Publications (6)4.52 Total impact

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    ABSTRACT: To explore clinical features of symptoms and comorbidity according to the age of onset of patients suffering from obsessive-compulsive disorder (OCD). The survey involved collecting data from both patient members of an OCD association, and a sample of 175 OCD patients seen in OCD specialty practice. All the patients (n=617) responded to a questionnaire on family and personal psychiatric OCD history, phenomenological features of OCD and comorbidity. They were classified according to OCD age at onset [group early age of onset (EO): under 15, group late age of onset (LO): older than 15]. A higher percentage of patients from Group LO complained of OCD triggering by factors such as professional difficulties and childbirth (P<0.05); also they more often had (P=0.05) a sudden onset of symptoms. On the other hand, clinical features, such as superstition and magic thoughts, parasite obsessions and repeating, counting, hoarding, tapping/rubbing and collecting compulsions were significantly more frequent (P<0.05) in EO; likewise, history of tics was more frequent in this group. The existence of comorbid depression (at least one episode) did not show any significant difference between groups. However, depression preceding OCD was more frequent in LO. There was no significant difference in treatment response according to age of onset OCD. The results showed a clear association of EO with obsessions of superstition and parasites, repetitive compulsions and motor and vocal tics, whereas a sudden onset, triggering factors and a more frequent depression preceding OCD characterized LO.
    Journal of Affective Disorders 04/2004; 79(1-3):241-6. DOI:10.1016/S0165-0327(02)00351-8 · 3.38 Impact Factor
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    ABSTRACT: Nowadays, there is a huge contrast between the scarcity of French-speaking publications concerning early-onset obsessive compulsive disorder and the prevalence of this illness according to the most recent publications. We present herein the epidemiological and clinical results of a vast national survey called “ABC-TOC” from which we extracted the complete data emanating from 36 children and adolescent aged from 6 to 15 years old.This study reveals that obsessive compulsive disorder in this age group is characterised by the plurality of many obsessions and concomitant compulsions whose evolution remains unstable and fluctuating, and is often marked by irritability and conduct disorders in the foreground. Moreover, there is an outstanding comorbid pathology: bipolar disorder (17.4% of the patients) preceded by a cyclothymic temperament, which is strongly related to a high suicidal risk: more than one third of the subjects of this study had suicidal ideations and 3 of them (9.7%) have attempted suicide several times since the OCD onset.
    Neuropsychiatrie de l Enfance et de l Adolescence 03/2002; 50(2):132-138. DOI:10.1016/S0222-9617(02)00081-8
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    ABSTRACT: Background : Clinical data is largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder.Methods : The rate of bipolar comorbidity in OCD was analyzed in a epidemiological survey which we undertook among the members of the French Association of patients suffering from OCD (AFTOC in French). To explore mood comorbidity, we used structured self-rated questionnaires for major depression, hypomania and mania (DSM-IV criteria) and self-rated Angst’s checklist of Hypomania and Cyclothymic Temperament (developped by Akiskal and Hantouche). From a total sample of 780, 453 files (58 %) were returned and analyzed : 76 % had suffered from a major depression (83 % recurrent) and 17 % had attempted suicide.Results : According to DSM-IV definitions of hypomania/mania, 11 % of the total sample were classified as bipolar (3 % as BP-I and 8 % as BP-II). However, 20 % had been recognized as bipolar or cyclothymic before the survey and treated with mood stabilizers. Furthermore, the Hypomania Checklist of Angst showed that 30 % obtained a cut-off score = 10. Analysis on the self-rated questionnaire for Cyclothymic Temperament showed that 50 % scored = 10, and so classified as BPII1/2. Both thresholds for self-rated hypomania and cyclothymia were previously validated by Hantouche et al. (1998). Finally, our analyses showed that anger attacks and suicide behavior were mainly linked to comorbid bipolarity.Conclusion : These data extend clinical research on “bipolar OCD” entity which is largely under-recognized in clinical practice. Also, they implicate cyclothymia in hostility and suicide risk in this population.
    Annales Médico-psychologiques revue psychiatrique 02/2002; 160(1-160):34-41. DOI:10.1016/S0003-4487(02)00142-7 · 0.22 Impact Factor

  • Annales Médico-psychologiques revue psychiatrique 01/2002; 160(1). · 0.22 Impact Factor

  • Neuropsychiatrie de l Enfance et de l Adolescence 01/2002; 50(2). DOI:10.1016/002409499553037
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    ABSTRACT: Clinical data are largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder. Most reports had evaluated the OCD comorbidity in unipolar and bipolar mood disorders (Kruger et al., 1995; Chen et Dilsaver, 1995). The only investigation in clinical population focused on the reverse issue was conducted in Pisa. Perugi et al. (1997) have showed in a consecutive series of 315 OCD outpatients, that 15.7% presented a bipolar comorbidity, mostly with BP-II disorder. Further analyses suggested that when comorbidity occurs with bipolar and unipolar depression, it has a differential impact on the clinical picture and course of OCD. The rate of bipolar comorbidity in OCD was analyzed in a recent epidemiological survey undertaken by the French Association of patients suffering from OCD (FA-OCD or AFTOC in French). In a sample of 453 OCD patients, 76% had suffered from a major depression, 11% from bipolar disorder (DSM IV mania or hypomania), 30% from hypomania (cases that obtained a score > or = 10 on the self-rated Angst Hypomania Checklist). According to the score > or = 10 on Self-rated Questionnaire for Cyclothymic Temperament, 50% were classified as cyclothymic. The self-assessment of soft-bipolar dimensions, such as hypomania and cyclothymia was previously validated in a multi-site study in major depression (Hantouche et al., 1998). Further analyses showed that comorbidity with soft bipolarity was characterized by significant interactions with high levels of impulsivity, anger attacks and suicidal behavior. In order to confirm these data, another cohort (n = 175 patients treated by psychiatrists for OCD) was formed and named "PSY-OCD". Comparative analyses between the two populations allowed showing very few demographic and clinical differences. The frequency rate of "bipolar OCD" was equivalent in both populations: BP-II disorder (DSM IV criteria) was present in 11% of FA-OCD and 16% of PSY-OCD. Furthermore using the Hypomania Checklist showed that BP-II disorder rate (score > or = 10) was higher: 32% of in both populations. Cyclothymic rate was also globally higher, but significant difference was obtained: 56% of FA-OCD versus 45% of PSY-OCD (p = 0.02). Moreover, mood switching rate under anti-OCD drugs was equivalent in both OCD populations (respectively 38% and 33%, p = ns). In case of BP comorbidity, patients had presented a greater number of concurrent major depressive episodes and suicidal attempts. When concurrent depression was considered, the rate diagnosis of soft bipolarity was 2.5 fold, and the number of suicidal attempts augmented by 7 fold (by comparison versus non-depressed OCD). Despite very early descriptions (since the beginning of the last century) of particular relationships between so-called "psychasthenia, folie de doute, folie raisonnante" and "circular and intermittent madness or cyclothymia", a few attention has been devoted to this complex pattern of comorbidity. The comparative data deriving from the collaborative survey with patients who are members of AFTOC and with a cohort of psychiatric outpatients, confirm the reality of bipolar-OCD comorbidity, which is largely under-recognized in clinical practice. More in depth analyses are now undertaken in order to investigate the characteristics of "bipolar OCD" by comparison to "non bipolar OCD".
    L Encéphale 01/2002; 28(1):21-8. · 0.70 Impact Factor