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Biomedical subjects

M Bouvard

Publications and source records attributed to M Bouvard.

At least 37 records · Page 2Linked to original sources
PubMed1995

A controlled study of cognitive behaviour therapy with buspirone or placebo in panic disorder with agoraphobia.

BACKGROUND: This multicentre study compared a 16-week buspirone treatment with placebo in patients presenting with panic disorder with agoraphobia and also receiving cognitive behaviour therapy (CBT). METHOD: Double-blind testing was maintained until week 68, but not tested; 91 patients were included; 14 placebo-responders excluded; 77 patients randomised; 48 reached week 16 and 41 reached week 68. RESULTS: At week 16, within-group analysis showed significant improvements in agoraphobia, panic attacks, and depression in both groups. Generalised anxiety improved only in CBT+buspirone. Between-group comparisons showed buspirone to have an effect on generalised anxiety and agoraphobia. Changes in degree of agoraphobia and depression were correlated in subjects on CBT+buspirone only. A significantly higher proportion of women, and of subjects showing high avoidance dropped out. Positive expectations regarding medication predicted success in both groups. At week 68, improvement was retained without significant buspirone effect. CONCLUSION: Buspirone enhanced the effects of cognitive behaviour therapy on generalised anxiety and agoraphobia in the short term.

Adolescent↗
PubMed1993

Exposure therapy, fluvoxamine, or combination treatment in obsessive-compulsive disorder: one-year followup.

Sixty outpatients with obsessive-compulsive disorder (OCD, 22 men, 38 women) were randomized to receive 6 months of antiexposure therapy with fluvoxamine (group F), exposure therapy with fluvoxamine (group Fe), or exposure therapy with placebo (group Pe). Patients in group F did not comply with antiexposure therapy, so it was in fact a neutral condition. Patients began with depressed mood (mean Hamilton depression score = 19). Fifty patients were reevaluated at week 8, 44 at week 24 (posttest), 37 at week 48, and 33 at 18 months, 1 year posttreatment (group F, n = 10; group Fe, n = 12; group Pe, n = 11). The three groups improved on rituals and depression. There was a drug effect on rituals at week 8 and on depression at week 24; both these effects disappeared at week 48. The 33 18-month completers had been comparable at baseline to those not followed up, apart from having more severe behavioral avoidance. At 18-month followup, patients as a whole remained improved with no between-group differences; over 80% of the Fe and Pe patients versus 40% of the F patients were not receiving antidepressant treatment (Fe vs. F: p < 0.04; Pe vs. F: p = 0.053; Fe vs. Pe: NS). In OCD fluvoxamine and exposure therapy were synergistic in the short term, and exposure reduced subsequent need for antidepressants in the followup year after they had been stopped.

Adult↗
PubMed1993

[Psychiatric sequelae of diencephalic tumors in children. 3 case reports].

Three cases of behavioral disorders in children previously treated for a diencephalic tumor are reported. In such cases, classical psychiatric evaluation is difficult because reference data on childhood psycho-organic syndromes are lacking. Another complicating feature is that multiple factors contribute to the impairment of social interactions, including maladaptive reactions to disease-related stress, sensory deficits, and cognitive disorders. A structured evaluation should be performed in order to assess the child's behavior, the psychological and educational environment, and impairment of neuropsychological and neurophysiological function.

Adaptation, Psychological↗
PubMed1992

Naltrexone open trial with a 5-year-old-boy. A social rebound reaction.

The neurobiological rationale for an opiate antagonist pharmacotherapy of autism is presented. Naltrexone efficacy in decreasing autistic behaviour and in increasing social-affiliative behaviour was explored in a 5-year-old autistic boy. Naltrexone (0.5 mg/kg 3 times peer week) was effective in immediately decreasing gross motor activity and stereotyped behaviour and caused a delayed increase of crying, smiling and rough-and-tumble play. This single case presents preliminary evidence that a therapeutically valuable rebound reaction is possible and that the human opioid system modulates social-affective processes. The possibility of psychological factors being instrumental in achieving this effect is discussed as being suitable for future clinical trials.

Attention Deficit Disorder with Hyperactivity↗
PubMed1990

A controlled study of fluvoxamine and exposure in obsessive-compulsive disorder.

DSM-3 obsessive-compulsive out-patients were randomly assigned to fluvoxamine with antiexposure (F), fluvoxamine with exposure (Fe), or placebo with exposure (Pe) for 24 weeks. Of 65 patients offered treatment 60 entered the trial, 50 reached week 8, 44 completed treatment to week 24, and 37 reached follow up to week 48. On average the patient had depressed mood (mean Hamilton depression rating scale = 19). Drop-out numbers, clinical status and behavioural measures were comparable across groups. Most F patients did not do antiexposure, but Fe and Pe patients complied in doing exposure. All three groups improved in rituals and depression from week 0 to week 24 and 48, with a slight but non-significant superiority for combined treatment up to week 24. At week 8 there was a drug between-group effect on rituals, but not on depression. At week 24 there was a drug between-group effect on depression, but not on rituals. The drug superiority was short-lived. At week 48 there was no between-group difference in rituals or depression. Depression was related to ritual outcome at week 24 in F, and tended to be so in Fe.

