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Although melancholy has been the focus of a large number of studies, this has not been the case for mania and even less for the passage from melancholy to mania, more particularly the passage from a depressive state to a self-triumphant state, the latter expression being used by Freud to characterize states of self-induced excitement or elation. On the basis of the specific pathological model of the passage from melancholy to mania, the present study has therefore attempted to determine the underlying metapsychological processes for what are commonly termed cyclic disorders or changes of mood, the dynamics of which is connected with the types of interaction between the various elements within the psychic system. The theoretical approach that has been adopted is essentially psychoanalytical, and in parallel to Freud’s analysis of this state, we are already able to delineate the context in which cyclic disorders occur: it consists of an “interior theatre”, and on its stage the self in its relation to the ideal self which continues to play the same role as it had previously assumed in its relation to the exterior object, i.e. before it had incorporated the exterior object and allowed it to take its place. The self thus finds itself in the position of the object confronted with its ideal self, and the omnipotence of the latter henceforth determines the course of their relations.Melancholy and mania are thus related to the same “complex” and their metapsychological difference lies in the fate of the introjected object: if in the case of melancholy the object has taken over the role assumed by the self, what has become of the self in the manic state? In the present study, the hypothesis proposed is that of committing an intrapsychic act, an indefinitely perpetrated crime, i.e. the act of murdering the object constructed on the basis of a working model of mourning which requires that the mourner “strikes a fatal blow” for a second time in order to actively confirm the subject’s own satisfaction at remaining alive. However, the state of manic exhaltation, just like the state of melancholic depression, is linked to the conflict between the self and its ideal self and to the law of an alter ego that is always as cruel toward a mythical lost object which remains a cause of irrepressible nostalgia. [Copyright &y& Elsevier]

Nowadays, there is a huge contrast between the scarcity of French-speaking publications concerning early-onset obsessive compulsive disorder and the prevalence of this illness according to the most recent publications. We present herein the epidemiological and clinical results of a vast national survey called “ABC-TOC” from which we extracted the complete data emanating from 36 children and adolescent aged from 6 to 15 years old.This study reveals that obsessive compulsive disorder in this age group is characterised by the plurality of many obsessions and concomitant compulsions whose evolution remains unstable and fluctuating, and is often marked by irritability and conduct disorders in the foreground. Moreover, there is an outstanding comorbid pathology: bipolar disorder (17.4% of the patients) preceded by a cyclothymic temperament, which is strongly related to a high suicidal risk: more than one third of the subjects of this study had suicidal ideations and 3 of them (9.7%) have attempted suicide several times since the OCD onset. [ABSTRACT FROM AUTHOR]

Background : Clinical data is largely focused on depressive comorbidity in OCD. However in practice, treating resistant or severe OCD sufferers revealed many cases who seem to have an authentic OCD with a hidden comorbid bipolar disorder.Methods : The rate of bipolar comorbidity in OCD was analyzed in a epidemiological survey which we undertook among the members of the French Association of patients suffering from OCD (AFTOC in French). To explore mood comorbidity, we used structured self-rated questionnaires for major depression, hypomania and mania (DSM-IV criteria) and self-rated Angst’s checklist of Hypomania and Cyclothymic Temperament (developped by Akiskal and Hantouche). From a total sample of 780, 453 files (58 %) were returned and analyzed : 76 % had suffered from a major depression (83 % recurrent) and 17 % had attempted suicide.Results : According to DSM-IV definitions of hypomania/mania, 11 % of the total sample were classified as bipolar (3 % as BP-I and 8 % as BP-II). However, 20 % had been recognized as bipolar or cyclothymic before the survey and treated with mood stabilizers. Furthermore, the Hypomania Checklist of Angst showed that 30 % obtained a cut-off score = 10. Analysis on the self-rated questionnaire for Cyclothymic Temperament showed that 50 % scored = 10, and so classified as BPII1/2. Both thresholds for self-rated hypomania and cyclothymia were previously validated by Hantouche et al. (1998). Finally, our analyses showed that anger attacks and suicide behavior were mainly linked to comorbid bipolarity.Conclusion : These data extend clinical research on “bipolar OCD” entity which is largely under-recognized in clinical practice. Also, they implicate cyclothymia in hostility and suicide risk in this population. [Copyright &y& Elsevier]