[Repeat evaluation of impulsiveness in a cohort of 155 patients with obsessive-compulsive disorder: 12 months prospective follow-up].

UNLABELLED: Relationships between OCD and impulsivity are currently under research.

METHOD: 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).

RESULTS: 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.