Given the significant rates of disability, morbidity, and mortality associated with OCD, addressing gaps in OCD care will reduce the U.S. burden of mental illness. Further research is needed to determine how the use of digital health technologies can increase the detection and management of OCD.
强迫症（OCD）是一种慢性且致残的疾病，终生患病率为 2%，是精神分裂症的两倍。尽管存在有效的治疗方法，但 OCD 常常未被充分发现和治疗。
作者对文献进行了范围综述（检索了 2000 年 1 月 1 日至 2020 年 2 月 1 日在 PubMed 和 PsycINFO 上发表的文章），以确定美国成年人 OCD 诊断和治疗方面的差距。描述了用于解决这些差距的患者、临床医生和医疗保健系统各级别的干预措施，并强调了世界各地有前途的方法。
在搜索中确定了 102 项潜在研究，其中 27 项（包括 5 项非美国研究）被纳入。这些研究表明，缺乏临床医生和患者对 OCD 的了解以及误诊导致其未被充分发现。选择性 5-羟色胺再摄取抑制剂药物的处方不规范以及暴露和反应预防的使用有限（作为一线心理治疗）导致 OCD 治疗不足。数字健康技术在提高 OCD 的检测、提供循证护理以及确保护理连续性（包括在 COVID-19 大流行期间）方面显示出前景。
鉴于 OCD 与残疾、发病率和死亡率的关联率较高，解决 OCD 护理方面的差距将减轻美国的精神疾病负担。需要进一步研究确定如何使用数字健康技术可以提高 OCD 的检测和管理。
