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Importance: Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder associated with significant impairment and a lifetime prevalence of 1% to 3%; however, it is often missed in primary care settings and frequently undertreated.Objective: To review the most current data regarding screening, diagnosis, and treatment options for OCD.Evidence Review: We searched PubMed, EMBASE, and PsycINFO to identify randomized controlled trials (RCTs), meta-analyses, and systematic reviews that addressed screening and diagnostic and treatment approaches for OCD among adults (≥18 years), published between January 1, 2011, and September 30, 2016. We subsequently searched references of retrieved articles for additional reports. Meta-analyses and systematic reviews were prioritized; case series and reports were included only for interventions for which RCTs were not available.Findings: Among 792 unique articles identified, 27 (11 RCTs, 11 systematic reviews or meta-analyses, and 5 reviews/guidelines) were selected for this review. The diagnosis of OCD was revised for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, which addresses OCD separately from anxiety disorders and contains specifiers to delineate the presence of tics and degree of insight. Treatment advances include increasing evidence to support the efficacy of online-based dissemination of cognitive behavioral therapies, which have demonstrated clinically significant decreases in OCD symptoms when conducted by trained therapists. Current evidence continues to support the use of selective serotonin reuptake inhibitors as first-line pharmacologic interventions for OCD; however, more recent data support the adjunctive use of neuroleptics, deep-brain stimulation, and neurosurgical ablation for treatment-resistant OCD. Preliminary data suggest safety of other agents (eg, riluzole, ketamine, memantine, N-acetylcysteine, lamotrigine, celecoxib, ondansetron) either in combination with selective serotonin reuptake inhibitors or as monotherapy in the treatment of OCD, although their efficacy has not yet been established.Conclusions and Relevance: The dissemination of computer-based cognitive behavioral therapy and improved evidence supporting it represent a major advancement in treatment of OCD. Although cognitive behavioral therapy with or without selective serotonin reuptake inhibitors remains a preferred initial treatment strategy, increasing evidence that supports the safety and efficacy of neuroleptics and neuromodulatory approaches in treatment-resistant cases provides alternatives for patients whose condition does not respond to first-line interventions. [ABSTRACT FROM AUTHOR]

IMPORTANCE: Tourette syndrome (TS) is characterized by high rates of psychiatric comorbidity; however, fewstudies have fully characterized these comorbidities. Furthermore, most studies have included relatively fewparticipants (<200), and none has examined the ages of highest risk for each TS-associated comorbidity or their etiologic relationship to TS. OBJECTIVE: To characterize the lifetime prevalence, clinical associations, ages of highest risk, and etiology of psychiatric comorbidity among individuals with TS. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional structured diagnostic interviews conducted between April 1, 1992, and December 31, 2008, of participants with TS (n = 1374) and TS-unaffected family members (n = 1142). MAIN OUTCOMES AND MEASURES: Lifetime prevalence of comorbid DSM-IV-TR disorders, their heritabilities, ages of maximal risk, and associations with symptom severity, age at onset, and parental psychiatric history. RESULTS: The lifetime prevalence of any psychiatric comorbidity among individuals with TS was 85.7%; 57.7%of the population had 2 or more psychiatric disorders. The mean (SD) number of lifetime comorbid diagnoses was 2.1 (1.6); the mean number was 0.9 (1.3) when obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) were excluded, and 72.1% of the individuals met the criteria for OCD or ADHD. Other disorders, including mood, anxiety, and disruptive behavior, each occurred in approximately 30% of the participants. The age of greatest risk for the onset of most comorbid psychiatric disorders was between 4 and 10 years, with the exception of eating and substance use disorders, which began in adolescence (interquartile range, 15-19 years for both). Tourette syndrome was associated with increased risk of anxiety (odds ratio [OR], 1.4; 95%CI, 1.0-1.9; P = .04) and decreased risk of substance use disorders (OR, 0.6; 95%CI, 0.3-0.9; P = .02) independent from comorbid OCD and ADHD; however, high rates of mood disorders among participants with TS (29.8%)may be accounted for by comorbid OCD (OR, 3.7; 95%CI, 2.9-4.8; P < .001). Parental history of ADHD was associated with a higher burden of non-OCD, non-ADHD comorbid psychiatric disorders (OR, 1.86; 95%CI, 1.32-2.61; P < .001). Genetic correlations between TS and mood (RhoG, 0.47), anxiety (RhoG, 0.35), and disruptive behavior disorders (RhoG, 0.48), may be accounted for by ADHD and, for mood disorders, by OCD. CONCLUSIONS AND RELEVANCE: This study is, to our knowledge, the most comprehensive of its kind. It confirms the belief that psychiatric comorbidities are common among individuals with TS, demonstrates that most comorbidities begin early in life, and indicates that certain comorbiditiesmay be mediated by the presence of comorbid OCD or ADHD. In addition, genetic analyses suggest that some comorbiditiesmay be more biologically related to OCD and/or ADHD rather than to TS. [ABSTRACT FROM AUTHOR]

Following a September 2020 FDA announcement of a boxed warning for benzodiazepines, this Viewpoint reviews the relative benefits and risks of the drugs to reduce overuse in at-risk patients, moderate underuse in clinically appropriate instances, and guide judicious, rational prescribing. [ABSTRACT FROM AUTHOR]

The article comments on a report on the challenges in the usability of health information technology (HIT) and potential ways to improve the design of electronic health records (EHR). Topics discussed include the need to consider clinicians and patients who interact with EHR when creating a user-friendly design, EHR design not considering user disabilities and medical students' request for accommodations for various disabilities and barriers to their use of EHR.

In this Viewpoint, Insel and colleagues discuss the roles that private sector companies and foundations might play and the advantages of public-private partnerships in nurturing new and early-career physician-investigators given an always-challenging funding environment and ever-increasing hurdles young physicians must overcome to establish a research career. [ABSTRACT FROM AUTHOR]

The Viewpoint reexamines the attribution of mass shootings to untreated serious mental illness. [ABSTRACT FROM AUTHOR]

The article presents a case study involving a 57-year-old male patient who presented to his physicians with mental depression and insomnia, and it mentions the use of medical screening techniques to diagnose depression. According to the article, the patient has been dealing with increased hopelessness and insomnia in the aftermath of his husband's death. The Patient Health Questionnaire 9 (PHQ-9) is examined, along with depressive symptoms and anxiety.

The article discusses the authors' views about methods for reducing the flow of individuals with serious mental illness into America's criminal justice system, and it mentions the claim that patients with schizophrenia, major depressive disorders, and bipolar disorder are being disproportionately incarcerated in U.S. jails and prisons instead of community-based mental health clinics. Recidivism rates and decriminalization are examined, along with mental health treatment engagement.