Cyclothymic OCD: a distinct form?
Cyclothymic OCD: a distinct form?
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DOI：
10.1016/s0165-0327(02)00461-5
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发表时间：
2003-06-01
影响因子：
6.6
通讯作者：
Akiskal, HS
中科院分区：
文献类型：
--
作者：
Hantouche, EG;Angst, J;Akiskal, HS
背景：关于强迫症（OCD）和其他焦虑症合并症的临床研究主要集中在抑郁症上。然而在实践中，顽固性或严重的强迫症患者经常患有隐蔽的或隐藏的双相情感障碍。方法：对法国强迫症患者协会 (AFTOC) 的 453 名成员以及强迫症门诊患者的精神病学样本 (n = 175) 进行系统性调查，探讨强迫症中双相情感障碍的发生率。由于我们之前的研究表明流行病学和临床样本相似，因此我们在本次分析中将它们结合起来 (n = 628)。为了评估心境障碍合并症，我们使用了针对重性抑郁、轻躁狂和躁狂的结构化自评问卷（DSM-IV 标准）、轻躁狂自评焦虑清单和环性气质自评清单（由 Akiskal 和 Hantouche 开发的法语版本）。结果：根据 DSM-IV 对轻躁狂/躁狂的定义，总样本中的 11% 被归类为双相情感障碍（3% BP-I 和 8% BP-II）。当进行维度评估时，30% 的人在轻躁狂检查表上获得的截止分数大于或等于 10。 50% 的人被归类为循环性。进行了对比分析。在患有强迫症 (n = 302) 和不患有循环性精神障碍 (n = 272) 之间进行。与非循环性强迫症相比，循环性强迫症患者的特征是更严重的强迫症综合征（攻击性、冲动、宗教和性强迫症、强迫性控制、囤积、重复的频率更高）；更多的情景课程；躁狂/轻躁狂和重度抑郁发作（强度和复发率较高）的发生率较高，与自杀未遂率和精神病入院率较高有关；最后，对抗强迫症抗抑郁药的反应较差，并且攻击性行为导致情绪转换率升高。局限性：临床医生的诊断访谈并未证实轻躁狂和循环性精神病。结论：我们的数据扩展了之前关于“强迫症-双相情感障碍”的研究，将其视为一种高度普遍且很大程度上未被充分认识和未经治疗的强迫症患者类别。此外，我们的数据表明“循环性 OCU”可能代表强迫症的一种独特形式。在研究和临床实践中应予以更多关注。 (C) 2003 Elsevier Science B.V. 保留所有权利。
Background: Clinical research on the comorbidity of obsessive compulsive disorder (OCD) and other anxiety disorders has largely focused on depression. However in practice, resistant or severe OCD patients not infrequently suffer from a masked or hidden comorbid bipolar disorder. Method: The rate of bipolar comorbidity in OCD was systematically explored among 453 members of the French Association of patients suffering from OCD (AFTOC) as well as a psychiatric sample of OCD out-patients (n = 175). As previous research by us has shown the epidemiologic and clinical sample to be similar, we combined them in the present analyses (n = 628). To assess mood disorder comorbidity, we used structured self-rated questionnaires for major depression, hypomania and mania (DSM-IV criteria), self-rated Angst's checklist of Hypomania and that for the Cyclothymic Temperament (French version developed by Akiskal and Hantouche). Results: According to DSM-IV definitions of hypomania/mania, 11% of the total combined sample was classified as bipolar (3% BP-I and 8% BP-II). When dimensionally rated, 30% obtained a cut-off score greater than or equal to 10. on the Hypomania checklist and 50% were classified as cyclothymic. Comparative analyses were. conducted between OCD with (n = 302) versus without cyclothymia (n = 272). In contrast to non-cyclothymics, the cyclothymic OCD patients were characterized by more severe OCD syndromes (higher frequencies of aggressive, impulsive, religious and sexual obsessions,, compulsions of control, hoarding, repetition); more episodic course; greater rates of manic/hypomanic and major depresive episodes (with higher intensity and recurrence) associated with higher rates of suicide attempts and psychiatric admissions; and finally, a less favorable response to anti-OCD antidepressants and elevated rate of mood switching with aggressive behavior. Limitation: Hypomania and cyclothymia were not confirmed by diagnostic interview by a clinician. Conclusion: Our data extend previous research on "OCD-bipolar comorbidity" as a highly prevalent and largely under-recognized and untreated class of OCD patients. Furthermore, our data suggest that "cyclothymic OCU" could represent a distinct form of OCD. More attention should be paid to it in research and clinical practice. (C) 2003 Elsevier Science B.V. All rights reserved.