Letters to the Editor

Sertraline in the Treatment of Obsessive-Compulsive Disorder

TO THE EDITOR: I am writing to bring to the attention of your readers an erroneous statement published in the article "Recognition and Treatment of Obsessive-Compulsive Disorder."¹ Information in Table 4 states that sertraline is "not FDA-labeled for the treatment of obsessive-compulsive disorder." In fact, sertraline was approved by the U.S. Food and Drug Administration (FDA) on October 25, 1996, for the treatment of obsessive-compulsive disorder.

The efficacy of sertraline in the treatment of obsessive-compulsive disorder was initially demonstrated in three multicenter, placebo-controlled studies of adult outpatients.^2-4 In all three of these studies, patients had moderate to severe obsessive-compulsive disorder (according to criteria in the Diagnostic and Statistical Manual of Mental Disorders [DSM-III or DSM-III-R]), with mean baseline ratings on the Yale Brown Obsessive-Compulsive Scale ranging from 23 to 25.

Thus, the incorrect statement that sertraline is not indicated for the treatment of obsessive-compulsive disorder should be deleted from Table 4, as sertraline has been recognized by the FDA since 1996 as an effective and safe treatment for obsessions and compulsions in patients with obsessive-compulsive disorder.

CATHRYN M. CLARY, M.D., M.B.A.
U.S. Pharmaceuticals
Pfizer Inc.
235 E. 42nd St.
New York, NY 10017-5755

REFERENCES

1. Eddy MF, Walbroehl GS. Recognition and treatment of obsessive-compulsive disorder. Am Fam Physician 1998;57:1623-8.
2. Greist J, Chouinard G, DuBoff E, Halaris A, Kim SW, Koran L, et al. Double-blind parallel comparison of three dosages of sertraline and placebo in outpatients with obsessive-compulsive disorder. Arch Gen Psychiatry 1995;52:289-95.
3. Chouinard G. A double-blind, multicenter, placebo-controlled study of sertraline in obsessive-compulsive disorder. 5th World Congress of the World Federation of Societies of Biological Psychiatry. June 9-14, 1991, Florence, Italy. Biol Psychiatry 1991;29(11 Suppl):1S-777S.
4. Chouinard G, Goodman W, Greist J, Jenike M, Rasmussen S, White K, et al. Results of a double-blind placebo controlled trial of a new serotonin uptake inhibitor, sertraline, in the treatment of obsessive-compulsive disorder. Psychopharmacol Bull 1990;26:279-84.

Maternal Self-Collection of Specimens for GBS Culture

TO THE EDITOR: The article by Dr. Keenan on screening for group B streptococcus (GBS) and the accompanying editorial by Dr. Deutchman highlight an important dilemma faced by family physicians who practice obstetrics.^1,2 Failure to diagnose and treat pregnant women with GBS places neonates at risk for life-threatening infection and physicians at risk for litigation.

The Centers for Disease Control and Prevention (CDC) offers two strategies for the prevention of neonatal GBS infection.³ Universal screening with a rectovaginal culture taken at 35 to 37 weeks' gestation detects most maternal carriage of GBS but is comparatively expensive. Relying on risk factors alone is less expensive but offers less sensitivity and specificity in the differentiation between colonized pregnant women and uncolonized pregnant women. GBS culture remains the "gold standard" for the detection of colonization.

The method of collection of GBS specimens that is described by the CDC may present a "convenience" barrier to physicians. Pregnant patients must undress, assume the lithotomy position and have a rectovaginal swab obtained by the caregiver, often with a chaperone in attendance. We offer an alternative. In an unpublished study of 241 pregnant women, we used a self-collection method for the GBS rectovaginal culture and found that women were as likely as their physicians to collect a sample that would show maternal carriage of GBS [79 percent versus 83 percent, Fisher's exact test=1.263(1), single tailed P =0.365]. Other investigators have found similar results and have also found that pregnant patients prefer self-collection of samples to collections made by the physician.^4,5

Physicians who prefer screening for GBS with a rectovaginal culture should consider the use of patient-collected specimens obtained when the pregnant patient collects her urine sample. This method does not require the patient to undress, requires no chaperone and may increase the time available for other matters during the office visit. For physicians who do not collect a GBS culture, this method may remove the "convenience" barrier to collection of GBS cultures.

MICHAEL R. SPIEKER, M.D.
Uniformed Services University of the Health Sciences
F. Edward Herbert School of Medicine
4301 Jones Bridge Rd.
Bethesda, MD 20889-4799

REFERENCES

1. Keenan C. Prevention of neonatal group B streptococcal infection. Am Fam Physician 1998;57:2713-20.
2. Deutchman M. Thoughts on the prevention of neonatal group B streptococcal infection [Editorial]. Am Fam Physician 1998;57:2602-6.
3. Centers for Disease Control and Prevention. Prevention of perinatal group B streptococcal disease: a public health perspective. MMWR Morb Mortal Wkly Rep 1996;45(RR-7):1-24 [Published erratum appears in MMWR Morb Mortal Wkly Rep 1996;45:679].
4. Mercer BM, Taylor MC, Fricke JL, Baselski VS, Sibai BM. The accuracy and patient preference for self-collected group B streptococcus cultures. Am J Obstet Gynecol 1995;173:1325-8.
5. Molnar P, Biringer A, McGeer A, McIsaac W. Can pregnant women obtain their own specimens for group B streptococcus? A comparison of maternal versus physician screening. The Mount Sinai GBS Screening Group. Fam Pract 1997;14:403-6.

IN REPLY: Any technique that helps in the identification of infants who are at risk for infection with group B streptococcus would be welcome, including self-collection techniques if they are found to have an acceptable degree of sensitivity and specificity after appropriate study.

MARK DEUTCHMAN, M.D.
University of Colorado Health Sciences Center
Department of Family Medicine
1180 Clermont St.
Denver, CO 80220

EDITOR'S NOTE: This letter was sent to the author of "Prevention of Neonatal Group B Streptococcal Infection," who declined to reply.

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The editors of AFP welcome input concerning topics of current medical interest and feedback in response to articles and other material published in AFP. Send letters to Jay Siwek, M.D., Editor, American Family Physician, 8880 Ward Pkwy., Kansas City, MO 64114; fax: 816-333-0303; e-mail: afplet@aafp.org. Please include your complete address, telephone number and fax number. Letters should be double-spaced, fewer than 500 words and limited to one table or figure and six references. Letters submitted for publication in AFP must not be submitted to any other publication. Letters pertaining to AFP subject matter must be received within two months of publication. Any financial associations or other possible conflicts of interest must be disclosed at time of submission. Submission of a letter constitutes transfer of copyright to the American Academy of Family Physicians. The editors reserve the right to edit correspondence to meet style and space requirements.

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