Obsessional Slowness Syndrom: Nature frequency and influence on clinical picture and response to treatment in obessive-compulsive disorder

Litterature concerning Obsessional Slowness (OS) is still scare and controv ersial about its nature, frequency and psychopathological influence in obse ssive-compulsive disorder (OCD). Objective: To examine in a clinical sample of patients with OCD the availab le data on OS in the literature and to compare with data previously obtaine d in the phase II from the multi-site study on OCD, "Screening-Understandin g-Treating OCD", which was undertaken in 27 centers in France. Method: Systematic comparison of various socio-demographic, clinical, psych ometric parameters and of response to treatment in a cohort of obsessional patients (n = 155 patients suffering from OCD, full criteria of DSM-III-R), divided in two subgroups following the presence and severity of slowness. This cohort was selected to participate to a prospective naturalistic follo w-up during a 12-month period with three psychometric assessment on M0, M6 and M12. Results: The group of "OCD with OS" was significantly characterized by: 1) older current age; 2) Higher global severity (higher scores on OCD scales: CPRS-OC, MOCI); 3) over-representation of obsessions-compulsions related to symmetry-orderliness-counting; 4) higher rate of depressive comorbidity (w ith higher score on MADRS: 29 vs 23, p < 10-4); 5) higher level of associat ed impulsivity (BDS score: 38 vs 32, p = 0.001); 6) greater tendency to aug mented suicidal risk (22% vs 11,4% p = 0.08); 7) prevalence of some prognos tic factors (such as poor insight: 31% vs 17%, p < 10-4; and social anxiety : 72% vs 39%, p < 10-4); 8) negative but non significant impact on response and remission rate to pharmacological treatments (fluoxetine, clomipramine ). Conclusion: These data could argue that Obsessional Slowness (OS) is not a separate syndrom from OCD (as suggested by Rachman in 1974). A wilder conce ption of OS would be more suitable as a "secondary" phenomenon or as a non- specific marker of OCD severity. Moreover, the presence of OS is a testimon y of depressive comorbidity and associated impulsivity within OCD. More stu dies are needed to explore the dynamic and temporal relationships between O S and other dimensions such as depressive retardation and behavioral dyscon trol.