Présentations amnésiques des troubles obsessionnels compulsifs - 17/02/08
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Nous rapportons les observations de 3 patients consultant dans un centre de mémoire. Les trois patients présentaient un trouble obsessionnel compulsif (TOC) comprenant toujours des vérifications cognitives dont ils ne parlèrent pas d'emblée et qui n'avaient jamais été pris en charge. Deux des patients avaient un récit qui posait la question d'un diagnostic différentiel neurologique tel que celui d'épilepsie temporale ou celui d'ictus amnésique. Une patiente se présenta avec des doutes quant à son fonctionnement mnésique. Les patients obtenaient des résultats normaux dans le bilan neuropsychologique en dehors d'un score dans le premier rappel libre de la Grober et Buschke en dessous de la norme. Deux des patients expliquèrent que ce rappel avait été perturbé par leur vérification cognitive. Une patiente présenta un comportement inhabituel dans la tâche d'évocation lexicale de noms d'animaux en produisant ses réponses par ordre alphabétique et révéla ainsi son fonctionnement cognitif. Le résultat des tests neuropsychologiques nous paraît devoir être interprété quantitativement et qualitativement pour ne pas passer à côté d'un diagnostic peu rapporté dans les consultations de mémoire, car probablement sous-estimé.
Amnesic presentations of the compulsive obsessional confusions (about 3 patients appearing in a consultation of memory) |
Disorders or complaints of memory are a frequent cause of consultation in depression, major anxiety and psychiatry disease with personality disorders. We report 3 patients with obsessive compulsive disorder (OCD), without diagnosis and treatment, examined in a specialized memory consultation. They always had OCD with cognitive checking. Diagnosis of transient global amnesia and temporal complex seizure were discussed in 2 cases. Psychometric impairment only was observed in first free recall of a verbal memory task and was no specific. Behavioural during testing seemed to be very important to analyse. First, a 49-year-old man consulted because he had stereotyped transient amnesia lasted one minute, 2 or 3 times a week, since 6 months. He was a teacher. Transient amnesia always occurred during lessons. Suddenly he didn't know where he was or what he was speaking about. Episodes lasted one minute. After them, he had no confusion and no difficulty in concentration but intense anxiety. In an another hand, when he was in his car, after lessons, he could forget where he was during some minutes. CT scan and EEG were normal. Neuropsychological tests only objectived impairment in first free recall of Grober and Buschke's words. Patient explained that he could not prevent to check responses. He told us checking obsessive compulsive disorder during since long time ago. We discussed clear differences which existed between seizure and ruminations or preoccupations. Secondly, a 55-year-old woman was afraid of her memory performances. She was medical secretary and had no problem in her work but she would like a memory consultation to reassure herself. She was neither depressed nor anxious. She presented curious production in fluency task. She had to produce as many animals's names as possible : she could say 35 names which was an excellent performance but only in alphabetic order ! Neuropsychological tests objectived impairment in her first free recall of Grober and Buschke's words. She tried in her first free recall to remember words in alphabetic order. She explained how she was bound to range everything in alphabetic order ! She had a lot of rituals. She thought that she had an obsessive compulsive disorder but never consulted about this. The observation illustrated suspiscions about memory operations which could be observed in patients group with obsessive compulsive disorders. Finally, a 62-year-old man told us that he had presented a transient global amnesia during 4 hours. He had an important appointment and was upset about that. He didn't go to it and wandered in his flat. He always asked the same questions and forgot everything. He had no neurological deficit. He was anxious, sad and cried several times. He perfectly remembered the episod and thought that he had a panic attack ! Verbal memory tests only objectived difficulties in his first free recall of Grober and Buschke words as the two others patients. He had a story of obsessive compulsive disorder with checking and rituals. In this observation, we discussed clear differences which existed between panic attacks and global transient amnesia. We analyzed patterns of neuropsychological performances which illustrated clinical features of obsessive compulsive disorder. These three patients impaired in their first free recall of verbal memory task. It is not a specific result. We observed during psychometric evaluation, strategic processing which impaired episodic memory : patients tried to check their performances. Memory complaints only were observed in checking obsessive compulsive disorder. It is a difficulty or a doubt about memory capacities. Difficulties could be due to particular cognitive processes who pertubate normal memory capacities.
Mots clés : Attaques de panique , Ictus amnésique , Mémoire , Troubles obsessionnels compulsifs.
Keywords:
Memory
,
Obsessive-compulsive disorder (OCD)
,
Panic attack
,
Partial seizure
,
Transient global amnesia.
Plan
© 2002 Elsevier Masson SAS. Tous droits réservés.
Vol 28 - N° 2
P. 154-159 - avril 2002 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.
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