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Les Troubles Obsessionnels Compulsifs Et Leur Prise En Charge

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Les Troubles Obsessionnels Compulsifs Et Leur Prise En Charge UNIVERSITÉ DE NANTES FACULTÉ DE PHARMACIE _________________________________________________________________________________________________________________ ANNÉE 2011 N° THÈSE pour le DIPLÔME D’ÉTAT DE DOCTEUR EN PHARMACIE par Charlotte PAVAGEAU Présentée et soutenue publiquement le 14 juin 2011 Les troubles obsessionnels compulsifs et leur prise en charge. Quel rôle pour le pharmacien d’officine ? Président : M. Alain Pineau, Professeur de Toxicologie Membres du jury : Mme Nicole Grimaud, Maître de Conférences de Pharmacologie M. Jean-Marie Vanelle, Professeur de Psychiatrie Mme Hélène Marinucci, Pharmacien SOMMAIRE REMERCIEMENTS ....................................................................... Erreur ! Signet non défini. LISTE DES ABREVIATIONS .................................................................................................. 3 INTRODUCTION ...................................................................................................................... 4 Partie 1 : Les Troubles Obsessionnels Compulsifs: .............................................................. 5 1) Historique ........................................................................................................................... 6 2) Définitions .......................................................................................................................... 7 A- Selon le DSM IV : ...................................................................................................... 7 B- Selon la CIM-10 ......................................................................................................... 8 3) Données épidémiologiques ................................................................................................ 9 4) Hypothèses physiopathologiques ..................................................................................... 10 A- Hypothèse génétique ................................................................................................ 10 1) Etudes chez les jumeaux .................................................................................... 10 2) Etudes familiales ................................................................................................ 11 3) Gènes impliqués ................................................................................................. 12 B- Hypothèse neurobiologique ...................................................................................... 12 1) Système sérotoninergique .................................................................................. 12 2) Système dopaminergique ................................................................................... 16 3) Autre hypothèse .................................................................................................. 17 C- Hypothèse neuroanatomique .................................................................................... 17 D- Hypothèse infectieuse : les TOC Pandas .................................................................. 20 5) Clinique ............................................................................................................................ 21 A- Les obsessions .......................................................................................................... 21 B- Les compulsions ....................................................................................................... 23 C- L’évitement .............................................................................................................. 24 D- Catégorisation du TOC par la clinique ..................................................................... 24 1) Les sujets dits ruminateurs ................................................................................. 24 2) Les sujets dits laveurs ......................................................................................... 24 3) Les sujets dits vérificateurs ............................................................................... 25 4) Les sujets qui recherchent l’ordre, la symétrie ou la perfection ......................... 25 5) Les sujets dits collectionneurs ou accumulateurs ............................................... 25 6) Les sujets dits procrastinateurs ........................................................................... 25 E- Le TOC chez l’enfant et l’adolescent ....................................................................... 26 6) Comorbidité ..................................................................................................................... 27 A- Dépression ................................................................................................................ 27 B- Phobie sociale ........................................................................................................... 28 C- Les troubles des conduites alimentaires –TCA ........................................................ 28 D- Schizophrénie ........................................................................................................... 28 E- Syndrome Gilles de la Tourette ................................................................................ 29 F- Troubles bipolaires ................................................................................................... 29 G- Troubles de personnalité .......................................................................................... 30 7) Diagnostic et évaluation ................................................................................................... 30 A- Diagnostic différentiel .............................................................................................. 31 1) Anxiété généralisée ............................................................................................ 31 2) Phobies ............................................................................................................... 31 3) Etat de stress post-traumatique ........................................................................... 31 4) Spectre des troubles associés au TOC ................................................................ 32 B- Evaluation ................................................................................................................. 34 1) L’inventaire de Leyton (LOI) ............................................................................. 34 2) L’inventaire des obsessions compulsions de Maudsley Moci............................ 35 3) L’échelle de Yale-Brown ................................................................................... 35 4) La liste des activités compulsives (compulsive activity checklist ou CAC) ...... 36 5) L’inventaire de Padoue (the Padua inventory) ................................................... 37 6) L’échelle d’évaluation des 4 Rituels cibles (four target rituals) ........................ 37 7) L’inventaire des croyances reliées aux obsessions (IRCO) ............................... 38 8) La liste des pensées obsédantes (LPO) .............................................................. 38 9) L’échelle d’évaluation des obsessions ............................................................... 38 BILAN ...................................................................................................................................... 39 Partie 2 : La prise en charge des TOC ................................................................................. 40 1) Prise en charge médicamenteuse .................................................................................. 42 A- Antidépresseurs ........................................................................................................ 42 1) Antidépresseurs tricycliques .............................................................................. 42 2) Inhibiteurs sélectifs de la recapture de la sérotonine .......................................... 45 3) Inhibiteurs sélectifs de la recapture de la sérotonine et de la noradrénaline ...... 51 4) Mirtazapine ......................................................................................................... 52 5) Association d’antidépresseurs ............................................................................ 53 B- Neuroleptiques ......................................................................................................... 53 1) Halopéridol ......................................................................................................... 54 2) Rispéridone ......................................................................................................... 55 3) Olanzapine .......................................................................................................... 55 4) Aripiprazole ........................................................................................................ 57 C- Anxiolytiques ........................................................................................................... 58 1) Clonazépam ........................................................................................................ 58 2) Buspirone ........................................................................................................... 58 D- Autres Alternatives ................................................................................................... 59 1) Lithium ............................................................................................................... 59 2) Inhibiteurs de la mono-amine oxydase
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