Hantouche E G, Lancrenon S, Bouhassira M, Ravily V, Bourgeois M L
SYLIA-STAT, Bourg-la-Reine.
Encephale. 1997 Mar-Apr;23(2):83-90.
Relationships between OCD and impulsivity are currently under research.
In the phase 3 of the national study on OCD, 155 patients suffering from an OCD (DSM III-R criteria, score on NIMH-OC > or = 7) had entered a naturalistic follow-up of 12 months duration. Impulsivity was assessed by using the BDS (Behavioral Dyscontrol Scale, offautoquestionnaire of 24 items) at day 0, 6th and 12th months and a semi-structured interview for Obsessive-Compulsive Related Syndrome and Behaviors Spectrum, as defined by Hollander (DSM III-R criteria).
Impulsivity was more intense in females (mean score on BDS 35.6 vs 31.9, p = 0.06), in patients with personal history of anxiety-depression (36.3 vs 32.3, p = 0.04) and suicidal behavior (38.3 vs 33.2, p = 0.06) and familial history of OCD (37.1 vs 33.0, p = 0.07). Moreover, syndromal typology of obsessions or compulsions did not seem to influence impulsivity. In contrast, presence of co-existing OC Related Syndrome was significantly linked to higher impulsivity score, especially with "Intermittent Explosive Syndrome" (mean score = 40.1 vs 30.8, p < 10(-4), "Compulsive Buying" (38.5 vs 32.4, p = 0.005), "Hypochondriasis" (36.7 vs 32.1, p = 0.02), "Dysmorphophobia" (37.1 vs 32.4, p = 0.02) and "Depersonnalization" (37.7 vs 32.9, p = 0.05). Paradoxically, impulsivity was augmented in patients with important to severe slowness syndrome (38.3 vs 31.8, p = 0.001). This mixed association between slowness and impulsivity can be an excellent testimony of "Dyscontrol" phenomenon. In 130 patients who had received an anti-obsessional pharmacologic treatment during 12 months follow-up, impulsivity score was gradually reduced from day 0 (mean score = 34.1) at M6 (24.8-22% reduction) and at M12 (20.1-36% reduction). After one year of follow-up, a decreased by > or = 50% of impulsivity score was observed in 42% of obsessional patients. Finally, the response rate of OCD to pharmacotherapy seemed to be modulated by the dimensions of impulsivity and slowness. In fact, the best results after 6 months of treatment were observed in the sub-groups presenting high level of "impulsivity" (62-66% were responders) versus 39% in the sub-group with important to severe slowness.
强迫症（OCD）与冲动性之间的关系目前正在研究中。
在全国强迫症研究的第三阶段，155名患有强迫症（符合DSM III-R标准，NIMH-OC评分≥7）的患者进入了为期12个月的自然随访。在第0天、第6个月和第12个月使用BDS（行为失控量表，24项自评问卷）评估冲动性，并对由霍兰德定义的强迫相关综合征和行为谱进行半结构化访谈（DSM III-R标准）。
女性的冲动性更强（BDS平均得分35.6对31.9，p = 0.06），有焦虑抑郁个人史的患者（36.3对32.3，p = 0.04）、有自杀行为的患者（38.3对33.2，p = 0.06）以及有强迫症家族史的患者（37.1对33.0，p = 0.07）也是如此。此外，强迫观念或强迫行为的综合征类型似乎不会影响冲动性。相比之下，共存的强迫相关综合征与较高的冲动性得分显著相关，尤其是与“间歇性爆发综合征”（平均得分 = 40.1对30.8，p < 10⁻⁴）、“强迫性购物”（38.5对32.4，p = 0.005）、“疑病症”（36.7对32.1，p = 0.02）、“畸形恐惧症”（37.1对32.4，p = 0.02）和“人格解体障碍”（37.7对32.9，p = 0.05）相关。矛盾的是，在有中度至重度迟缓综合征的患者中冲动性增强（38.3对31.8，p = 0.001）。这种迟缓与冲动性之间的混合关联可以很好地证明“失控”现象。在12个月随访期间接受抗强迫药物治疗的130名患者中，冲动性得分从第0天（平均得分 = 34.1）逐渐降低，在第6个月时（降低24.8 - 22%）和第12个月时（降低20.1 - 36%）。经过一年的随访，42%的强迫观念患者的冲动性得分降低≥50%。最后，强迫症对药物治疗的反应率似乎受冲动性和迟缓程度的调节。事实上，在治疗6个月后，在“冲动性”水平较高的亚组中观察到最佳结果（62 - 66%为反应者），而在有中度至重度迟缓的亚组中为39%。
