Résumés
Résumé
Introduction Le trouble obsessionnel compulsif (TOC) est une pathologie psychiatrique chronique et figure parmi les affections psychiatriques les plus fréquentes. Cette étude vise à analyser les habitudes de prescription des psychiatres marocains pour le TOC, à identifier les écarts par rapport aux recommandations internationales et à explorer les différences éventuelles dans les pratiques de prescription en fonction du statut médical (résident ou psychiatre), du secteur d’exercice (public ou privé) et du type d’établissement (CHU ou autre)
Méthodologie Il s’agit d’une étude transversale descriptive et analytique menée auprès de médecins psychiatres et de résidents en psychiatrie au Maroc. Un autoquestionnaire anonyme a été utilisé pour explorer leurs habitudes de traitement du TOC. Les données ont été collectées dans divers établissements de santé, tant publics que privés, entre le 16 janvier et le 24 juillet 2024. Les analyses statistiques ont été réalisées à l’aide du logiciel SPSS afin d’évaluer la conformité des pratiques de prescription avec les recommandations internationales.
Résultats L’étude a inclus 116 participants, la majorité des participants recommandaient un traitement médicamenteux en première intention, principalement des ISRS (92,2 %), tandis que seuls 4,3 % recommandaient la TCC seule. Après l’échec d’un premier ISRS, 35,3 % recommandaient d’essayer un autre ISRS, tandis que les autres préconisaient d’ajouter un antipsychotique ou d’essayer la clomipramine (respectivement 37,9 % et 14,7 %). Les analyses ont montré que les praticiens formés à la TCC étaient plus enclins à la recommander, et des différences significatives ont été observées entre résidents et spécialistes quant à l’utilisation de la clomipramine après un échec thérapeutique.
Conclusion Cette étude souligne des tendances marquées dans les pratiques de traitement du TOC dans notre contexte, mettant en évidence à la fois des concordances et des divergences avec les recommandations internationales. La diffusion et l’adoption des meilleures pratiques de prescription, ainsi que le suivi régulier des schémas thérapeutiques, sont essentiels pour améliorer la prise en charge des patients atteints de TOC et garantir une approche plus conforme aux recommandations internationales.
Mots-clés :
- trouble obsessionnel compulsif,
- traitement,
- psychiatres,
- résidents,
- Maroc
Abstract
Introduction Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition and one of the most common psychiatric disorders. This study aims to analyze the prescribing habits of Moroccan psychiatrists for OCD, identify deviations from international recommendations, and explore potential differences in prescribing practices based on medical status (resident or psychiatrist), practice sector (public or private), and type of establishment (university hospital or other).
Methodology This is a descriptive and analytical cross-sectional study conducted among psychiatrists and psychiatry residents in Morocco. An anonymous self-administered questionnaire was used to explore their treatment habits for OCD. Data were collected from various healthcare facilities, both public and private, between January 16 and July 24, 2024. Statistical analyses were performed using SPSS software to assess the conformity of prescribing practices with international recommendations.
Results The study included 116 participants. The majority of participants recommended a pharmacological treatment as the first-line therapy, primarily SSRIs (92.2%), while only 4.3% recommended CBT alone. After the failure of an initial SSRI, 35.3% recommended trying another SSRI, while others suggested adding an antipsychotic or trying clomipramine (37.9% and 14.7%, respectively). The analyses showed that practitioners trained in CBT were more likely to recommend it, and significant differences were observed between residents and specialists regarding the use of clomipramine after therapeutic failure.
Conclusion This study highlights marked trends in OCD treatment practices in our context, revealing both concordances and discrepancies with international recommendations. The dissemination and adoption of best prescribing practices, as well as regular monitoring of therapeutic regimens, are crucial to improving the management of patients with OCD and ensuring a more guideline-conformant approach.
