No description available.

L’objectif de cette étude était de démontrer que le léchage excessif de surface (LES) chez le chien représente un signe clinique d’un trouble digestif sous-jacent plutôt qu’un trouble obsessionnel compulsif. Vingt chiens présentés pour LES (groupe L) ont été divisés en 2 sous-groupes de 10 chiens chacun : L0, sans, et LD, avec des signes cliniques digestifs concomitants. Dix chiens en santé ont été assignés à un groupe contrôle (groupe C). Une évaluation comportementale complète, un examen physique et neurologique ont été réalisés avant un bilan diagnostic gastro-intestinal (GI) complet (hématologie, biochimie, analyse urinaire, mesure des acides biliaires pré et post-prandiaux et de l’immunoréactivité spécifique de la lipase pancréatique canine, flottaison fécale au sulfate de zinc, culture de selles, échographie abdominale et endoscopie GI haute avec prise de biopsies). En fonction des résultats, un interniste recommandait un traitement approprié. Les chiens étaient suivis pendant 90 jours durant lesquels le comportement de léchage était enregistré. Des troubles GI ont été identifiés chez 14/20 chiens du groupe L. Ces troubles GI sous-jacents incluaient une infiltration éosinophilique du tractus GI, une infiltration lymphoplasmocytaire du tractus GI, un retard de vidange gastrique, un syndrome du côlon irritable, une pancréatite chronique, un corps étranger gastrique et une giardiose. Une amélioration >50% en fréquence ou en durée par rapport au comportement de léchage initial a été observée chez une majorité de chiens (56%). La moitié des chiens ont complètement cessé le LES. En dehors du LES, il n’y avait pas de différence significative de comportement (p.ex. anxiété), entre les chiens L et les chiens C. Les troubles GI doivent être considérés dans le diagnostic différentiel du LES chez le chien. / The objective of this study was to characterize excessive licking of surfaces (ELS) in dogs and demonstrate that it can be a sign of underlying gastrointestinal (GI) pathology rather than an obsessive-compulsive disorder. Twenty dogs presented with ELS (L group) were divided in 2 subgroups of 10 dogs each: L0 without and LD with concomitant digestive signs. Ten healthy dogs were assigned to a control group (C group). Behavioral, physical and neurological examinations were performed prior to a complete work-up of the GI system (CBC, serum chemistry panel, urinalysis, assessment of total serum bile acids and canine specific pancreatic lipase immunoreactivity, fecal flotation by zinc sulfate, fecal culture, abdominal ultrasonography and upper GI endoscopy with biopsies). Based on results, appropriate treatment was recommended. Dogs were monitored subsequently for 90 days during which the licking behavior was recorded. Gastrointestinal disorders were identified in14/20 L dogs. Underlying GI disorders included eosinophilic infiltration of the GI tract, lymphoplasmacytic infiltration of the GI tract, delayed gastric emptying, irritable bowel syndrome, chronic pancreatitis, gastric foreign body and giardiasis. Significant improvement (>50%) in frequency or duration of the basal ELS behavior was observed in the majority of dogs (56%). Resolution of ELS occurred in half of the L dogs. Except for ELS, there was no significant difference in the behavior (e.g. anxiety) of L dogs and C dogs. GI disorders should be considered in the differential diagnosis of ELS in dogs

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Obsessive–compulsive disorder (OCD) is a psychiatric condition that is characterized by two main symptom cohorts, namely recurrent inappropriate thoughts (obsessions) and seemingly purposeless repetitive motor actions (compulsions). In 70% of cases, the condition only re–sponds to chronic, but not sub–chronic, high dose treatment with the selective serotonin reup–take inhibitors (SSRIs), such as fluoxetine and escitalopram. This indicates a role for hyposero–tonergic functioning in the primary brain areas involved in OCD, namely the components of the cortico–striatal–thalamic–cortical (CSTC) circuit which include the prefrontal cortex, the basal ganglia, and the thalamus. A number of studies have demonstrated a lower serotonin trans–porter (SERT) availability in OCD patients compared with healthy controls, supporting the hy–pothesis of a hyposerotonergic state in OCD. The current study focuses on the validation of the deer mouse (Peromyscus maniculatus bairdii) model of OCD and builds on previous work done in our laboratory. Deer mice that are bred and housed in confinement naturally develop two main forms of stereotypical behaviour, namely vertical jumping and pattern running. Furthermore, these behaviours can be catego–rized into various levels of severity, namely high (HSB), low (LSB) and non–stereotypic (NSB) cohorts. The seemingly purposeless and repetitive nature of these behaviours mimics the com–pulsions that characterize human OCD and constitutes the basis for the face validity of the model. However, although these two forms of stereotypy seem equally repetitive and persis–tent, stereotypical pattern runners do not complete the required number of cage revolutions per 30 minutes compared to the amount of jumps executed by stereotypical vertical jumpers. As only one set of criteria for the appraisal of the different topographies of deer mouse stereotypy has been applied in previous studies, the matter of whether pattern runners do in fact generate stereotypical behaviour of the same persistent and severe nature as opposed to the behaviour expressed by vertical jumpers, is problematic. Therefore, the first objective of the current study was to develop a new classification system for the appraisal of the different forms of behavioural topographies of deer mice and subse–quently to evaluate whether pattern runners can indeed be categorized into non–, low– and high stereotypical cohorts. After an eight–week behavioural assessment period, deer mice express–ing the two different behavioural topographies could be classified into non–, low– and high stereotypical cohorts (NSB, LSB, and HSB respectively), applying different criteria for each be–havioural topography. Based on the weekly mean stereotypy count generated during three 30–minute intervals of highest stereotypical behaviour over the course of a 12–hour assessment period, HSB pattern runners were found to execute on average 296 cage revolutions per 30 minutes, while HSB vertical jumpers executed an average of 3063 jumps per 30 minutes. This discrepancy between the generated numbers of the different topographies of stereotypy indi–cates that one classification system for the appraisal of both behavioural topographies is indeed inappropriate, and hence requires re–evaluation and validation. As patients with OCD present with a lower central SERT availability compared to healthy controls, the second objective of the study was to determine whether a decrease in SERT den–sity could be demonstrated in HSB animals compared to the NSB and LSB controls. After eight weeks of behavioural assessment, animals were sacrificed and frontal–cortical and striatal SERT binding was performed. HSB deer mice presented with significantly lower striatal, but not fron–tal–cortical SERT availability compared to the [NSB/LSB] control animals (p = 0.0009). As far as it concerns a lower SERT availability in HSB animals and involvement of the CSTC circuitry, this data is congruent with that demonstrated in human OCD and strengthens the construct validity of the model. Although previous studies undertaken in our laboratory demonstrated that deer mouse stereotypy is attenuated after chronic (21–day) fluoxetine administration, OCD only responds to chronic, but not sub–chronic treatment with the SSRIs. The lack of response of deer mouse stereotypy to sub–chronic treatment has not been established and therefore the third study ob–jective was to assess the behavioural effects of sub–chronic (7–day) and chronic (28–day) SSRI treatment on expression of deer mouse stereotypy. Chronic, but not sub–chronic treatment with oral escitalopram (50 mg/kg/day) significantly increased the number of intervals over a 12–hour assessment period during which no stereotypical behaviour were expressed by HSB deer mice (p = 0.0241) and decreased the number of intervals during which high–stereotypical be–haviour were executed (p = 0.0054). Neither chronic, nor sub–chronic treatment significantly affected the behaviour of animals in the [NSB/LSB] cohort. The fact that the model demon–strates a lack of response to sub–chronic treatment with high dose SSRIs, positively contributes to the predictive validity of the deer mouse model of OCD. The results from the current study therefore strengthens the construct and predictive valid–ity of the deer mouse model of OCD and confirm the model’s status as a prominent animal model of OCD. Not only is hyposerotonergic functioning in the CSTC circuitry implicated in the behaviour of HSB animals, but the model also demonstrates selective response to chronic SSRI–treatment - two core characteristics of human OCD. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2012.

