le trouble obsessionnel-compulsif

je voudrai attirer votre attention sur une maladie encore meconnue pour la majorité des marocains mais qui en touche des milliers ce sont les troubles obsessionnels compulsifs:les TOC
est ce que vous avez une idée sur la question????

[de_passages]

j'y connais un petit chwiya...

mais aurais-tu une question plus précises? le sujet est vaste...

c'est koi un toc?c'est come un tic? :-?

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toc: trouble obsessionnel-compulsif
ça peut être assez embêtant voire complètement paralysant comme trouble.

[de_passages]

c'est long comme article... mais ça a l'avantage d'être complet

Overview of obsessive-compulsive disorder

Paul Ciechanowski, MD
Wayne Katon, MD


INTRODUCTION — Obsessive-compulsive disorder (OCD) is one of the more disabling and potentially chronic anxiety disorders. It is characterized by anxiety-provoking intrusive thoughts and repetitive behaviors. Obsessions may consist of aggressive thoughts and impulses, fears of contamination by germs or dirt, or fears of harm befalling someone. Compulsions such as washing, checking, or counting are rituals whose purpose is to neutralize or reverse the fears. Related disorders include trichotillomania (hair-pulling) and Tourette's syndrome.

EPIDEMIOLOGY AND SPECTRUM OF DISEASE — OCD occurs in 2 to 3 percent of the United States population [1]. There is probably a bimodal distribution of the age of onset, with studies of juvenile OCD finding a mean age at onset of around 10 years, and adult OCD studies finding a mean age at onset of 21 years [1-4]. Early onset OCD has been associated with a higher frequency of tic-like compulsions and comorbid tic disorders [5,6]. (See "Hyperkinetic movement disorders"). In general, the modal age of onset is younger for males than for females [7]. There has traditionally been a significant delay between symptom onset and treatment seeking because of patient embarrassment and the long held perception (by both the patient and the medical community) that little can be done about the symptoms of OCD.

OCD shares many features with somatoform disorders, dissociative disorders, eating disorders, impulse control disorders, and neurologic disorders (show table 1). These diseases have been classified under the rubric "obsessive-compulsive spectrum disorders" and are thought to approach a prevalence rate in the primary care setting of 10 percent [8]. An expert consensus guideline has determined that bulimia and body dysmorphic syndrome also are conditions in this spectrum that can be treated with similar pharmacologic agents as in OCD [9]. Hypochondriasis, trichotillomania, nail-biting, and skin-picking are conditions commonly seen in the medical setting that also are possibly responsive to OCD treatment.

In addition to significant disability and burden to patients and their families, total costs of OCD were estimated at $8 billion in 1990 [10]. More recent analyses estimate lifetime indirect costs due to lost wages at $40 billion [11].

PATHOPHYSIOLOGY — There is a higher incidence of OCD among first degree relatives of patients with OCD than in the general population. Functional imaging studies over the past several years have implicated prefrontal cortex, cingulate gyrus, and basal ganglia (especially caudate nucleus) dysfunction in the pathogenesis of this disorder. As an example, treatment studies using PET scans have shown that patients with OCD who improved during pharmacological or cognitive-behavioral treatment had reductions in cerebral metabolism or blood flow in specific regions of the brain, including the right caudate nucleus; the degree of reduction correlated with the degree of response to therapy [12]. Serotonin is also believed to play a primary role in OCD.

A pediatric subgroup of patients has been identified that developed OCD characterized by prepubertal acute onset after group A beta-hemolytic streptococcal pharyngitis [13]. It has been postulated that the basal ganglia is involved in this process, a hypothesis that is supported by neuropsychological and neuroimaging evidence of basal ganglia dysfunction in both OCD and Sydenham's chorea, and by demonstrations of similar antineuronal antibodies in both disorders.

CLINICAL MANIFESTATIONS AND DIAGNOSIS — Patients with OCD present with persistent thoughts, ideas, and images that intrude into conscious awareness, are recognized as a product of one's mind, and are perceived as senseless and intrusive. Commonly these obsessions have a theme that a small oversight will result in inconceivable catastrophe. Other common themes are contamination, a need for ordering things, aggressive impulses, and sexual imagery.