Adult↗
PubMed1990

[Menstrual pneumothorax and pelvic endometriosis. Discussion of pathogenesis].

The authors report a new case of menstrual pneumothorax and pelvic endometriosis which was discovered at this time. In this case (because of the presence of lesions suggesting the condition on thoracotomy) the probable mechanism thought to cause this pneumothorax would be the cyclical shedding of pleural endometriotic lesions. The authors review the characteristics of this unusual syndrome and base their review on an analysis of the hundred cases reported in the literature. They show that there are two theories of pathogenicity classically held. The first is the existence of congenital gaps in the diaphragm which allow air to pass into the pleura during the periods, the other is the possibility of endometriotic pleural lesions damaging the cortex of the lung as they shed their cells during the period.

Adult↗
PubMed1984

Abnormal dexamethasone suppression test in primary obsessive-compulsive patients: a confirmatory report.

The dexamethasone suppression test (DST) was administered after baseline cortisol measurements in 20 patients (10 males, 10 females) who met DSM-III criteria for obsessive-compulsive disorder (OCD). Six patients (30%) showed an abnormal escape from dexamethasone suppression. DST suppressors vs. DST nonsuppressors showed no differences on age, rate of secondary depressive disorders, or scores on the Hamilton Rating Scale for Depression, the Minnesota Multiphasic Personality Inventory D scale, or OCD rating scales. Surprisingly, there was a trend for suppressors to have a stronger family history of depressive disorders, and for nonsuppressors to include an excess of male subjects. Moreover, there was a significant correlation between levels of cortisol before and after DST. In five of six nonsuppressors, both depressive symptoms and obsessive-compulsive behaviors showed a diminution in response to antidepressant therapy combined, in one case, with intensive behavior therapy. The relationships between OCD and endogenous depression, as well as the specificity of the DST, are discussed.

Adolescent↗
PubMedDate not supplied

Validation of the French translation of the agoraphobic cognitions questionnaire.

BACKGROUND: The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). METHODS: Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. RESULTS: The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. CONCLUSIONS: These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9-20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.

Adult↗
PubMedDate not supplied

A randomized controlled trial of cognitive therapy versus intensive behavior therapy in obsessive compulsive disorder.

BACKGROUND: The study was designed to compare cognitive therapy (CT) with intensive behavior therapy (BT) in obsessive-compulsive disorder (OCD) and to study their change process. METHODS: Sixty-five outpatients with DSM-4 OCD were randomized into 2 groups for 16 weeks of individual treatment in 3 centers. Group 1 received 20 sessions of CT. Group 2 received a BT program of 20 h in two phases: 4 weeks of intensive treatment (16 h), and 12 weeks of maintenance sessions (4 h). No medication was prescribed. RESULTS: Sixty-two patients were evaluated at week 4, 60 at week 16 (post-test), 53 at week 26 and 48 at week 52 (follow-up). The response rate was similar in the 2 groups. The Beck Depression Inventory (BDI) was significantly more improved by CT (p = 0.001) at week 16. The baseline BDI and Obsessive Thoughts Checklist scores predicted a therapeutic response in CT, while the baseline BDI score predicted a response in BT. At week 16, only the changes in Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and a scale measuring the interpretation of intrusive thoughts correlated in CT, while the changes in Y-BOCS, BDI, and interpretation of intrusive thoughts correlated in BT. Improvement was retained at follow-up without a between-group difference. The intent-to-treat analysis (last observation carried forward) found no between-group differences on obsessions, rituals and depression. CONCLUSIONS: CT and BT were equally effective on OCD, but at post-test CT had specific effects on depression which were stronger than those of BT. Pathways to improvement may be different in CT and BT. The outcomes are discussed in the light of an effect size analysis.

Adult↗
PubMedDate not supplied

[The evaluation of perceived responsibility among obsessive-compulsive patients].

Although many authors agree that excessive responsibility is associated with Obsessive-Compulsive Disorder (OCD), some believe that the manifestations of responsibility are more easily observed among patients suffering from checking compulsions (36, 42). This study compares a group of obsessive-compulsive patients that have been sub-divided into three groups (washers, checkers, ruminators) with a group of normal volunteers that are healthy with regards to responsibility. The sample consisted of 58 adults who meet diagnostic criteria for OCD and 20 normal individuals. During an individual interview, a clinician administered the ADIS III-R (section on OCD) as well as other instruments in order to precise the diagnosis. The participants then filled out questionnaires that assess symptoms, responsibility, perfectionism and general functioning. The results confirm that OC patients obtain higher scores than the normal group with regards to responsibility. However, no significant difference was found between the three sub-groups of OC patients. Thus, it seems to be pertinent of consider excessive responsibility as a characteristic of OC clients, for checkers and washers, as well as ruminators.

Adult↗
PubMedDate not supplied

[Preliminary studies of the structured diagnostic interview for personality disorders: SCID II].

