Comparison of DBS Targets in Obsessive-compulsive Disorder

Inclusion criteria :

• Age 18 - 60

• OCD according to DSM IV, at least 5 years since diagnosis

• Severe OCD responsible for a clinically significant and objective alteration of psychosocial functioning and suffering: YBOCS score>25, CGI score >= 4 and EGF score <= 40

• Resistance of OCD to at least 3 antidepressants from the serotonin reuptake inhibitors category, including clomipramine, given for at least 12 weeks with doses of at least 80mg/d for fluoxetine, 300mg/d for fluvoxamine, 200mg/d for sertraline, 60mg/d for paroxetine and citalopram, 250mg/d for clomipramine). Plus resistance to each of these 3 antidepressant associated first to risperidone or pimozide for a month then to Lithium carbonate, clonazepam, buspirone or pindolol for a month

• Resistance to at least 2 behavioural and cognitive therapies conducted by as many different specialists, following validated protocols (e.g. exposition and prevention of response)

• Oral and written knowledge of French

• Social security coverage

• Written consent of the patient after clear description of the study

Exclusion criteria :

• cognitive alteration with PM38 score < IQ85

• Other axis 1 disorder according to DSM IV, excepted, global anxiety disorder, social phobia, nicotine dependance, and antecedent of major depressive episodes

• suicidal risk >=2 on item 10 of MADRS (Montgomery Asberg Depression Rating Scale)

• Personality disorder (axis 2 of DSM IV assessed using the SCID II)

• Contra indication to MRI, abnormal brain MRI, other severe intercurrent disease

• Fertile woman without adequate contraception

• Pregnancy

• Forced psychiatric hospitalisation

• Any kind of legal protection