[Washing, checking, and rumination: are the belief domains, obsessions and compulsions specific to OCD subtypes?]. / Laveurs, vérificateurs, ruminateurs: spécificité des croyances dysfonctionnelles, des obsessions et des compulsions?

AIM OF THE STUDY: The aim of the present study is to explore the validity of the Padua inventory and two belief questionnaires: the obsessive beliefs questionnaire (OBQ) and the interpretation of intrusions inventory (III). BACKGROUND: The Padua inventory is a 60-item self-report measurement of obsessive compulsive symptoms that measures both classic compulsive checking and cleaning behaviour as well as various types of obsessions, including impulses. Studies in several countries have provided support for the reliability and validity of the Padua inventory, including Italy, the Netherlands, North America, and the UK. The obsessive beliefs questionnaire assesses belief domains related to obsessive compulsive disorder (OCD): inflated responsibility, importance of thoughts, control of thoughts, overestimation of threat, perfectionism, and intolerance of uncertainty. It consists of 87 items representing dysfunctional assumptions covering these six domains. The interpretation of intrusions inventory consists of 31 items that refer to interpretations of intrusions that have occurred recently. Three of the above domains are represented: importance of thoughts, control of thoughts and responsibility. Data from clinical or non-clinical samples are used to study the factor structure, reliability, and convergent and divergent validity of these two questionnaires. METHODOLOGY: The three questionnaires were administrated to two groups of people as follows: 96 patients with OCD and 53 non-clinical subjects. The patients were selected from Rhone Alpes clinics and hospitals using DSM-IV criteria for diagnosis, prior to treatment. Diagnosis was based on semi-structured interview (MINI) and clinical interview by a trained psychiatrist using DSM-IV criteria. The second aim of the study was to investigate generality and congruence criterion of the subscales of the Padua inventory and beliefs domains in OCD symptom subtypes (rumination, washing, checking). The present study investigates whether specific OCD symptom subtypes are associated with specific symptom subscales and belief domains in an OCD sample. The criteria for categorizing a participant into an OCD symptom subtype was a score greater or equal to 75% of one main ritual. Fifty participants (52%) met these criteria: washing (n=20), rumination (n=16), checking (n=8), hoarding (n=1), perfectionism (n=3), and repeating (n=2). The other 46 subjects formed a non-specific symptom subtype (two or more rituals). Participants in the precision (perfectionism), the hoarding, and repeating symptom subtypes were excluded because of a small sample. RESULTS: The Padua inventory and the two questionnaires OBQ and III discriminated between French OCD and non clinical controls. In the OCD sample, the three subtypes (washers, rumination and checkers) did not differ from each other on total YBOCS score and total Padua score. The "washer" subjects scored higher than both "checker" subjects and subjects with rumination on the washing scale of the Padua inventory. The "checker" subjects scored higher than the two other subtypes on the checking scale. The impaired mental control and urges and worries of losing control scales failed to discriminate between the subjects with rumination and the two other (checking and washing) subtypes. The OBQ total and the six subscale scores failed to discriminate between the three OCD subtypes. These results were replicated with the III. The ANOVAs revealed that the participants in the rumination symptom subtype scored higher only on the importance/control of thoughts of the OBQ-44 than the participants in the checking subtype. Implications for future research are discussed.

Thalamic venous infarction as a cause of subacute dementia.

The clinical picture of deep cerebral vein thromboses (DCVT) usually is acute, combining vigilance disorders, headaches, and focal neurologic deficit. The authors describe a patient who presented with isolated subacute dementia as the sole manifestation of DCVT. In the setting of subacute cognitive deficit, the diagnosis of DCVT must be considered when neuroimaging shows bilateral thalamic changes. Enhanced venous MR angiography is the noninvasive method of choice to ascertain the diagnosis.

Sustained attention in patients with obsessive-compulsive disorder: a controlled study.

Studies on attentional processes in obsessive-compulsive disorder (OCD) have been inconsistent. The present study focused on the question of sustained attention in OCD, using the 'Degraded Stimulus Continuous Performance Test' (DS-CPT) sensitivity index over time. This study included 20 OCD patients and 25 control subjects, comparable in sex, age and educational level. All subjects had a neuropsychiatric structured diagnostic interview, as well as a psychometric battery. The DS-CPT evaluated sustained attention. The sensitivity decrement during DS-CPT was significant in both controls and OCD subjects. Contrary to our expectations, OCD patients did not show a greater decrease in sensitivity over time, compared to controls: thus, OCD patients presented a no more important attention decrease than controls. Controls and OCD subjects became more conservative in their response criteria throughout the DS-CPT test. Comparing OCD with and without pharmacological treatment did not reveal any difference in CPT outcome. Moreover, we observed, in OCD, a positive significant correlation between the Y-BOCS compulsion score and the CPT sensitivity index. A significant negative correlation of the Y-BOCS compulsive score with the CPT false alarm score was also found. In conclusion, OCD patients did not present any disturbance in sustained attention during a task requiring an increased processing load.

[Validation of a scale for responsibility (Salkovskis Responsibility Scale)]. / Etude de validation d'une échelle de responsabilité (Responsability Scale de Salkovskis).

Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.