Obsessive–compulsive disorder (OCD) is a psychiatric condition that is characterized by two main symptom cohorts, namely recurrent inappropriate thoughts (obsessions) and seemingly purposeless repetitive motor actions (compulsions). In 70% of cases, the condition only re–sponds to chronic, but not sub–chronic, high dose treatment with the selective serotonin reup–take inhibitors (SSRIs), such as fluoxetine and escitalopram. This indicates a role for hyposero–tonergic functioning in the primary brain areas involved in OCD, namely the components of the cortico–striatal–thalamic–cortical (CSTC) circuit which include the prefrontal cortex, the basal ganglia, and the thalamus. A number of studies have demonstrated a lower serotonin trans–porter (SERT) availability in OCD patients compared with healthy controls, supporting the hy–pothesis of a hyposerotonergic state in OCD. The current study focuses on the validation of the deer mouse (Peromyscus maniculatus bairdii) model of OCD and builds on previous work done in our laboratory. Deer mice that are bred and housed in confinement naturally develop two main forms of stereotypical behaviour, namely vertical jumping and pattern running. Furthermore, these behaviours can be catego–rized into various levels of severity, namely high (HSB), low (LSB) and non–stereotypic (NSB) cohorts. The seemingly purposeless and repetitive nature of these behaviours mimics the com–pulsions that characterize human OCD and constitutes the basis for the face validity of the model. However, although these two forms of stereotypy seem equally repetitive and persis–tent, stereotypical pattern runners do not complete the required number of cage revolutions per 30 minutes compared to the amount of jumps executed by stereotypical vertical jumpers. As only one set of criteria for the appraisal of the different topographies of deer mouse stereotypy has been applied in previous studies, the matter of whether pattern runners do in fact generate stereotypical behaviour of the same persistent and severe nature as opposed to the behaviour expressed by vertical jumpers, is problematic. Therefore, the first objective of the current study was to develop a new classification system for the appraisal of the different forms of behavioural topographies of deer mice and subse–quently to evaluate whether pattern runners can indeed be categorized into non–, low– and high stereotypical cohorts. After an eight–week behavioural assessment period, deer mice express–ing the two different behavioural topographies could be classified into non–, low– and high stereotypical cohorts (NSB, LSB, and HSB respectively), applying different criteria for each be–havioural topography. Based on the weekly mean stereotypy count generated during three 30–minute intervals of highest stereotypical behaviour over the course of a 12–hour assessment period, HSB pattern runners were found to execute on average 296 cage revolutions per 30 minutes, while HSB vertical jumpers executed an average of 3063 jumps per 30 minutes. This discrepancy between the generated numbers of the different topographies of stereotypy indi–cates that one classification system for the appraisal of both behavioural topographies is indeed inappropriate, and hence requires re–evaluation and validation. As patients with OCD present with a lower central SERT availability compared to healthy controls, the second objective of the study was to determine whether a decrease in SERT den–sity could be demonstrated in HSB animals compared to the NSB and LSB controls. After eight weeks of behavioural assessment, animals were sacrificed and frontal–cortical and striatal SERT binding was performed. HSB deer mice presented with significantly lower striatal, but not fron–tal–cortical SERT availability compared to the [NSB/LSB] control animals (p = 0.0009). As far as it concerns a lower SERT availability in HSB animals and involvement of the CSTC circuitry, this data is congruent with that demonstrated in human OCD and strengthens the construct validity of the model. Although previous studies undertaken in our laboratory demonstrated that deer mouse stereotypy is attenuated after chronic (21–day) fluoxetine administration, OCD only responds to chronic, but not sub–chronic treatment with the SSRIs. The lack of response of deer mouse stereotypy to sub–chronic treatment has not been established and therefore the third study ob–jective was to assess the behavioural effects of sub–chronic (7–day) and chronic (28–day) SSRI treatment on expression of deer mouse stereotypy. Chronic, but not sub–chronic treatment with oral escitalopram (50 mg/kg/day) significantly increased the number of intervals over a 12–hour assessment period during which no stereotypical behaviour were expressed by HSB deer mice (p = 0.0241) and decreased the number of intervals during which high–stereotypical be–haviour were executed (p = 0.0054). Neither chronic, nor sub–chronic treatment significantly affected the behaviour of animals in the [NSB/LSB] cohort. The fact that the model demon–strates a lack of response to sub–chronic treatment with high dose SSRIs, positively contributes to the predictive validity of the deer mouse model of OCD. The results from the current study therefore strengthens the construct and predictive valid–ity of the deer mouse model of OCD and confirm the model’s status as a prominent animal model of OCD. Not only is hyposerotonergic functioning in the CSTC circuitry implicated in the behaviour of HSB animals, but the model also demonstrates selective response to chronic SSRI–treatment - two core characteristics of human OCD. / Thesis (M.Sc. (Pharmacology))--North-West University, Potchefstroom Campus, 2012.

