The asthenia issue in obsessive-compulsive disorder [II problema della astenia nel disturbo ossessivo-compulsivo]

One of Pierre Janet's most important clinical intuition was to correlate the concept of psycho-asthenia to the complexity of obsessive patients and its nuclear role in obsessive-compulsive psychopathology. Clinical experience suggests that patients affected by Obsessive-Compulsive Disorder show a great sensitivity to fatigue or lack of rest: this vulnerability condition seems to have a specific effect, because all weakness states may worsen obsessions and compulsions. Starting from these considerations and from few and aspecific existing instruments, we elaborated a questionnaire to assess obsessive- compulsive characteristics-related asthenia. The questionnaire includes 31 items assessing different aspects of asthenia: fatigue, tiredness, energy, need of sleep, related to an increase of obsessive-compulsive symptoms and was administered to healthy subjects and to patients with different DSM-IV disorders (Obsessive-Compulsive Disorder, Depressive Disorders, Panic Disorder). Statistical and psychopathological analysis show that the instrument discriminates the obsessive patients from healthy individuals and from patients with panic disorder. However, it does not detect differences between Obsessive-Compulsive Disorder and Mood Disorders, suggesting, for the former, a primary weakness of cortical function and for the latter weakness of the subcortical areas.