Keywords:
- obsessive-compulsive disorder,
- treatment,
- psychiatrists,
- residents,
- Morocco
Parties annexes
Bibliographie
- American Psychiatric Association [APA]. (2013). Diagnostic and Statistical Manual of Mental Disorders,5th ed (DSM-5). American Psychiatric Publishing. https://www.psychiatry.org/psychiatrists/practice/dsm
- Baldwin, D. S., Anderson, I. M., Nutt, D. J., Allgulander, C., Bandelow, B., den Boer, J. A., Christmas, D. M., Davies, S., Fineberg, N., Lidbetter, N., Malizia, A., McCrone, P., Nabarro, D., O’Neill, C., Scott, J., van der Wee, N. et Wittchen, H.-U. (2014). Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder : A revision of the 2005 guidelines from the British Association for Psychopharmacology. Journal of Psychopharmacology, 28(5), 403-439. https://doi.org/10.1177/0269881114525674
- Bandelow, B., Allgulander, C., Baldwin, D. S., Costa, D. L. D. C., Denys, D., Dilbaz, N., Domschke, K., Hollander, E., Kasper, S., Möller, H.-J., Eriksson, E., Fineberg, N. A., Hättenschwiler, J., Kaiya, H., Karavaeva, T., Katzman, M. A., Kim, Y.-K., Inoue, T., Lim, L., … Zohar, J. (2023). World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for treatment of anxiety, obsessive-compulsive and posttraumatic stress disorders–Version 3. Part II : OCD and PTSD. The World Journal of Biological Psychiatry, 24(2), 118-134. https://doi.org/10.1080/15622975.2022.2086296
- Bhugra, D., Easter, A., Mallaris, Y. et Gupta, S. (2011). Clinical decision making in psychiatry by psychiatrists. Acta Psychiatrica Scandinavica, 124(5), 403‑411. https://doi.org/10.1111/j.1600-0447.2011.01737.x
- Blanco, C., Olfson, M., Stein, D. J., Simpson, H. B., Gameroff, M. J. et Narrow, W. H. (2006). Treatment of obsessive-compulsive disorder by U.S. psychiatrists. The Journal of Clinical Psychiatry, 67(6), 946-951. https://doi.org/10.4088/jcp.v67n0611
- Bloch, M. H., McGuire, J., Landeros-Weisenberger, A., Leckman, J. F. et Pittenger, C. (2010). Meta-analysis of the dose-response relationship of SSRI in obsessive-compulsive disorder. Molecular Psychiatry, 15(8), 850‑855. https://doi.org/10.1038/mp.2009.50
- Brakoulias, V., Starcevic, V., Albert, U., Arumugham, S. S., Bailey, B. E., Belloch, A., Borda, T., Dell’Osso, L., Elias, J. A., Falkenstein, M. J., Ferrao, Y. A., Fontenelle, L. F., Jelinek, L., Kalogeraki, L., Kay, B., Laurito, L. D., Lochner, C., Maina, G., Marazziti, D., … Fineberg, N. A. (2019). Treatments used for obsessive-compulsive disorder-An international perspective. Human Psychopharmacology, 34(1), e2686. https://doi.org/10.1002/hup.2686
- Brakoulias, V., Starcevic, V., Belloch, A., Dell’Osso, L., Ferrão, Y. A., Fontenelle, L. F., Lochner, C., Marazziti, D., Martin, A., Matsunaga, H., Miguel, E. C., Reddy, Y. C. J., do Rosário, M. C., Shavitt, R. G., Sundar, A. S., Stein, D. J. et Viswasam, K. (2016). International prescribing practices in obsessive-compulsive disorder (OCD). Human Psychopharmacology, 31(4), 319-324. https://doi.org/10.1002/hup.2541
- Chaker, H. (2022, 26 juillet). L’état déprimant de la santé mentale : Seuls 343 psychiatres pour 36 millions de Marocains. Maroc Hebdo. https://www.maroc-hebdo.com/article/sante-mentale-343-psychiatres-maroc
- Clair, A.– H., Trybou, V., Mallet, L., Hantoucle, E. et Morgiève, M. (2022). Comprendre Et Traiter Les TOC. Dans Scribd (3e édition). Dunod. https://fr.scribd.com/document/781808133/Comprendre-Et-Traiter-Les-TOC-Anne-Helene-Clair
- Huppert, J. D., Simpson, H. B., Nissenson, K. J., Liebowitz, M. R. et Foa, E. B. (2009). Quality of life and functional impairment in obsessive-compulsive disorder : A comparison of patients with and without comorbidity, patients in remission, and healthy controls. Depression and Anxiety, 26(1), 39-45. https://doi.org/10.1002/da.20506
- Isomura, K., Nordsletten, A. E., Rück, C., Ljung, R., Ivarsson, T., Larsson, H. et Mataix-Cols, D. (2016). Pharmacoepidemiology of obsessive-compulsive disorder : A Swedish nationwide cohort study. European Neuropsychopharmacology : The Journal of the European College of Neuropsychopharmacology, 26(4), 693-704. https://doi.org/10.1016/j.euroneuro.2016.02.004
- Jacobi, F., Wittchen, H.-U., Hölting, C., Sommer, S., Lieb, R., Höfler, M. et Pfister, H. (2002). Estimating the prevalence of mental and somatic disorders in the community : Aims and methods of the German National Health Interview and Examination Survey. International Journal of Methods in Psychiatric Research, 11(1), 1-18. https://doi.org/10.1002/mpr.118