Estudos evidenciam a eficácia da terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) e para pacientes com transtorno obsessivo-compulsivo (TOC). O processo das terapias em grupo é complexo e apresentam fatores considerados terapêuticos por facilitarem novas aprendizagens. Entretanto, estudos sobre o processo terapêutico de TCCG ainda são escassos. Os objetivos deste estudo foram: avaliar o efeito dos fatores terapêuticos na resposta à TCCG para pacientes com TP e para pacientes com TOC; identificar e relacionar os fatores terapêuticos que ocorrem na TCCG com a fase e as técnicas cognitivo-comportamentais. Trata-se de um ensaio clínico de 12 sessões de TCCG para TP e para TOC. A gravidade dos sintomas foi avaliada antes e depois da TCCG. Em pacientes com TP, utilizou-se a Escala de gravidade do TP (PDSS), a Impressão Clínica Global (CGI), a Hamilton Ansiedade (HAM-A) e o Inventário de Depressão de Beck (BDI). Em pacientes com TOC, a gravidade específica foi avaliada pela Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e pela CGI, bem como pela HAM-A e pelo BDI. O Questionário de Fatores Terapêuticos de Yalom foi aplicado no final de cada sessão para avaliar os 12 fatores: altruísmo, coesão, universalidade, aprendizagem interpessoal-input, aprendizagem interpessoal-output, orientação, catarse, identificação, redefinição familiar, autocompreensão, instilação de esperança e fatores existenciais. O estudo foi aprovado pelo CEP/HCPA (nº 130400). Todos os pacientes assinaram o termo de consentimento livre e esclarecido. A amostra foi composta por 31 pacientes, sendo 16 no grupo do TP com idade média de 36,2(DP=9,98) anos e 15 pacientes no grupo do TOC com idade média de 37,4(DP=11,10) anos. Os fatores terapêuticos totalizaram 192 observações no grupo do TP e 180 no grupo do TOC. Houve melhora significativa da gravidade dos sintomas de ansiedade, depressivos e específicos comparados com a avaliação inicial em ambos os grupos (p<0,001). Oito fatores foram considerados de utilidade significativa para os pacientes ao longo das sessões do grupo do TP. Observou-se interação significativa no grupo dos pacientes com TP entre o efeito do fator reedição familiar na melhora dos sintomas de ansiedade e depressivos. Os fatores existenciais foram significativos com a melhora dos sintomas depressivos e com os específicos do TP verificado pela PDSS. Quanto à CGI no TP, não se verificou interação significativa com nenhum fator terapêutico. No grupo de pacientes com TOC, os fatores considerados mais úteis foram dois. Constatou-se interação significativa no grupo do TOC entre o efeito de nove fatores e a melhora dos sintomas de ansiedade, porém nenhuma interção com sintomas depressivos. Também houve interação significativa entre a melhora dos sintomas obsessivo-compulsivos verificado pela YBOCS com altruísmo, universalidade, aprendizagem interpessoal-input e output, reedição familiar, autocompreensão e fatores existenciais. Quanto à CGI no TOC, houve interação significativa com os fatores aprendizagem interpessoal-input, autocompreensão e fatores existenciais. Os resultados demonstram que fatores terapêuticos de grupo influenciam positivamente a resposta da TCCG para ambos os grupos. Contudo, existem diferenças de efeito a serem consideradas para que haja melhor compreensão do processo terapêutico e aprimoramento da terapia de grupo. / Studies have demonstrated the effectiveness of cognitive-behavioral group therapy (CBGT) for patients with panic disorder (PD) and those with obsessive-compulsive disorder (OCD). The group therapy process is complex and has factors deemed to be therapeutic, in that they facilitate new learning. However, studies on the CBGT therapeutic process are still scarce. The objectives of this study were: assess the effect of therapeutic factors in the response to CBGT of PD patients and OCD patients; identify and relate the therapeutic factors that occur in CBGT with the stage and cognitive-behavioral techniques. This study is a clinical trial involving 12 CBGT sessions for PD and OCD. Severity of symptoms was assessed before and after CBGT. In PD patients, the PD Severity Scale (PDSS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A) and Beck Depression Inventory (BDI) were used. In OCD patients, specific severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), CGI, HAM-A and BDI. Yalom's Curative Factors Questionnaire was administered at the end of each session to evaluate 12 factors, namely: altruism, cohesiveness, universality, interpersonal learning input, interpersonal learning output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope and existential factors. The study was approved by the CEP/HCPA (No. 130400). All patients signed a free and informed consent form. The sample consisted of 31 patients: 16 in the PD group with a mean age of 36.2 (SD=9.98) years and 15 patients in the OCD group with a mean age of 37.4 (SD=11.10) years. The therapeutic factors totaled 192 observations in the PD group and 180 in the OCD group. There was significant improvement in severity of symptoms of anxiety, depression and specific ones, compared to the baseline assessment in both groups (p<0.001). Eight factors were considered to provide significant benefits to patients over the course of the PD group sessions. There was significant interaction in the PD group related to the effect of the family re-enactment factor in improving the symptoms of anxiety and depression. Existential factors were significant in the improvement of depressive symptoms and PD-specific ones as seen with the PDSS. As far as CGI in the PD group, no significant interaction with any therapeutic factor was noted. In the OCD group, two factors were considered to be the most helpful. There was significant interaction in the OCD group between the effect of nine factors and improvement of the symptoms of anxiety. However, no interaction with depressive symptoms was noted. There was also significant interaction between improvement in obsessive-compulsive symptoms as seen with the YBOCS, in terms of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding and existential factors. With respect to CGI in the OCD group, there was significant interaction with the factors of interpersonal learning input, self-understanding and existential factors. The results show that group therapeutic factors positively influence the response to CBGT in both groups. However, there are differences of effect to be considered, in order to better understand the therapeutic process and improve group therapy. / Estudios evidencian la eficacia de la terapia cognitivo-actitudinal en grupo (TCCG) para pacientes con trastorno de pánico (TP) y para pacientes con trastorno obsesivo-compulsivo (TOC). El proceso de las terapias en grupo es complejo y presenta factores considerados terapéuticos por facilitar nuevos aprendizajes. Sin embargo, estudios sobre el proceso terapéutico de TCCG todavía son escasos. Los objetivos de este estudio fueron: evaluar el efecto de los factores terapéuticos en la respuesta a la TCCG para pacientes con TP y para pacientes con TOC; identificar y