Jean Cottraux
Hopital Neurologique
59 boulevard Pinel, 69394, LYON
Tel: 04 72 11 80 65, Fax: 04 72 35 73 30, E-mail : cottraux@univ-lyon1.fr
Résumé
La validation et l'analyse factorielle de la version française de l'échelle d'attitudes dysfonctionnelles (DAS - forme A) de Weissman et Beck sont présentées. L'étude porte sur deux groupes de sujets : un groupe de sujets dépressifs (n = 100) et un groupe de sujets contrôles (n = 93). Les deux groupes sont comparables en ce qui concerne l'âge et le sexe. L'échelle d'attitudes dysfonctionnelles forme A possède une fidélité et une cohérence interne satisfaisantes. Elle apparaît valide, différenciant les sujets dépressifs des sujets contrôles. ec deux autres questionnaires, l'échelle de désespoir de Beck et le questionnaire des pensées automatiques d'Hollon. Elle est peu satisfaisante avec le Beck 13 et une échelle simple d'évaluation du risque suicidaire (ERSD de Ducher) et pas du tout satisfaisante avec l'échelle de dépression d'Hamilton. L'analyse factorielle met en évidence quatre facteurs se rapportant globalement à la notion de sociotropie/autonomie. Afin d'améliorer les qualités psychométriques du questionnaire en particulier la stabilité, nous proposons une version réduite à 29 items. Les items retenus ont une corrélation supérieure à 0,50 avec l'un des quatre facteurs de l'analyse factorielle.
mots clefs : thérapie cognitive, dépression, cognitions, méthodologie.
Summary :
The French version of Weissman and Beck Dysfunctional Attitudes Scale (fo rm A) was administered to 93 control subjects and to 100 depressed patients in order to test its validity, its reliability and to determine its factorial structure. The two groups were comparable as far as age and sex are concerned. The Dysfunctional Attitudes Scale has a good test retest reliability and a good internal consistency. The DAS (form A) is valid and differenciates depressive patients from control subjects. Validity is satisfactory in relation with other scales assessing depressive cognitions, the automatic thoughts questionnaire and the Hopelessness scale ; it is less satisfactory in relation with Beck 13 scale and a scale assessing the suicidal risk (ERSD) ; it is not at all satisfactory with Hamilton depression scale. The factorial analysis elicits four factors globally reflecting sociotropic-autonomic dimensions. A short version of the DAS is proposed to improve the psychometric properties of the questionnaire. This short version is composed of the 29 items which have tors of the factorial analysis.
Key-words : cognitive therapy, depression, cognitions, methodology.
Summary
Memory processes were compared in 26 patients presenting dsm-3-r obsessive compulsive disorder (ocd) with 20 sex, age and education-matched normal controls. a significant between-group difference was found: visual memory was significantly lower in ocd, whereas no between-group significant differences in verbal memory were observed. a sub-sample of 17 ocd were also compared with the 20 control subjects on an explicit-memory free-recall task and an implicit-memory completion task using neutral, obsessive and guilt-responsibility words to test the effects of an emotional verbal input on memory functioning. no between-group difference was found, suggesting that emotionally-laden words processing did not modify implicit and explicit memory performances.
key words
obsessive compulsive disorder ; verbal memory ; visual memory ; implicit memory ; explicit memory
Summary:
Twenty four DSM-3-R non-depressed obsessive-compulsive (OCD) patients were compared to 21 normal subjects in three lexical decision experiments, to distinguish neutral, obsessive and responsibility words from pseudo-words. Error frequencies were comparable across groups. A significant taboo effect was found in both groups for obsessive and responsibility words. OCD patients did not differ from control subjects in their processing of neutral words and responsibility words. However, OCD patients were significantly ve words. Furthermore, OCD patients processed pseudo-words slower than controls if these were presented in the same experiment as obsessive words. Whereas when mixed with neutral or responsibility words, the performance of OCD patients with pseudo-words was similar to that of control subjects. The level of sub-clinical depression (as apreciated on the HAM-D scale) and psychotropic drugs (such as serotonin reuptake inhibitor) don't modify these results. Lexical decision performances were interpreted in terms of a cognitive disturbance triggered by obsessive stimuli that spreads to a neutral task. These results are compatible with the cognitive model of OCD (Salkovskis, 1985).
