OBSESSIVE-COMPULSIVE DISORDER - 11/09/11
Résumé |
Obsessive-compulsive disorder (OCD), the fourth most common psychiatric disorder,72 is a chronic and heterogeneous condition characterized by sudden, recurrent upsetting cognitions that intrude into consciousness (obsessions), and rule governed acts that the person feels driven to perform (compulsions). Recognizable descriptions of OCD symptomatology are found in the fifteenth-century religious documents on demonology and seventeenth-century observations on abnormally intense religious scruples. Equivalent descriptions of obsessions were reported in the eighteenth and nineteenth centuries by authors, such as Hartley (“fixed and recurrent ideas” in 1774); Esquirol (“reasoning monomanias or partial deliria” in 1838); Krafft-Ebing (“obsessive representation” in 1867); Griesinger (“ruminative sickness” in 1868), and Legrand du Saule (“touching madness” in 1875).1
In the modern era, substantial advances have been made in the recognition and treatment of OCD. Nonetheless, the mechanisms by which treatments confer their beneficial effects as well as the cause and pathophysiology of OCD remain incompletely understood.
As described in other sections of this issues, the hypothesis of basal ganglia involvement in OCD stems, in part, from the description of obsessive-compulsive symptoms (OCS) or OCD in several neurologic disorders known to affect basal ganglia structures, such as postencephalitic parkinsonism62 (see elsewhere in this issue), Sydenham's chorea118 (see elsewhere), Huntington's disease33 (see elsewhere), Tourette's syndrome111 (see elsewhere), and lesions in the neostriatum150 and globus pallidus.76 Findings from neuroimaging research (see elsewhere) provide additional evidence supporting a role for corticostriatal pathways in the pathophysiology of OCD.
In this article, we provide a review of the epidemiology and phenomenology of OCD, as well as an overview of relevant neurobiologic research and a summary of effective treatment strategies.
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Address reprint requests to Euripedes C. Miguel, MD, PhD, Instituto de Psiquiatria do Hospital das Clinicas de Faculdade de Medicina da USP, Rua Ovidio Pires de Campos s/n°, São Paulo, SP; CEP: 05403–010; Brasil Supported in part by a grant from Fundação de Amparo à Pesquisa do Estado de Sø Paulo (FAPESP) (grant: 95/5012–7; 96/11991–0; 96/7525–0) and Conselho Nacional de Desenvolvimento Científico e Technológico (CNPq) (grant: 521369/96–7) to Dr. Miguel. Dr. Rauch is supported in part by grants from the National Institute of Mental Health (MH01215) and the National Alliance for Research on Schizophrenia and Depression. Dr. Jenike receives support from the David Judah Research Fund. |
Vol 20 - N° 4
P. 863-883 - décembre 1997 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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