relacionar los factores terapéuticos que ocurren en la TCCG con la etapa y las técnicas cognitivo-actitudinales. Se trata de un ensayo clínico de 12 sesiones de TCCG para TP y para TOC. La gravedad de los síntomas se la evaluó antes y después de la TCCG. En conjunto con TP, se utilizó la Escala de Gravedad del TP (PDSS), la Impresión Clínica Global (CGI), la Hamilton Ansiedad (HAM-A) y el Inventario de Depresión de Beck (BDI). En pacientes con TOC, la gravedad específica fue evaluada por la Escala Obsesivo-Compulsivo de Yale-Brown (Y-BOCS) y por la CGI, así como por la HAM-A y por el BDI. El cuestionario de factores terapéuticos de Yalom se aplicó al final de cada sesión para evaluar los 12 factores, a saber: altruismo, cohesión, universalidad, aprendizaje interpersonal-input aprendizaje interpersonal- output, orientación, catarsis, identificación, redefinición familiar, autocomprensión, instilación de esperanza y factores existenciales. El estudio lo aprobó el CEP/HCPA (nº 130400). Todos los pacientes firmaron el término de consentimiento libre y aclarado. La muestra estuvo compuesta por 31 pacientes, 16 en el grupo do TP con edad promedio de 36,2(DP=9,98) años y 15 pacientes en el grupo do TOC con promedio de edad de 37,4(DP=11,10) años. Los factores terapéuticos totalizaron 192 observaciones en el grupo del TP y 180 en el grupo del TOC. Hubo mejora significativa de la gravedad de los síntomas de ansiedad, depresivos y específicos comparados con la evaluación inicial en ambos grupos (p<0,001). Ocho factores fueron considerados de utilidad significativa para los pacientes a lo largo de las sesiones del grupo del TP. Se observó interacción significativa en el grupo de los pacientes con TP entre el efecto del factor reedición familiar en la mejora de los síntomas de ansiedad y depresivos. Los factores existenciales fueron significativos con la mejora de los síntomas depresivos y con los específicos del TP verificado por la PDSS. Cuanto a la CGI en el TP, no se verificó interacción significativa con ningún factor terapéutico. En el grupo de pacientes con TOC, los factores considerados más útiles fueron dos. Se constató interacción significativa en el grupo del TOC entre el efecto de nueve factores y la mejora de los síntomas de ansiedad, pero ninguna interacción con síntomas depresivos. También hubo interacción significativa entre la mejora de los síntomas obsesivo-compulsivos verificado por la YBOCS con altruismo, universalidad, aprendizaje interpersonal input y output reedición familiar, autocomprensión y factores existenciales. Cuanto a la CGI en el TOC, hubo interacción significativa con los factores aprendizaje interpersonal input, autocomprensión y factores existenciales. Los resultados demuestran que factores terapéuticos de grupo influyen positivamente la respuesta de la TCCG para ambos grupos. Sin embargo, existen diferencias de efecto a ser consideradas para que haya mejor comprensión del proceso terapéutico y perfeccionamiento de la terapia de grupo.

CARVALHO , Evelyn Benevides. O papel do pai na fobia e na neurose obsessiva: o Pequeno Hans e o Homem dos ratos em Freud e em Lacan. 2006. 151f. Dissertação (Mestrado em Psicologia) – Universidade Federal do Ceará, Departamento de Psicologia, Programa de Pós-Graduação em Psicologia, Fortaleza-CE, 2006. / Submitted by moises gomes (celtinha_malvado@hotmail.com) on 2012-01-06T12:20:39Z No. of bitstreams: 1 2006_dis_EBCarvalho.PDF: 814361 bytes, checksum: 6f41d2cdad2649e2a1c4668261af9ca7 (MD5) / Approved for entry into archive by Maria Josineide Góis(josineide@ufc.br) on 2012-03-08T15:03:08Z (GMT) No. of bitstreams: 1 2006_dis_EBCarvalho.PDF: 814361 bytes, checksum: 6f41d2cdad2649e2a1c4668261af9ca7 (MD5) / Made available in DSpace on 2012-03-08T15:03:08Z (GMT). No. of bitstreams: 1 2006_dis_EBCarvalho.PDF: 814361 bytes, checksum: 6f41d2cdad2649e2a1c4668261af9ca7 (MD5) Previous issue date: 2006-11-24 / This work aims at thinking upon the actions of the father (here understood as father in reality) in his possible contribution in leading the son to an obsessive neurosis or phobia from the relationships that happen in the context of the Oedipal triangulation. As neurosis is a defense strategy in face of castration, which particularities in the desiring relationships could lead to one typical form of defense or another? If the obsessive conflict unfolds eminently in the level of thought and the phobic in the level of reality (in the relationship with the phobic object), what could generate this difference? Aiming at clarifying some aspects of the role of the real father in structuring the child’s neurosis, it is necessary to observe the very development of the paternal function in its real, symbolic and imaginary levels; the relationship of the father with several other elements of the family’s dynamics: the desiring dynamics in the parental couple, the way that each of them relates to the law, the elements that interfere in those relationships, how the circulation of the phallus takes place in each case, among others. We have decided to carry out a bibliographical research and selected the clinical cases ‘Little Hans’ and ‘Rat Man’ as the fundamental basis of our discussion, as we believe that the analysis of what is most particular can unveil universal aspects of each structure. Furthermore, we start from the principle that the Freudian text is not exhausted in its possibilities of surprising us and offering new questions. We utilize the Lacanian contribution (in an initial moment of his teachings) and another reading of those clinical cases. Authors such as Jerusalinsk, Julien, Dor, Ambertín, Gazzola, Melman, among others, are also summoned to enrich our discussion. We investigate the similarities and the differences in the way that the father, in each case, has performed his function, which is dual: restrainer and model of identification, as well as his possible consequences on the subject, the subject’s way of dealing with desire and castration. In phobia, to delimitate and allay the anguish, the subject needs to resort to the phobic object as a supplement to the paternal function that appears in an insufficient form in the relationship mother-son. This object comes to provide limits to the subject’s world, to demarcate points of danger and to serve as support to a series of symbolic-imaginary elaborations which can render possible a meaningful change, as in Hans’ case, in which there was an analytical intervention. In the obsessive neurosis, there is a subject tormented by recurring thoughts and driven to rituals as attempts of protection in face of danger, permanently in conflict with the phallic instance, oscillating between the wish of transgressing it and the devoted submission. A law that, for the obsessive has become difficult to elaborate, perhaps because it has been put in excessive or ambiguous way in the desiring context of the child. In the obsessive, the passage from the ‘being’ to the ‘having’ becomes more problematic due to the message of maternal dissatisfaction in relation to the husband. That makes it difficult to the subject to give up on his imaginary