Citation

Hantouche EG, Demonfaucon C. Encephale (1974) 2008; 34(6): 611-617.

Vernacular Title

Toc resistant : caracteristiques cliniques, facteurs predictifs et influence des

Affiliation

Centre des troubles anxieux et de l'humeur, Paris, France. hantouche@ctah.eu

Copyright

(Copyright © 2008, Masson Editeur)

DOI

10.1016/j.encep.2007.12.008

PMID

19081459

Abstract

BACKGROUND: Despite significant advances in clinical research, Obsessive Compulsive Disorder, OCD represents a difficult to treat condition. The French Association of patients suffering from OCD, "AFTOC" is highly concerned by this issue. A new survey was implemented with the aim of exploring Resistant Obsessive Compulsive disorder "ROC". METHOD: Patients with OCD and members of the "AFTOC" were included in the survey. A self-rated file was elaborated in order to get the maximum of information on the clinical and therapeutic aspects and conditions of OCD. The full version of "TEMPS-A" was also included for assessment of affective temperaments. Statistical analyses were performed for inter-group comparison between "ROC" (resistant OCD) and good responders. Logistic regression analyses with "ROC" method were used to search for independent predictive factors to "ROC". RESULTS: The new survey of "AFTOC", "TOC & ROC" selected a sample of 360 patients, who are members of the association. The rate of "ROC" was 44.2%, 25.3% of Good Responders (GR), and 30.5% in between. Inter-group comparisons ("ROC" versus GR) showed significant higher rates of psychiatric admissions (49% versus 28%), and suicide attempts (26% versus 13%), greater numbers of doctors consulted (5.5 versus. 3.2), compulsions (4.6 versus 3.4), and psychiatric comorbidity (2.8 disorders versus. 2.0; notably agoraphobia, social anxiety and worry about appearance) in the "ROC" group. Assessment by full "TEMPS-A" scale revealed, significantly higher rates of Cyclothymic Temperament (63% versus 43%; p: 0.0003), Depressive Temperament (72% versus 53%; p: 0.004), and Irritable Temperament (21% versus 9%; p: 0.02) in the ROC group. Moreover, the mean global score on each of these temperaments was significantly higher in the "ROC" group. No difference was obtained in the rate or the mean score on the hyperthymic temperament scale. The most predictive factors of "ROC" were represented by "slow continuous course", "worsening under SRI", "worry about appearance", current age above 40 years and psychiatric admission. CONCLUSION: Our data provides a more precise clinical picture of "ROC", which should be initially explored through baseline severity, compulsive dominance, hoarding, special comorbidity such as recurrent depression, obsession of appearance, agoraphobia, social anxiety, and complex mixture of unstable affective temperament (cyclothymic, irritable, and depressive), and course of illness. Furthermore, vigilance towards the notion of worsening linked to drug therapy, and the increased suicide risk is warranted in the clinical management of "ROC".

Language: fr