Myelofibrosis and anemia: a German claims data analysis to describe treatment sequencing, survival outcomes, and healthcare resource utilization.

Obsessive-compulsive disorder (OCD) is characterized by unwanted, intrusive, and recurrent thoughts, urges, or images (obsessions) and/or the repetitive performance of behaviors or mental acts (compulsions) that are excessive or irrational and intended to curb obsessional distress []. Although the nature of obsessive-compulsive symptoms is heterogeneous, there are four predominant symptom dimensions including (1) contamination, (2) unacceptable/taboo thoughts, (3) responsibility for harm, and (4) symmetry []. While people with OCD may have varying levels of symptom insight, most experience their symptoms as ego-dystonic and/or recognize the irrationality and excessiveness []. OCD is relatively common with a worldwide lifetime prevalence of 1.3%, with roughly equal gender distribution of incidence []. Yet, it takes an average of 12.78 years from symptom onset to diagnosis which may be due in part to inaccurate diagnosis among front line clinicians []. In comparison, schizophrenia, another serious mental health condition with a lifetime prevalence of approximately 1%, has an average time to treatment from the prepsychotic prodromal phase of over 5 years [, ]. Several factors have been implicated including lack of clinician familiarity with OCD, atypical symptom presentations, other comorbid mental disorders, and limited use of validated tools [, ]. Among primary care physicians in the greater New York area, OCD was misdiagnosed in about half of the provided vignettes with higher rates of misidentification in taboo and harm dimensions []. Missed or misdiagnosis has substantial implications including delayed care, inappropriate treatment recommendations, diminished quality of life, increased disability, and financial costs for individuals and health systems []. Medical school curricula may provide an ideal opportunity to educate future physicians across all specialties about OCD. A study conducted among Canadian medical schools evaluated the scope of OCD-related content finding that all institutions that responded covered at least three of the symptom dimensions with a disproportionate focus on contamination and symmetry dimensions []. Only 25% of schools covered categories within the unacceptable/taboo dimension (i.e., aggressive, religious, and sexual), and over half of the institutions did not qualify that aggressive obsessions are ego-dystonic and do not pose risk to self or others []. While informative, the nature of training in United States medical schools has not been examined which was the goal of the present descriptive paper.