phallic identification, while at the same time he recognizes the existence and fears the instance of the law. As to the phobic, it can be that he has been more at the mercy of maternal desire, without a third instance to protect him of the risk of annihilation. ‘Killing (the father) or dying’ is the obsessive’s impasse. ‘Escaping (the maternal pleasure) is the phobic’s effort. This way, we attempt to bring our contributions, to recognize paradox and leave unanswered some questions that arise along the process and that can serve as a starting point to future research. / Este trabalho tem como objetivo pensar a atuação do pai (entendido, aqui, como pai da realidade), em sua possível contribuição ao encaminhamento do filho para uma neurose obsessiva ou fobia, a partir da relações que acontecem no contexto da triangulação edipiana. Sendo a neurose uma estratégia de defesa frente à castração, que particularidades nas relações desejantes poderiam conduzir a uma ou outra forma típica de defesa? Se a conflitiva obsessiva desenrola-se eminentemente no plano do pensamento; e a fóbica, no plano da realidade (na relação com o objeto fóbico), o que poderia gerar esta diferença? Visando esclarecer alguns aspectos acerca do papel do pai real na estruturação da neurose da criança, é necessário observar o próprio desdobramento da função paterna em seus níveis real, simbólico e imaginário; a relação do pai com diversos outros elementos da dinâmica familiar: a dinâmica desejante no casal parental, a forma como cada um de relaciona com a lei, os elementos que interferem nestas relações, como se dá a circulação do falo em cada caso, dentre outros. Optamos por uma pesquisa bibliográfica e elegemos os casos clínicos ‘Pequeno Hans’ e ‘Homem dos Ratos’ como base primordial de nossa discussão, pois acreditamos que a análise do que é mais particular pode revelar aspectos universais de cada estrutura. Além disso, partimos do princípio de que o texto freudiano não está esgotado em suas possibilidades de nos surpreender e oferecer novos questionamentos. Utilizamos a contribuição lacaniana (em um momento inicial de seu ensino) e sua releitura destes casos clínicos. Autores como Jerusalinsk, Julien, Dor, Ambertín, Gazzola, Melman, dentre outros, também são convocados a enriquecer nossa discussão. Investigamos as semelhanças e diferenças na forma como o pai, em cada caso, cumpriu sua função que é dupla: interditor e modelo de identificação, assim como suas possíveis conseqüências sobre o sujeito, a forma deste lidar com o desejo e a castração. Na fobia, para delimitar e apaziguar a angústia, o sujeito precisa lançar mão do objeto fóbico como suplência para a função paterna que comparece de forma insuficiente na relação mãe-filho. Este objeto vem fornecer limites ao mundo do sujeito, demarcar pontos de perigo e servir de suporte a uma série de elaborações simbólico-imaginárias que podem possibilitar um remanejamento significante, como no caso de Hans em que houve uma intervenção analítica. Na neurose obsessiva, observa-se um sujeito atormentado por pensamentos recorrentes e impelido a rituais como tentativas de proteção frente ao perigo, eternamente em conflito com a instância fálica, oscilando entre o desejo de transgredi-la e a submissão fervorosa. Lei que, para o obsessivo ficou difícil de elaborar, talvez por ter sido colocada de forma excessiva ou ambígua no contexto desejante da criança. No obsessivo, a passagem do ‘ser’ ao ‘ter’ torna-se mais problemática pela mensagem de insatisfação materna em relação ao marido. Isto dificulta o sujeito abrir mão de sua identificação fálica imaginária, ao mesmo tempo em que reconhece a existência e teme a instância da lei. Já o fóbico, pode ter ficado mais a mercê do desejo materno, sem uma instância terceira que o proteja do risco de aniquilamento. ‘Matar (o pai) ou morrer’ é o impasse do obsessivo. ‘Escapar (do gozo materno)’ é o esforço do fóbico. Desta forma, buscamos trazer nossas contribuições, reconhecer paradoxos e deixar em aberto algumas perguntas que se abrem ao longo do processo e que podem servir como ponto de partida para futuras pesquisas.

Estudos evidenciam a eficácia da terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) e para pacientes com transtorno obsessivo-compulsivo (TOC). O processo das terapias em grupo é complexo e apresentam fatores considerados terapêuticos por facilitarem novas aprendizagens. Entretanto, estudos sobre o processo terapêutico de TCCG ainda são escassos. Os objetivos deste estudo foram: avaliar o efeito dos fatores terapêuticos na resposta à TCCG para pacientes com TP e para pacientes com TOC; identificar e relacionar os fatores terapêuticos que ocorrem na TCCG com a fase e as técnicas cognitivo-comportamentais. Trata-se de um ensaio clínico de 12 sessões de TCCG para TP e para TOC. A gravidade dos sintomas foi avaliada antes e depois da TCCG. Em pacientes com TP, utilizou-se a Escala de gravidade do TP (PDSS), a Impressão Clínica Global (CGI), a Hamilton Ansiedade (HAM-A) e o Inventário de Depressão de Beck (BDI). Em pacientes com TOC, a gravidade específica foi avaliada pela Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e pela CGI, bem como pela HAM-A e pelo BDI. O Questionário de Fatores Terapêuticos de Yalom foi aplicado no final de cada sessão para avaliar os 12 fatores: altruísmo, coesão, universalidade, aprendizagem interpessoal-input, aprendizagem interpessoal-output, orientação, catarse, identificação, redefinição familiar, autocompreensão, instilação de esperança e fatores existenciais. O estudo foi aprovado pelo CEP/HCPA (nº 130400). Todos os pacientes assinaram o termo de consentimento livre e esclarecido. A amostra foi composta por 31 pacientes, sendo 16 no grupo do TP com idade média de 36,2(DP=9,98) anos e 15 pacientes no grupo do TOC com idade média de 37,4(DP=11,10) anos. Os fatores terapêuticos totalizaram 192 observações no grupo do TP e 180 no grupo do TOC. Houve melhora significativa da gravidade dos sintomas de ansiedade, depressivos e específicos comparados com a avaliação inicial em ambos os grupos (p<0,001). Oito fatores foram considerados de utilidade significativa para os pacientes ao longo das sessões do grupo do TP. Observou-se interação significativa no grupo dos pacientes com TP entre o efeito do fator reedição familiar na melhora dos sintomas de ansiedade e depressivos. Os fatores existenciais foram significativos com a melhora dos sintomas depressivos e com os específicos do TP verificado pela PDSS. Quanto à CGI no TP, não se verificou interação significativa com nenhum fator terapêutico. No grupo de pacientes com TOC, os fatores considerados mais úteis foram dois. Constatou-se interação significativa no grupo do TOC entre o efeito de nove fatores e a melhora dos sintomas de ansiedade, porém nenhuma interção com sintomas depressivos. Também houve interação significativa entre a melhora dos sintomas obsessivo-compulsivos verificado pela YBOCS com altruísmo, universalidade, aprendizagem interpessoal-input e output, reedição familiar, autocompreensão e fatores existenciais. Quanto à CGI no TOC, houve interação significativa