Compulsions are urges or impulses for repetitive intentional behavior performed in a stereotyped manner (eg, touching, counting, arranging) in an attempt to alleviate the anxiety which most frequently results from the obsessions. Often these behaviors are believed to help defend the patient and others from potential harm. Such behaviors may cause minor physical signs that can be recognized by the physician. As examples, the compulsive hand washer may present with a serious dermatitis, the skin-picker may develop dermatologic lesions, or the patient with trichotillomania will have alopecia. Other behaviors can be disabling by virtue of the time required to perform them. As with many anxiety disorders, symptoms worsen at times of stress.

Quality of life is considerably decreased in patients with OCD due to the shame, distress, and time consumed in carrying out compulsive behaviors. Interpersonal relationships suffer, with resulting interference in family relationships, friendships, and academic and work achievement. The potentially devastating consequences of OCD were illustrated in a study which found that 13 percent of patients had attempted suicide secondary to OCD symptoms [14].

The diagnostic criteria for OCD suggest that the obsessions and compulsions are time consuming, cause significant distress, or interfere with daily routine, social, or occupational functioning (show table 2) [7].

However, a correct diagnosis is often difficult to make because many of the symptoms of OCD overlap with generalized anxiety disorder and major depression, or OCD may coexist with these disorders [15]. One study reported a 17-year gap on average between the onset of symptoms and appropriate treatment for OCD, due in part to the difficulty in establishing the diagnosis and to the reluctance of these patients to seek help [11]. This gap is expected to decrease with increasing media attention and increased diagnostic sophistication among the medical and psychiatric community.

Patients seldom present complaining of intrusive obsessive thoughts because of the inherent shame that accompanies these symptoms. Thus, physicians must actively screen for OCD, particularly when presenting symptomatology suggests the diagnosis. Examples of useful questions include the following:

Are there certain thoughts that go through your mind over and over that you cannot get rid of?

Are there behaviors or habits that you feel compelled to repeat?


In addition, a short version of the Yale-Brown Obsessive Compulsive Screen can be a useful adjunct to the interview in diagnosing OCD (show table 3) [16]. It can also be used to assess the severity of OCD and to monitor treatment.

NATURAL HISTORY — The natural history of OCD was described in a long-term follow-up study of 144 patients with the disorder followed for 40 years [17]. Although two-thirds of patients had some degree of improvement within one decade of the onset of their illness, only one-fifth of the cohort achieved full remission, with two-thirds continuing to experience clinical or subclinical symptoms. One-fifth of patients who recovered early had a late relapse after being symptom free for more than 20 years. The authors point out that during the most of the study period, there were no effective and lasting therapies for OCD.

TREATMENT — Treatment of OCD can be difficult because of frequent relapse and incomplete response. Adults with mild OCD should be referred to an OCD specialist for cognitive-behavioral therapy with or without medication; moderate or severe cases require cognitive-behavioral therapy and treatment with selective serotonin reuptake inhibitors (SSRIs) or clomipramine [18].

Psychotherapy — Psychotherapeutic measures include a combination of the behavioral therapy known as exposure and response prevention, and cognitive therapy [19]. The efficacy of these approaches has been well established in patients with OCD. (See "Psychological treatment of psychiatric disorders", section on Obsessive compulsive disorder.)

Exposure capitalizes upon the fact that anxiety usually decreases after sufficient duration of contact with a feared stimulus. A patient with obsessions about contamination with germs, then, would remain in contact with a selected feared object or place that was considered contaminated until the anxiety was extinguished. Repeated multiple exposures eventually result in loss of fear of the targeted stimulus. Patients must concurrently avoid rituals or response behaviors until their anxiety disappears. The faulty estimation of danger or exaggerated sense of personal responsibility often seen in the patient with OCD is dealt with by using cognitive therapy.

Drug therapy — Pharmacological treatment is indicated for most patients with OCD. Clomipramine, a serotonin-selective tricyclic agent, has been the first-line therapy for many years. The efficacy of clomipramine was demonstrated in two controlled studies of over 500 patients with OCD [20]. The mean reduction in the Yale-Brown Obsessive Compulsive Scale score at the end of 10 weeks of clomipramine was 38 and 44 percent in studies 1 and 2, respectively, versus 3 and 5 percent for those in the placebo groups.

