Enlentecimiento Obsesivo: Caso clínico y revisión bibliográfica / Obsessional slowness: a clinical case and bibliographic review

Introducción: El Enlentecimiento Obsesivo (EO) es un síndrome caracterizado por un enlentecimiento en la ejecución motora. Se caracteriza por un enlentecimiento conductual, una extrema me-ticulosidad, ausencia de ansiedad prodrómica o disconfort antes, durante o después del comportamiento, con relativa resistencia al mismo, siendo altamente incapacitante.Objetivos: Realizar una revisión bibliográfica del fenómeno del EO en la literatura reciente y mostrar un caso paradigmático aten-dido en nuestro Equipo.Métodos: Se ha realizado un método mixto. Por un lado, de descripción de un paciente diagnosticado de EO y por otro, de re-visión no sistemática mediante la base de datos Pubmed usando la palabra clave: “obsessional slowness”. Se excluyeron los estu-dios de validación de escalas del EO y aquellos estudios en que el EO aparece en otras patologías de manera comórbida como en el síndrome de Tourette, síndrome de Down o enlentecimiento aso-ciado a la depresión. Para la preservación de la confidencialidad y anonimato del paciente, se han modificado aspectos en relación a sus antecedentes biográficos.Resultados: El enlentecimiento obsesivo es una condición nor-malmente secundaria a un Trastorno Obsesivo Compulsivo. Tiene una escasa prevalencia, pero manifiesta casi siempre gravedad y tendencia deterioro. Va asociada a diversas comorbilidades psi-quiátricas (por ejemplo, Trastornos del Espectro Autista y/o Sín-drome de Tourette). Afecta fundamentalmente a hombres y tiene especificidades propias, como la falta de malestar prodrómico, la falta de resistencia subjetiva a la clínica y la presencia de clínica encubierta en ocasiones por las manifestaciones conductuales del enlentecimiento. Discusión Y Conclusiones: El tratamiento ha de ser multitécnico (en la parte más psicológica) y multidisciplinar. En todo caso, se ha de destacar que aún nos falta muchos conocimientos y actualización de los datos disponibles actualmente.(AU)

Introduction: Obsessive Slowness (OS) is a syndrome cha-racterized by a slowing in motor execution. It is characterized by behavioral slowing, extreme meticulousness, absence of prodromal anxiety or discomfort before, during or after the behavior, with rela-tive resistance to it, being highly incapacitating.Objectives: To carry out a bibliographic review of the OS phe-nomenon in the recent literature and to show a paradigmatic case treated in our Team.Methods: A mixed method has been carried out. On the one hand, a description of a patient diagnosed with OE and on the other, a non-systematic review using the Pubmed database using the keyword: “obsessional slowness”. Validation studies of OS scales and those studies in which OS appears in other comorbid patho-logies such as Tourette’s syndrome, Down’s syndrome or depres-sion-associated slowing were excluded. For the preservation of the confidentiality and anonymity of the patient, aspects in relation to his biographical background have been modified.Results: Obsessive slowing is a condition usually secondary to Obsessive Compulsive Disorder. It has a low prevalence, but al-most always manifests severity and a tendency to deterioration. It is associated with various psychiatric comorbidities (for example, Autism Spectrum Disorders and/or Tourette’s Syndrome). It fun-damentally affects men and has its own specificities, such as the lack of prodromal discomfort, the lack of subjective resistance to symptoms, and the presence of symptoms sometimes hidden by the behavioral manifestations of slowness.discussion and conclusion: The treatment must be multi-tech-nical as psychological therapies and multidisciplinary. In any case, it should be noted that we still lack much knowledge and updating of currently available data.(AU)

Obsessional slowness in obsessive-compulsive disorder: identifying characteristics and comorbidities in a clinical sample.

BACKGROUND: Obsessional slowness (OS) is characterised by debilitating motor slowness during initiation and completion of daily tasks such as washing, dressing, eating or walking. Yet, the clinical features of OS are still poorly understood. METHODS: This study aimed to delineate demographics, comorbid disorders and obsessive-compulsive symptoms (OCS) associated with OS. Cross sectional data from 667 OCD outpatients aged 9-82 years (M = 37.86, SD = 12.78) who underwent comprehensive standardised assessments administered by trained clinicians were analysed. Participants with (n = 189) and without (n = 478) OS were compared and contrasted. RESULTS: Logistic regression revealed that being single, having tics and displaying higher severity of aggression, contamination, symmetry and hoarding symptoms significantly predicted participants having OS. CONCLUSIONS: This is the largest-scale descriptive study of OS, which also provides preliminary evidence that OS may be a more severe form of OCD. Further empirical validation of these findings is required, and future research should focus on developing OS assessment.Key PointsThis was the first large-scale descriptive study of obsessional slowness (OS), that provided preliminary evidence for an OS phenotype within obsessive-compulsive disorderOS is associated with increased severity of aggression, contamination, symmetry and hoarding obsessive-compulsive symptomsIndividuals with OS are more likely to have comorbid tics, suggesting that there may be underlying motor factors contributing to this conditionFuture research would benefit from collecting both qualitative and quantitative data when assessing OS.

Revisiting the Syndrome of "Obsessional Slowness".

BACKGROUND: Obsessional slowness (OS) denotes a rare condition of disablingly slow motor performance. It was originally described in patients with obsessive-compulsive disorder as a "primary" condition; however, subsequent reports have included heterogeneous clinical populations. We wished to reassess patients with this diagnosis at our own institution and also revisit the literature to provide an overview of this condition. METHODS: Clinical documentation and videos of 3 patients diagnosed with OS in the National Hospital for Neurology and Neurosurgery (London, UK) were reviewed. One of the patients was clinically reappraised. A systematic review of published articles with sufficient clinical patient information was also conducted. RESULTS: Our 3 cases were male with symptom onset in adolescence or early adulthood. Motor slowness with poverty of movement and a history of obsessive-compulsive symptoms were characteristic. Poor speech production, bizarre postures, mannerisms, echophenomena, and oculogyric tics were also noted. Dopaminergic imaging was normal in 2 cases. One case had autistic features. Systematic literature review identified 77 further cases. Male preponderance with symptom onset mainly during the second decade and presence of obsessive-compulsive symptoms were noted. Additional motor and neuropsychiatric features were often present. CONCLUSION: The existence of OS as a "primary" condition is doubtful. This diagnosis has been given to characterize different clinical presentations ranging from obsessive-compulsive disorder with motor slowness resulting from covert obsessive-compulsive symptoms to catatonia. Clinicians should be aware of this syndrome to separate it from juvenile parkinsonism and other causes of motor slowness given that diagnostic approaches and treatment strategies differ.