com os fatores aprendizagem interpessoal-input, autocompreensão e fatores existenciais. Os resultados demonstram que fatores terapêuticos de grupo influenciam positivamente a resposta da TCCG para ambos os grupos. Contudo, existem diferenças de efeito a serem consideradas para que haja melhor compreensão do processo terapêutico e aprimoramento da terapia de grupo. / Studies have demonstrated the effectiveness of cognitive-behavioral group therapy (CBGT) for patients with panic disorder (PD) and those with obsessive-compulsive disorder (OCD). The group therapy process is complex and has factors deemed to be therapeutic, in that they facilitate new learning. However, studies on the CBGT therapeutic process are still scarce. The objectives of this study were: assess the effect of therapeutic factors in the response to CBGT of PD patients and OCD patients; identify and relate the therapeutic factors that occur in CBGT with the stage and cognitive-behavioral techniques. This study is a clinical trial involving 12 CBGT sessions for PD and OCD. Severity of symptoms was assessed before and after CBGT. In PD patients, the PD Severity Scale (PDSS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A) and Beck Depression Inventory (BDI) were used. In OCD patients, specific severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), CGI, HAM-A and BDI. Yalom's Curative Factors Questionnaire was administered at the end of each session to evaluate 12 factors, namely: altruism, cohesiveness, universality, interpersonal learning input, interpersonal learning output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope and existential factors. The study was approved by the CEP/HCPA (No. 130400). All patients signed a free and informed consent form. The sample consisted of 31 patients: 16 in the PD group with a mean age of 36.2 (SD=9.98) years and 15 patients in the OCD group with a mean age of 37.4 (SD=11.10) years. The therapeutic factors totaled 192 observations in the PD group and 180 in the OCD group. There was significant improvement in severity of symptoms of anxiety, depression and specific ones, compared to the baseline assessment in both groups (p<0.001). Eight factors were considered to provide significant benefits to patients over the course of the PD group sessions. There was significant interaction in the PD group related to the effect of the family re-enactment factor in improving the symptoms of anxiety and depression. Existential factors were significant in the improvement of depressive symptoms and PD-specific ones as seen with the PDSS. As far as CGI in the PD group, no significant interaction with any therapeutic factor was noted. In the OCD group, two factors were considered to be the most helpful. There was significant interaction in the OCD group between the effect of nine factors and improvement of the symptoms of anxiety. However, no interaction with depressive symptoms was noted. There was also significant interaction between improvement in obsessive-compulsive symptoms as seen with the YBOCS, in terms of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding and existential factors. With respect to CGI in the OCD group, there was significant interaction with the factors of interpersonal learning input, self-understanding and existential factors. The results show that group therapeutic factors positively influence the response to CBGT in both groups. However, there are differences of effect to be considered, in order to better understand the therapeutic process and improve group therapy. / Estudios evidencian la eficacia de la terapia cognitivo-actitudinal en grupo (TCCG) para pacientes con trastorno de pánico (TP) y para pacientes con trastorno obsesivo-compulsivo (TOC). El proceso de las terapias en grupo es complejo y presenta factores considerados terapéuticos por facilitar nuevos aprendizajes. Sin embargo, estudios sobre el proceso terapéutico de TCCG todavía son escasos. Los objetivos de este estudio fueron: evaluar el efecto de los factores terapéuticos en la respuesta a la TCCG para pacientes con TP y para pacientes con TOC; identificar y relacionar los factores terapéuticos que ocurren en la TCCG con la etapa y las técnicas cognitivo-actitudinales. Se trata de un ensayo clínico de 12 sesiones de TCCG para TP y para TOC. La gravedad de los síntomas se la evaluó antes y después de la TCCG. En conjunto con TP, se utilizó la Escala de Gravedad del TP (PDSS), la Impresión Clínica Global (CGI), la Hamilton Ansiedad (HAM-A) y el Inventario de Depresión de Beck (BDI). En pacientes con TOC, la gravedad específica fue evaluada por la Escala Obsesivo-Compulsivo de Yale-Brown (Y-BOCS) y por la CGI, así como por la HAM-A y por el BDI. El cuestionario de factores terapéuticos de Yalom se aplicó al final de cada sesión para evaluar los 12 factores, a saber: altruismo, cohesión, universalidad, aprendizaje interpersonal-input aprendizaje interpersonal- output, orientación, catarsis, identificación, redefinición familiar, autocomprensión, instilación de esperanza y factores existenciales. El estudio lo aprobó el CEP/HCPA (nº 130400). Todos los pacientes firmaron el término de consentimiento libre y aclarado. La muestra estuvo compuesta por 31 pacientes, 16 en el grupo do TP con edad promedio de 36,2(DP=9,98) años y 15 pacientes en el grupo do TOC con promedio de edad de 37,4(DP=11,10) años. Los factores terapéuticos totalizaron 192 observaciones en el grupo del TP y 180 en el grupo del TOC. Hubo mejora significativa de la gravedad de los síntomas de ansiedad, depresivos y específicos comparados con la evaluación inicial en ambos grupos (p<0,001). Ocho factores fueron considerados de utilidad significativa para los pacientes a lo largo de las sesiones del grupo del TP. Se observó interacción significativa en el grupo de los pacientes con TP entre el efecto del factor reedición familiar en la mejora de los síntomas de ansiedad y depresivos. Los factores existenciales fueron significativos con la mejora de los síntomas depresivos y con los específicos del TP verificado por la PDSS. Cuanto a la CGI en el TP, no se verificó interacción significativa con ningún factor terapéutico. En el grupo de pacientes con TOC, los factores considerados más útiles fueron dos. Se constató interacción significativa en el grupo del TOC entre el efecto de nueve factores y la mejora de los síntomas de ansiedad, pero ninguna interacción con síntomas depresivos. También hubo interacción significativa entre la mejora de los síntomas obsesivo-compulsivos verificado por la YBOCS con altruismo, universalidad, aprendizaje interpersonal input y output reedición familiar, autocomprensión y factores existenciales. Cuanto a la CGI en el TOC, hubo interacción significativa con los factores aprendizaje interpersonal input, autocomprensión y factores existenciales. Los resultados demuestran que factores terapéuticos de grupo influyen positivamente la respuesta de la TCCG para ambos grupos. Sin embargo, existen diferencias de efecto a ser consideradas para que haya mejor comprensión del proceso terapéutico y perfeccionamiento de la terapia de grupo.