However, clomipramine is associated with frequent anticholinergic side effects, postural hypotension, somnolence, and weight gain. Thus, the selective serotonin reuptake inhibitors (SSRIs) now have surpassed it as first-line treatment for OCD.

A meta-analysis of four large placebo-controlled trials found that SSRIs were effective for the treatment of OCD [21]. In comparison studies, fluoxetine and fluvoxamine were as efficacious as clomipramine [22,23]. Onset was faster with clomipramine, but these patients also experienced more side effects [23]. A prospective study of 66 patients with OCD found that treated patients had a 47 and 12 percent chance of achieving partial or full remission, respectively; relapse occurred in 48 percent of treated patients who achieved a partial remission [15]. In children and adolescents, fluoxetine 20 to 60 mg daily was shown to be an effective treatment for OCD in a double-blind, placebo-controlled trial of 103 patients aged 7 to 17 [24].

Treatment with SSRIs should continue for at least 10 weeks before they are considered ineffective [15,25]. After a failed trial with one SSRI, either another SSRI can be tried or the patient can be switched to clomipramine.

SSRIs must be started at low doses because of potential initial side effects such as activation, nausea, diarrhea, drowsiness, and headache. Starting doses of 5 to 10 mg of paroxetine, 12.5 to 25 mg of sertraline, 25 mg of fluvoxamine, 5 mg of fluoxetine, or 10 mg of citalopram can be gradually titrated up to full doses of 40 to 60 mg of paroxetine, 100 to 200 mg of sertraline, 200 to 300 mg of fluvoxamine, and 20 to 80 mg of fluoxetine, and 20 to 60 mg of citalopram (show table 4). The SSRI doses necessary to treat OCD are generally higher than those needed to treat depression [15].

A significant percentage of men and women develop sexual side effects after several weeks or months of SSRI therapy; these adverse effects can lead to medication discontinuation. The management of SSRI-induced sexual dysfunction is discussed separately. (See "Sexual dysfunction associated with selective serotonin reuptake inhibitor (SSRI) antidepressants").

The rate of relapse after initial therapy for OCD is relatively high [15]. Continued therapy with an SSRI may reduce the relapse rate, particularly in patients who required a high dose of the drug to achieve an acute response [26].

Venlafaxine may also be of benefit in OCD. A randomized trial comparing venlafaxine and paroxetine (no placebo arm) in 150 patients found comparable effects on OCD symptoms with the two treatments [27].

Other drugs have been used in combination with SSRIs with variable success. Neuroleptic agents are effective in patients with OCD and coexisting tic-spectrum disorders [28]. In contrast, buspirone and lithium are of little benefit [29,30].



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ta deconné avec ton texte!! meme en français je l aurait pas lu ! :-D

faty_sup a écrit*: je voudrai attirer votre attention sur une maladie encore meconnue pour la majorité des marocains mais qui en touche des milliers ce sont les troubles obsessionnels compulsifs:les TOC est ce que vous avez une idée sur la question????

En fait, c'est un trouble psychiatrique qui se manifeste par le besoin impérieux de répéter des gestes dans le but de diminuer ses angoisses.
En termes peux techniques, c'est à peu prés ce que ça veut dire.
Une forme particuliére et intérressante de cette maladie est dite de "gilles de la tourette".

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le syndrome de gilles latourette c pas un toc quand même !!!
ou j'aurais tout compris de travers?! :-?

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je savais que je divaguais pas


Qu'est-ce que le Syndrome de Gilles Latourette?

C’est un trouble neurologique présentant un désordre du mouvement caractérisé principalement par des tics moteurs et vocaux involontaires, simples ou complexes, stéréotypés, d’intensité variable, qui se développent durant l’enfance et qui peuvent persister toute la vie. Divers symptômes, tels les obsessions/compulsions et l’hyperactivité y sont fréquemment associés. Il s’agit donc d’un désordre neuro-comportemental à caractère nettement organique dont la symptomatologie reste à la limite entre les maladies neurologiques et psychiatriques.

Tu as tout à fait raison.

Je me suis mal exprimé, en fait dans 60% des cas, le Syndrome de gille de la tourette est associé au trouble obsessionnel compulsif, il s'agit en fait d'une comorbidité étonnante dans ce cas précis.

Salut de passage.