Psychological Disorders: How to Give Patients What They Want and What They Need
September 1, 2013 less than 1 minute read
Commonplace psychiatric disorders such as anxiety, depression, posttraumatic stress disorder, and obsessive compulsive disorder respond to pharmacotherapy, psychotherapy, and their combination. The National Comorbidity Survey Replication data have indicated that persons with psychiatric disorders often do not use mental health services because of perceived barriers to access (e.g., cost, logistics). Identification of patient preferences for treatment is of value not only for patient satisfaction, but also because clinical outcomes are better among patients who receive their treatment of choice. Additionally, patients who are concordant with the therapeutic choice have been reported to be more adherent with therapy.
Data from 34 clinical trials (total patient n = 90,071) were assessed by meta-analysis. Overall, patients expressed a preference for psychological treatment over pharmacotherapy by 3:1. This preference was consistent irrespective of the underlying psychiatric disorder studied, including depression, anxiety, and hypochondriasis. The availability of additional alternatives (e.g., combination treatment, watchful waiting, no treatment) did not affect the balance of patient preferences.
At the current time, treatment of patients with mild-moderate psychiatric disorders with pharmacotherapy vs psychotherapy is at equipoise. Hence, identification of patient preference — in situations where outcomes are similar between choices — is a sensible direction to take. This large literature base suggests that as many as 75% of patients with commonplace psychiatric issues prefer psychological treatment to pharmacotherapy. Although pharmacotherapy is often a more expedient path for primary care clinicians, the importance of addressing patient preference is well highlighted by this study.
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