Estudos evidenciam a eficácia da terapia cognitivo-comportamental em grupo (TCCG) para pacientes com transtorno de pânico (TP) e para pacientes com transtorno obsessivo-compulsivo (TOC). O processo das terapias em grupo é complexo e apresentam fatores considerados terapêuticos por facilitarem novas aprendizagens. Entretanto, estudos sobre o processo terapêutico de TCCG ainda são escassos. Os objetivos deste estudo foram: avaliar o efeito dos fatores terapêuticos na resposta à TCCG para pacientes com TP e para pacientes com TOC; identificar e relacionar os fatores terapêuticos que ocorrem na TCCG com a fase e as técnicas cognitivo-comportamentais. Trata-se de um ensaio clínico de 12 sessões de TCCG para TP e para TOC. A gravidade dos sintomas foi avaliada antes e depois da TCCG. Em pacientes com TP, utilizou-se a Escala de gravidade do TP (PDSS), a Impressão Clínica Global (CGI), a Hamilton Ansiedade (HAM-A) e o Inventário de Depressão de Beck (BDI). Em pacientes com TOC, a gravidade específica foi avaliada pela Escala Obsessivo-Compulsivo de Yale-Brown (Y-BOCS) e pela CGI, bem como pela HAM-A e pelo BDI. O Questionário de Fatores Terapêuticos de Yalom foi aplicado no final de cada sessão para avaliar os 12 fatores: altruísmo, coesão, universalidade, aprendizagem interpessoal-input, aprendizagem interpessoal-output, orientação, catarse, identificação, redefinição familiar, autocompreensão, instilação de esperança e fatores existenciais. O estudo foi aprovado pelo CEP/HCPA (nº 130400). Todos os pacientes assinaram o termo de consentimento livre e esclarecido. A amostra foi composta por 31 pacientes, sendo 16 no grupo do TP com idade média de 36,2(DP=9,98) anos e 15 pacientes no grupo do TOC com idade média de 37,4(DP=11,10) anos. Os fatores terapêuticos totalizaram 192 observações no grupo do TP e 180 no grupo do TOC. Houve melhora significativa da gravidade dos sintomas de ansiedade, depressivos e específicos comparados com a avaliação inicial em ambos os grupos (p<0,001). Oito fatores foram considerados de utilidade significativa para os pacientes ao longo das sessões do grupo do TP. Observou-se interação significativa no grupo dos pacientes com TP entre o efeito do fator reedição familiar na melhora dos sintomas de ansiedade e depressivos. Os fatores existenciais foram significativos com a melhora dos sintomas depressivos e com os específicos do TP verificado pela PDSS. Quanto à CGI no TP, não se verificou interação significativa com nenhum fator terapêutico. No grupo de pacientes com TOC, os fatores considerados mais úteis foram dois. Constatou-se interação significativa no grupo do TOC entre o efeito de nove fatores e a melhora dos sintomas de ansiedade, porém nenhuma interção com sintomas depressivos. Também houve interação significativa entre a melhora dos sintomas obsessivo-compulsivos verificado pela YBOCS com altruísmo, universalidade, aprendizagem interpessoal-input e output, reedição familiar, autocompreensão e fatores existenciais. Quanto à CGI no TOC, houve interação significativa com os fatores aprendizagem interpessoal-input, autocompreensão e fatores existenciais. Os resultados demonstram que fatores terapêuticos de grupo influenciam positivamente a resposta da TCCG para ambos os grupos. Contudo, existem diferenças de efeito a serem consideradas para que haja melhor compreensão do processo terapêutico e aprimoramento da terapia de grupo. / Studies have demonstrated the effectiveness of cognitive-behavioral group therapy (CBGT) for patients with panic disorder (PD) and those with obsessive-compulsive disorder (OCD). The group therapy process is complex and has factors deemed to be therapeutic, in that they facilitate new learning. However, studies on the CBGT therapeutic process are still scarce. The objectives of this study were: assess the effect of therapeutic factors in the response to CBGT of PD patients and OCD patients; identify and relate the therapeutic factors that occur in CBGT with the stage and cognitive-behavioral techniques. This study is a clinical trial involving 12 CBGT sessions for PD and OCD. Severity of symptoms was assessed before and after CBGT. In PD patients, the PD Severity Scale (PDSS), Clinical Global Impression (CGI), Hamilton Anxiety Scale (HAM-A) and Beck Depression Inventory (BDI) were used. In OCD patients, specific severity was assessed using the Yale-Brown Obsessive Compulsive Scale (Y-BOCS), CGI, HAM-A and BDI. Yalom's Curative Factors Questionnaire was administered at the end of each session to evaluate 12 factors, namely: altruism, cohesiveness, universality, interpersonal learning input, interpersonal learning output, guidance, catharsis, identification, family re-enactment, self-understanding, instillation of hope and existential factors. The study was approved by the CEP/HCPA (No. 130400). All patients signed a free and informed consent form. The sample consisted of 31 patients: 16 in the PD group with a mean age of 36.2 (SD=9.98) years and 15 patients in the OCD group with a mean age of 37.4 (SD=11.10) years. The therapeutic factors totaled 192 observations in the PD group and 180 in the OCD group. There was significant improvement in severity of symptoms of anxiety, depression and specific ones, compared to the baseline assessment in both groups (p<0.001). Eight factors were considered to provide significant benefits to patients over the course of the PD group sessions. There was significant interaction in the PD group related to the effect of the family re-enactment factor in improving the symptoms of anxiety and depression. Existential factors were significant in the improvement of depressive symptoms and PD-specific ones as seen with the PDSS. As far as CGI in the PD group, no significant interaction with any therapeutic factor was noted. In the OCD group, two factors were considered to be the most helpful. There was significant interaction in the OCD group between the effect of nine factors and improvement of the symptoms of anxiety. However, no interaction with depressive symptoms was noted. There was also significant interaction between improvement in obsessive-compulsive symptoms as seen with the YBOCS, in terms of altruism, universality, interpersonal learning input and output, family re-enactment, self-understanding and existential factors. With respect to CGI in the OCD group, there was significant interaction with the factors of interpersonal learning input, self-understanding and existential factors. The results show that group therapeutic factors positively influence the response to CBGT in both groups. However, there are differences of effect to be considered, in order to better understand the therapeutic process and improve group therapy. / Estudios evidencian la eficacia de la terapia cognitivo-actitudinal en grupo (TCCG) para pacientes con trastorno de pánico (TP) y para pacientes con trastorno obsesivo-compulsivo (TOC). El proceso de las terapias en grupo es complejo y presenta factores considerados terapéuticos por facilitar nuevos aprendizajes. Sin embargo, estudios sobre