The field of obsessive-compulsive MS-275 order disorder (OCD) owes much to French physicians. Pinel (1745-1826) coined the term folie raisonnante; Esquirol (1772-1840) identified monomanie and folie du doute et du toucher. Morel (1886) gave a good semiological description, and Luys (1883) was the first to use the word “obsession” in an article entitled “Des obsessions pathologiques.” Pierre Janet1 (1903)
defined “psychasthenia” and viewed obsessions as the result of diminishing psychic energy Inhibitors,research,lifescience,medical and as a degradation product of higher mental activity. He was also one of the first to describe a pediatric case. For a child psychiatrist trained 30 years ago, OCD in children was an infrequent encounter. Most clinical discussions revolved around the Freudian theory of neurotic anal regression secondary to an unresolved (Edipal conflict (although Freud postulated a certain predisposition), as outlined in the famous Rat Man case (S. Freud2) and specific defense mechanisms, such as affect isolation, Inhibitors,research,lifescience,medical reaction
formation, retroactive annulation, pathological doubts, and rituals (A. Freud3). Much was said, and taught, about the psychodynamic treatment of this disorder in younger patients, and accounts of such therapies were published, even if the results were equivocal in the long run. For older adolescents, clinicians debated the role of obsessive-compulsive Inhibitors,research,lifescience,medical manifestations as a prodromal symptom of schizophrenia, and there were anecdotal accounts of much older Inhibitors,research,lifescience,medical adults with severe obsessions, resistant
to all known treatments, who in the 1940s and 1950s had neurosurgical procedures such as frontal lobotomy. The late 1960s and early 1970s saw the introduction of the first specific drug therapies for adults such as phenelzine and, most importantly, clomipramine. Inhibitors,research,lifescience,medical At the same time, the first behavioral treatments appeared, and were developed and studied in later years. In the late 1980s, fluoxetine was released and quickly recognized as a powerful antiobsessional drug. It is worthy of note that in 1942, Berman,4 in an article on obsessive-compulsive neurosis in children, reviewed the psychodynamic theories on the subject, giving an account of few cases; a prevalence of 0.02% was Bay 11-7085 found in 2800 children admitted between 1935 and 1939, at the Bellevue Hospital in New York. It is with the pioneering work of Judith Rapoport5 at the National Institute of Mental Health (USA) in the early 1970s, trying the thenunreleased drug clomipramine on adolescents with severe OCD, that serious research began. As related in the introduction of her book, The Boy Who Couldn’t Stop Washing,5 the fact that over 50% of adults with OCD had the first manifestations of their illness during childhood and adolescence emphasized the great importance of such work.