Hantouche E G, Lancrenon S
Service hospitalo-universitaire de Santé mentale et de Thérapeutique, Centre hospitalier Sainte-Anne, Paris.
Encephale. 1996 May;22 Spec No 1:9-21.
The most common strategy to search for homogenous subgroups of Obsessive-Compulsive Disorder (OCD) patients has been based on the OCD symptoms themselves as a classifying variables. The purpose of this study was to: expand recognition of major clinical OCD subtypes in a large cohort of patients recruited from the national french survey: "Screening-Understanding-Treating OCD"; reproduce preliminary data coming from a US collaborative study on OCD sub-types [Baer L, J Clin Psychiatry, 1994; 55 (3):18-23].
From 731 OCD/OCS (OC disorder or syndromes) patients recruited in the phase 1 of the national french survey, complete collected data on the Y-BOCS Symptom Checklist (YBOCS-CL) were obtained in 615 patients and on the OCD spectrum inventory in 646 patients. Principal components analysis (PCA) was firstly applied on major symptom categories of the YBOCS-CL, and next on each individual symptom. Gender effect on clinical aspects of OCD was also explored by comparative descriptive analysis.
The first PCA on major symptoms categories confirmed the grouping of all categories in three major factors, named as following: Facteur 1 = "Predominantly Compulsive" (loaded with items of symmetry, order, hoarding, repeting, counting, checking); Facteur 2 = "Predominantly Obsessive" (loaded with aggression, violent, religious, sexual obsessions) and Facteur 3 = "Mixed" (with contamination and somatic obsessions and washing compulsions). Our data seemed to be very close to US collaborative study that had found in a sample of 107 OCD patients, the presence of the same three major clinical factors. The second PCA applied on all YBOCS-CL individual items had provided interesting items groupings, suggesting a reorganization and re-labelling of YBOCS-CL symptoms categories. Therefore, a new presentation of the YBOCS-CL can be proposed with a more clinical relevance than the original version. Results from OC spectrum inventory showed high comorbidity rate with many of OCD related disorders. Finally, a gender influence on OC clinical manifestations was observed, especially more severity and higher rate of difficult OC-subtypes in male patients. The french national survey data on OC symptoms sub-typing and clustering showed a "natural" groupings of OC symptom categories which add more validity to the subtypes proposed by ICD-10 (based on syndromal predominance : obsessions, compulsions or mixed). These sub-categories are not part of the DSM III-R, neither of the new version of DSM IV!
寻找强迫症（OCD）患者同质亚组最常用的策略是将OCD症状本身作为分类变量。本研究的目的是：在从法国全国性调查“筛查-理解-治疗强迫症”中招募的大量患者中，扩大对主要临床OCD亚型的认识；重现来自美国一项关于OCD亚型的合作研究的初步数据[Baer L，《临床精神病学杂志》，1994年；55(3):18 - 23]。
从法国全国性调查第一阶段招募的731名OCD/OCS（OC障碍或综合征）患者中，615名患者获得了关于耶鲁布朗强迫症症状检查表（YBOCS - CL）的完整收集数据，646名患者获得了关于OCD谱系量表的数据。主成分分析（PCA）首先应用于YBOCS - CL的主要症状类别，然后应用于每个个体症状。还通过比较描述性分析探讨了性别对OCD临床方面的影响。
对主要症状类别的首次PCA证实所有类别可分为三个主要因素，命名如下：因素1 = “主要为强迫行为”（负载对称、秩序、囤积、重复、计数、检查等项目）；因素2 = “主要为强迫观念”（负载攻击、暴力、宗教、性强迫观念）；因素3 = “混合”（包含污染和躯体强迫观念以及洗涤强迫行为）。我们的数据似乎与美国合作研究非常接近，该研究在107名OCD患者样本中发现了相同的三个主要临床因素。对所有YBOCS - CL个体项目应用的第二次PCA提供了有趣的项目分组，表明YBOCS - CL症状类别需要重新组织和重新标记。因此，可以提出一种比原始版本更具临床相关性的YBOCS - CL新呈现方式。OCD谱系量表的结果显示与许多OCD相关障碍的共病率很高。最后，观察到性别对OC临床表现有影响，特别是男性患者中OC亚型的严重程度更高且困难亚型的发生率更高。法国全国性调查关于OC症状亚型分类和聚类的数据显示了OC症状类别的“自然”分组，这为ICD - 10提出的亚型（基于综合征优势：强迫观念、强迫行为或混合）增加了更多有效性。这些子类别既不是DSM III - R的一部分，也不是新版DSM IV的一部分！
