tDCS Associated With Symptom Provocation in the Management of Patients With Resistant Obsessive Compulsive Disorder

Inclusion criteria

• Patient suffering from OCD evolving for at least 2 years diagnosed according to DSM-V criteria;
• Patient with good insight, defined by a score less than or equal to 18 at the threshold of delusions on the BABS (Brown Assessment of Beliefs Scale) insight scale;
• Absence of a current depressive episode (MADRS score < 21) or suicidal risk (MADRS score item 10 < 3);
• Absence of epileptic pathology;
• Chronic obsessive-compulsive disorder defined by a total YBOCS score > 20, or a subscale score > 15;
• Drug-resistant obsessive-compulsive disorder despite treatment with:

• at least 2 antidepressants of the IRS type at an effective dose and for a sufficient duration
• and/or Behavioral and Cognitive therapy for at least 1 year;
• Therapeutic stability (antidepressants) for more than 12 weeks without significant improvement. This treatment, at a fixed dose, will be maintained during the study;
• Patient aged between 18 and 70 included
• Patient who has given his/her informed consent after having received written information on the planned procedure;
• Patient benefiting from social security or by benefiting through a third party.

Exclusion criteria

• Woman of childbearing age without effective means of contraception (hormonal/mechanical: oral, injectable, transcutaneous, implantable, intrauterine device, or surgical: tubal ligation, hysterectomy, total oophorectomy)
• Pregnant or nursing woman;
• Patient hospitalized under duress (SPDT, SPDRE);
• Patient under guardianship or curatorship;
• Patient with another DSM-V Axis 1 diagnosis (Schizophrenic Disorder, Bipolar Disorder, Substance Abuse or Substance Dependence).

Generalized anxiety disorder, social phobia, nicotine addiction and history of major depressive episodes are not exclusion criteria. Axis I comorbidity will be explored using MINI 5.0.0. ;

• Patient suffering from a current depressive episode;
• Patient at risk of suicide;
• Patient with skin lesions on the scalp;
• History of head trauma;
• Patient with an intracerebral metal object
• Patient with a pacemaker;
• Presence of epileptic pathology;
• Patient in an emergency situation or unable to give personal consent