el proceso terapéutico de TCCG todavía son escasos. Los objetivos de este estudio fueron: evaluar el efecto de los factores terapéuticos en la respuesta a la TCCG para pacientes con TP y para pacientes con TOC; identificar y relacionar los factores terapéuticos que ocurren en la TCCG con la etapa y las técnicas cognitivo-actitudinales. Se trata de un ensayo clínico de 12 sesiones de TCCG para TP y para TOC. La gravedad de los síntomas se la evaluó antes y después de la TCCG. En conjunto con TP, se utilizó la Escala de Gravedad del TP (PDSS), la Impresión Clínica Global (CGI), la Hamilton Ansiedad (HAM-A) y el Inventario de Depresión de Beck (BDI). En pacientes con TOC, la gravedad específica fue evaluada por la Escala Obsesivo-Compulsivo de Yale-Brown (Y-BOCS) y por la CGI, así como por la HAM-A y por el BDI. El cuestionario de factores terapéuticos de Yalom se aplicó al final de cada sesión para evaluar los 12 factores, a saber: altruismo, cohesión, universalidad, aprendizaje interpersonal-input aprendizaje interpersonal- output, orientación, catarsis, identificación, redefinición familiar, autocomprensión, instilación de esperanza y factores existenciales. El estudio lo aprobó el CEP/HCPA (nº 130400). Todos los pacientes firmaron el término de consentimiento libre y aclarado. La muestra estuvo compuesta por 31 pacientes, 16 en el grupo do TP con edad promedio de 36,2(DP=9,98) años y 15 pacientes en el grupo do TOC con promedio de edad de 37,4(DP=11,10) años. Los factores terapéuticos totalizaron 192 observaciones en el grupo del TP y 180 en el grupo del TOC. Hubo mejora significativa de la gravedad de los síntomas de ansiedad, depresivos y específicos comparados con la evaluación inicial en ambos grupos (p<0,001). Ocho factores fueron considerados de utilidad significativa para los pacientes a lo largo de las sesiones del grupo del TP. Se observó interacción significativa en el grupo de los pacientes con TP entre el efecto del factor reedición familiar en la mejora de los síntomas de ansiedad y depresivos. Los factores existenciales fueron significativos con la mejora de los síntomas depresivos y con los específicos del TP verificado por la PDSS. Cuanto a la CGI en el TP, no se verificó interacción significativa con ningún factor terapéutico. En el grupo de pacientes con TOC, los factores considerados más útiles fueron dos. Se constató interacción significativa en el grupo del TOC entre el efecto de nueve factores y la mejora de los síntomas de ansiedad, pero ninguna interacción con síntomas depresivos. También hubo interacción significativa entre la mejora de los síntomas obsesivo-compulsivos verificado por la YBOCS con altruismo, universalidad, aprendizaje interpersonal input y output reedición familiar, autocomprensión y factores existenciales. Cuanto a la CGI en el TOC, hubo interacción significativa con los factores aprendizaje interpersonal input, autocomprensión y factores existenciales. Los resultados demuestran que factores terapéuticos de grupo influyen positivamente la respuesta de la TCCG para ambos grupos. Sin embargo, existen diferencias de efecto a ser consideradas para que haya mejor comprensión del proceso terapéutico y perfeccionamiento de la terapia de grupo.

L’incertitude est un processus cognitif communément expérimenté lors d’une prise de décision. Dansle trouble obsessionnel-compulsif (TOC), il est excessif et compromet les capacités décisionnelles del'individu.Ce travail avait comme objectif une meilleure compréhension des aspects physiologiques etphysiopathologiques de l’incertitude, au travers d'une double approche, comportementale etélectrophysiologique. Dans un premier temps, nous avons construit une tâche originale qui permetd'exprimer son incertitude au cours d'une prise de décision. Avec cette "tâche d’incertitude", nousavons exploré les relations entre mémoire de travail et incertitude. Nous avons montré que lescapacités de mémoire de travail prédisaient la propension à l'incertitude chez les volontaires sains alorsque l'incertitude était suivie d'une dégradation des performances mnésiques chez les patients TOC.Puis, nous avons trouvé une relation entre capacités mnésiques et incertitude dans une population depatients épileptiques caractérisée par des déficits mnésiques, confirmant ainsi le rôle des capacitésmnésiques dans la survenue de l'incertitude physiologique.Pour l'étude des corrélats neuronaux, nous avons mesuré l'activité électrophysiologique intracérébraledes régions impliquées dans la prise de décision au cours de la tâche d'incertitude, chez des patientsépileptiques pour les structures corticales et chez des patients TOC pour les structures sous-corticales.Nous avons montré que l'incertitude était associée à : 1/ une diminution d’amplitude des potentielsévoqués des régions préfrontales et prémotrices ; 2/ une moindre synchronisation des bandes defréquence alpha et bêta en temps-fréquence ; 3/ une augmentation de l'amplitude des potentielsévoqués dans le noyau sous-thalamique. Nos résultats suggèrent un défaut d'engagement des structurescorticales impliquées dans la prise de décision au cours de l'incertitude. Enfin, notre travail tend àconfirmer le rôle du noyau sous-thalamique dans la physiopathologie du TOC et dans les mécanismessous-tendant l’incertitude pathologique. / Uncertainty is a cognitive process that frequently influences our decisions in everyday life. Inobsessive-compulsive disorder (OCD), the high level of uncertainty usually alters the decision-makingprocess.This work aimed to a better understanding of physiological and pathophysiological aspects ofuncertainty, by exploring its relationships with working memory abilities and its neural correlates. Anoriginal task derived from a delayed matching-to-sample task was created with the possibility toexpress felt uncertainty during decision-making. With this "uncertainty task", we demonstrated thatbaseline working memory abilities predicted the occurrence of uncertainty in healthy individualswhereas uncertainty was followed by a decrease in working memory abilities in OCD patients. Therole of working memory abilities in the occurrence of uncertainty was further confirmed in a clinicalpopulation of epileptic patients suffering from baseline working memory impairments.For the study of the neural correlates of uncertainty, we measured intracerebral local field potentials(LFPs) in regions involved in decision-making during the uncertainty task. Cortical and subcorticalLFPs were obtained in epileptic and OCD patients, respectively. We showed that uncertainty wasassociated with: 1/ a decreased amplitude of evoked responses in cortical prefrontal and premotorregions, 2/ a reduced synchronization of alpha-beta frequency bands in time-frequency analyses, 3/ anincreased amplitude of evoked responses in the subthalamic nucleus. Our findings suggested adiminished cortical activation in uncertain decision-making and confirmed the role of the subthalamicnucleus in OCD pathophysiology and in the mechanisms underlying the occurrence of pathologicaluncertainty.