Key-words: obsessive compulsive disorder, information processing, taboo word, lexical decision, cognition, serotonin reuptake inhibitor
Summary
Background:
This multicenter study compared a 16-week buspirone treatment with placebo in patients presenting panic disorder with agoraphobia who were also receiving cognitive-behaviour therapy (CBT).
Method
Double-blind was maintained until week 68. Ninety one patients were included; 14 placebo-responders were excluded; 77 patients were randomized; 48 reached week 16 and 41 week 68.
Results:
Baseline variables and rate of drop-outs were comparable in the two groups. At week 16, there was a significant improvement of agoraphobia, panic attacks, and depression in both groups. Generalized anxiety improved only in CBT+buspirone. Between-group comparisons of the change from week 0 to 16 found that CBT+buspirone was significantly better on generalize estionnaire. No significant between-group difference was found on the general criterion of improvement. Female sex and higher avoidance predicted drop-outs. Lower negative expectations regarding medication predicted success in both groups. At week 68, improvement was retained with no significant between-group difference.
Conclusion:
Buspirone significantly enhanced CBT effects on generalized anxiety and agoraphobia in the short term.
Key words : panic attacks, agoraphobia, buspirone, cognitive therapy, behaviour therapy
Abstract:
Background:
Indications for automatic implantable cardioverter defibrillator (AID) are expanding. Nonetheless, one find in some patients a certain d egree of suffering which suggests that prolonged survival after implantation is not always accompanied by high quality of life.
Methods :
A sample of 32 patients (28 males, 4 females) with automatic defibrillator implantation was surveyed to determine the psycho-social benefit resulting from this treatment and the influence of the shock delivery on quality of life. Hamilton anxiety scale, Beck depression inventory (13 item version) and a scale shortened version of MMPI (minimult) were used for psychometric assessment of the psychological state. A 10 item scale of quality of life (AID-QOL) and a global index of quality of life (AID-GIQOL) were especially designed to assess AID tolerance and the effects of its implantation on patient's current well-being.
Results:
Ten patients reached the criteria for a current psychiatric diagnosis according to axis I of the DSM-III-R classification. Compared with the 22 patients without psychiatric illness, they sho of history of psychiatric illness, higher depression, anxiety and MMPI scores and lower AID-QOL and AID-GIQOL scores. Both AID-QOL and AID-GIQOL scores were negatively correlated with anxiety and depression. Comparison of the patients who experienced shock delivery (n=15) with those who did not (n=17), found no statistically significant differences in psychiatric diagnosis frequency, scores on psychometric instruments and quality of life scales. Return to work was related to age but not to shock delivery or a current psychiatric diagnosis.
Conclusion:
The questionnaires provided a simple and reliable measure of quality of life in AID patients. It was sugested that after AID implantation, due to confidence in its protective effects, improved quality of life was observed. Occurence of shocks had no influence on psychological well-being. Both history of psychopathological disorders and current psychiatric illness should be taken into account to predict the benefit /risk ratio of the procedure. To increase AID tolerance and patient's well-being additional psychiatric treatments should be considered in patient exhibiting a current psychiatric illness. Eventually, this research strategy might be useful to identifiy and measure quality of life indicators for future AID clinical trials.
Key words: automatic implantable cardioverter defibrillator, quality of life, behavioral medicine, health psychology.
Abstract
Ten DSM-3-R non-depressed OCD with predominant checking rituals were compared with 10 sex and age-matched controls. Hemispheric and regional cerebral blood flow (rCBF) were measured wi 4 conditions: rest, auditory stimulation with idiosyncratic normal or abnormal obsession, auditory stimulation with neutral verbal stimuli, and rest. Order of neutral and obsessive stimulation was randomized. Higher subjective response to obsessive than to neutral stimulation was found in both groups; subjective response was higher in OCD when obsessive stimulation was presented first. A four-way ANOVA group x stimulation order x hemisphere x condition (neutral or obsessive stimulation) was performed on stimulation minus rest normalized rCBF values. Controls had higher rCBF in the thalamus (p<0.05) and putamen (p=0.050). A trend towards higher rCBF in OCD was found in the superior temporal regions (p<0.07). When neutral stimulation was presented first, rCBF was higher in the caudate region of controls (p=0.031). Obsessive stimulation produced higher rCBF than neutral stimulation in orbitofrontal regions (p<0.05), in both groups. Under obsessive stimulation, superior temp oral and orbitofrontal activities were correlated in OCD but not in controls. Our study suggests specific abnormalities of information processing in basal ganglia and temporal structures of compulsive checkers.