- Katzman, M. A., Bleau, P., Blier, P., Chokka, P., Kjernisted, K., Van Ameringen, M., Canadian Anxiety Guidelines Initiative Group on behalf of the Anxiety Disorders Association of Canada/Association canadienne des troubles anxieux and McGill University, Antony, M. M., Bouchard, S., Brunet, A., Flament, M., Grigoriadis, S., Mendlowitz, S., O’Connor, K., Rabheru, K., Richter, P. M. A., Robichaud, M. et Walker, J. R. (2014). Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders. BMC Psychiatry, 14 Suppl 1(Suppl 1), S1. https://doi.org/10.1186/1471-244X-14-S1-S1
- Kessler, R. C., Chiu, W. T., Demler, O., Merikangas, K. R. et Walters, E. E. (2005). Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 617-627. https://doi.org/10.1001/archpsyc.62.6.617
- Koran, L. et Simpson, H. B. (2013). Guideline Watch (March 2013) : Practice guideline for the treatment of patients with obsessive-compulsive disorder. APA Pract. Guidel., 1‑22. https://es.aetnabetterhealth.com/content/dam/aetna/medicaid/Obsessive-compulsive%20disorder-Guideline%20Watch_LA.pdf
- Mazzoleni, A., Bhatia, S., Bantounou, M. A., Kumar, N. S., Dzalto, M. et Soiza, R. L. (2023). Clinical practice guidelines on the use of deep brain stimulation for the treatment of obsessive-compulsive disorder : Systematic review. BJPsych Open, 9(5), e148. https://doi.org/10.1192/bjo.2023.539
- National Institute for Health and Care Excellence (NICE). (2013). Obsessive-compulsive disorder : Evidence Update 47. https://www.nice.org.uk/guidance/cg31/documents/cg31-obsessive-compulsive-disorder-ocd-and-body-dysmorphic-disorder-bdd-evidence-update2
- Osland, S., Arnold, P. D. et Pringsheim, T. (2018). The prevalence of diagnosed obsessive compulsive disorder and associated comorbidities : A population-based Canadian study. Psychiatry Research, 268, 137-142. https://doi.org/10.1016/j.psychres.2018.07.018
- Pagano, J., Kyle, B. N., Johnson, T. L. et Saeed, S. A. (2017). Training Psychiatry Residents in Psychotherapy : The Role of Manualized Treatments. The Psychiatric Quarterly, 88(2), 285-294. https://doi.org/10.1007/s11126-016-9476-5
- Patel, S. R., Humensky, J. L., Olfson, M., Simpson, H. B., Myers, R. et Dixon, L. B. (2014). Treatment of obsessive-compulsive disorder in a nationwide survey of office-based physician practice. Psychiatric Services, 65(5), 681‑684. https://doi.org/10.1176/appi.ps.201300192
- Poppe, C., Müller, S. T., Greil, W., Walder, A., Grohmann, R. et Stübner, S. (2016). Pharmacotherapy for obsessive compulsive disorder in clinical practice–Data of 842 inpatients from the International AMSP Project between 1994 and 2012. Journal of Affective Disorders, 200, 89-96. https://doi.org/10.1016/j.jad.2016.04.035
- Roh, D., Jang, K. W. et Kim, C.-H. (2023). Clinical Advances in Treatment Strategies for Obsessive-compulsive Disorder in Adults. Clinical Psychopharmacology and Neuroscience : The Official Scientific Journal of the Korean College of Neuropsychopharmacology, 21(4), 676-685. https://doi.org/10.9758/cpn.23.1075
- Skapinakis, P., Caldwell, D. M., Hollingworth, W., Bryden, P., Fineberg, N. A., Salkovskis, P., Welton, N. J., Baxter, H., Kessler, D., Churchill, R. et Lewis, G. (2016). Pharmacological and psychotherapeutic interventions for management of obsessive-compulsive disorder in adults : A systematic review and network meta-analysis. The Lancet. Psychiatry, 3(8), 730-739. https://doi.org/10.1016/S2215-0366(16)30069-4
- Sookman, D., Phillips, K. A., Anholt, G. E., Bhar, S., Bream, V., Challacombe, F. L., Coughtrey, A., Craske, M. G., Foa, E., Gagné, J.-P., Huppert, J. D., Jacobi, D., Lovell, K., McLean, C. P., Neziroglu, F., Pedley, R., Perrin, S., Pinto, A., Pollard, C. A., … Veale, D. (2021). Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Research, 303, 113752. https://doi.org/10.1016/j.psychres.2021.113752
- Soomro, G. M., Altman, D., Rajagopal, S. et Oakley-Browne, M. (2008). Selective serotonin re-uptake inhibitors (SSRIs) versus placebo for obsessive compulsive disorder (OCD). The Cochrane Database of Systematic Reviews, 2008(1), CD001765. https://doi.org/10.1002/14651858.CD001765.pub3
- Sorsdahl, K., Blanco, C., Rae, D. S., Pincus, H., Narrow, W. E., Suliman, S. et Stein, D. J. (2013). Treatment of anxiety disorders by psychiatrists from the American Psychiatric Practice Research Network. Revista Brasileira De Psiquiatria, 35(2), 136‑141. https://doi.org/10.1590/1516-4446-2012-0978