Key words : Brain imaging, functional neuro-anatomy, anxiety disorder, information processing, obsessions, compulsions.
Résumé
Les pensées intrusives et leurs interprétations selon les 3 dimensions de responsabilité, culpabilité et infériorité, sont étudiées chez 35 patients présentant un trouble obsessif-compulsif (TOC) et chez 65 s ouveau questionnaire, le questionnaire des pensées intrusives et de leurs interprétation (QPII) est étudié. Le questionnaire d'interprétation présente trois sous-scores: responsabilité, culpabilité et infériorité. Par rapport aux contrôles, les TOC ont les pensées intrusives beaucoup plus fréquentes; ils ont aussi des interprétations irrationnelles des pensées intrusives beaucoup plus fréquentes. Plus les pensées intrusives sont fréquentes, plus les interprétations irrationnelles sont importantes. Ces interprétations ont lieu dans les trois dimensions de responsabilité, culpabilité et infériorité. L'infériorité est corrélée significativement à l'intensité de la pathologie obsessionnelle (Y-BOCS), mais n'est corrélée ni à l'anxiété ni &agrav e; la dépression. En revanche, la responsabilité et la culpabilité sont significativement corrélées à la pathologie obsessionnelle (Y-BOCS), à la dépression et à l'anxiété. Le QPII a une bonne validité empirique et concurrente, et possède aussi une cohérence interne acceptable. Il mesure essentiellement la fréquence des pensées intrusives et leurs interprétations et différencie ainsi très nettement les TOC des normaux. Les relations entre infériorité, obsessions-compulsions et phobie sociale comorbide sont discutées.
Mots clés: obsessions-compulsions; pensées intrusives; infériorité; responsabilité; culpabilité; modèle cognitif.
Summary
Validation study of the Intrusive Thoughts and their Interpretation Questionnaire (ITIQ). Importance of inferiority in obsess ts and their interpretations of 35 patients with obsessive-compulsive disorder (OCD) and 65 controls are studied with the Intrusive Thoughts and their Interpretation Questionnaire (ITIQ). Compared with the control group, OCD patients had more frequent intrusive thoughts and more irrational interpretations of these thoughts than the control group. The more frequent the intrusive thoughts, the higher the irrational interpretations scores. The frequency of the intrusive thoughts in the ITIQ correlated significantly with the Bouvard's Obsessive Thoughts Checklist (OTC) Marks Compulsive Activity Chek-List (CAC) and Beck Depression Inventory-21 (BDI). The irrational interpretation total score in the ITIQ correlated significantly with the Y-BOCS and Beck Anxiety Inventory. The sub-scale of inferiority correlated with the obsessive-compulsive pathology (Y-BOCS) and not with depression and anxiety. The sub-scales of responsibility and guilt, correlated with the obsessive-compulsive pathology (Y-BOCS), and also with depression and anxiety. The ITIQ showed a good emprirical validity and a reasonably good internal consistency . New research pathways on inferiority and comorbid social phobia in OCD are suggested.
Key words: obsessive-compulsive disorder, cognitive intrusions, inferiority, responsability, guilt, cognitive model.
Abstract :
Background : The change of psychopathological dimensions during treatment of panic disorder is attracting increasing interest.
Methods : A population of subjects experiencing panic disorder with agoraphobia is evaluated with the French version of the factor structure of the Symptom Checklist 90 R (SCL 90 group receiving cognitive behaviour therapy (CBT) combined with buspirone and a group receiving cognitive behaviour therapy combined with placebo.
Results : Comparative analysis of pre- and post-test changes between both groups completing treatment showed that the combination cognitive behaviour therapy plus buspirone provided better results than those in patients who had received cognitive behaviour therapy plus placebo. This difference between treatments did not persist at the 1-year follow-up, since while results had been effectively maintained in the CBT plus buspirone group, the CBT plus placebo group continued to improve significantly for the target dimensions of treatment.
Conclusions : Psychopathological dimensions on the SCL 90 R show that combination of buspirone and cognitive behaviour therapy accelerates the behaviour modification process only in the short term.
Key words : Panic disorder with agoraphobia - Symptom checklist 90 R - Cognitive behaviour therapy - Buspirone - Controlled study - Factor structure.