The aim of the study was to compare control subjects and consultant patients with the SCID II (interview and questionnaire), then to compare clinical diagnosis with the SCID II (interview and questionnaire). The preliminary study was carried out to assess the feasibility of the procedure. This appraisal was conducted with a group of patients (n = 26) and a control group (n = 16). Only the patients were diagnosed according to DSM IV criteria. The patients and the control group completed the Mini-Mult and the SCID II (questionnaire and interview). The two groups were matched on sex, age and educational level. The two groups were discriminated on all Mini-Mult scales but one: the internalization index. The results showed that the SCID questionnaire and the SCID interview differentiate the two groups. The SCID questionnaire showed high sensitivity in the group of patients. It is a more efficient instrument to screen control subjects except one personality disorder (obsessive-compulsive). The diagnostic agreement between the clinical diagnosis and the structured interview was poor. However our results are comparable to the other studies.

Adult↗
PubMedDate not supplied

[Social anxiety in patients with social phobia: validation of the Liebowitz social anxiety scale: the French version].

The Liebowitz's Social Anxiety Scale (LSAS) (Liebowitz, 1987) is a rating scale of fear and avoidance in social interaction (12 items) and performance-oriented situations (12 items). This paper present the study of empirical and concurrent validation of the LSAS. Ninety-six patients suffering from social phobia according to DSM IV were included and compared with 64 non-clinical control subjects. Both patients and controls were divided into two sub-groups: the LSAS passation by hetero-evaluation or auto-evaluation. Social phobics had much higher scores on anxiety and avoidance of the LSAS than control subjects, whatever the method. There were no differencies between hetero and auto-evaluation in both groups of patients and non-clinical subjects, either on anxiety or on avoidance. The LSAS correlated better with social anxiety and negative cognition in social situations than with anxiety-depression in social phobics. The French version of the LSAS showed a good empirical and concurrent validity and the scale presents a good sensitivity to change after cognitive behavioral therapy in social phobics.

Adult↗
PubMedDate not supplied

[Validation of a scale for responsibility (Salkovskis Responsibility Scale)].

Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.

Adult↗
PubMedDate not supplied

[A standardized cognitive-behavioural group treatment program for obsessive compulsive disorder: preliminary outcomes].

This study provides preliminary outcome data about the efficacy of a cognitive behavioural group therapy program for obsessive compulsive disorder (OCD). Twenty patients were studied, 19 completed the group and one dropped out (5%), Twelve patients were evaluated at 6 month follow-up (40% of drop-outs). All were outpatients who received a primary DSM IV diagnosis of OCD. All evaluations were performed before and after the beginning of the group. Evaluations involved: 1) one or more face-to-face interviews, 2) scales or questionnaires which are designed to provide information relevant to anxiety (Beck Anxiety Inventory), depression (Beck Depression Inventory), OCD symptoms (YBOCS, four target rituals and four target obsessions) and OCD cognitive measures (Obsessive Beliefs Questionnaire: OBQ). The patients completed a 12-week closed-ended treatment program. The group meets once a week for 3 hours. The first 6 sessions included cognitive therapy and the 6 other sessions focused on behaviour therapy. During the first session of each technique, workbooks are provided and discussed with the patients. During the cognitive treatment of the weekly group, patients apply the cognitive therapy of Salkovskis during the sessions and at home. The therapy focused on challenging OCD appraisals and beliefs through various cognitive techniques. During the 6 last sessions explanations of behavioural therapy techniques are done then the patients practiced in vivo and imaginal exposures and response prevention. Morever, each patient received an exposure homework practice. Then six monthly meeting dates are scheduled and patients are encouraged to carry on homeworks. The sample included 12 women and 8 men and the mean age at intake was 37 (SD=9.33) years. Eighteen of the patients were taking medication for their OCD symptoms before and concurrent with group participation. The sample had a mean education of 15 (SD=3) years. Average symptom duration was 14 (SD=9) years. Significant reduction in YBOCS and obsessive beliefs (OBQ) were observed for subjects following treatment. A repeated measure analysis of variance failed to find a significant difference at post-test in Beck Depression and Anxiety Inventories. On main targets (four target rituals and four target obsessions) of the therapy, there was a change after the introduction of the cognitive therapy. There was no change between the cognitive therapy and the behaviour therapy. The difference was only maintained after the complete program. Extending the duration of the group to behaviour therapy did not enhance eventual outcomes. Clinical impressions suggested that behaviour therapy helped to maintain the results in the long term. The present study also demonstrated that most patients maintained gains made during the group at 6-month follow-up. Maintenance of gains was apparent for both the YBOCS and target symptoms (rituals and obsessions). However, there was no change in depression. At pre-test, the OCD patients had a mean score of 18, which is a mild level. Interestingly, there was a significant difference at 6 months in the Beck Anxiety Inventory. The anxiety level needed more time to decrease than OCD symptoms. Cognitive and behaviour therapy delivered in group was effective in decreasing OCD symptom severity and produced a decrease in all but one of the cognitive measures, the estimation of the threat. The result obtained at the end of the therapy was not sufficient at the follow up. This belief was common in all the anxiety disorders and was not specific of OCD. This clinical study is the first report of a cognitive and behavioural group program for OCD. Despite the limitations of this study, it demonstrates the utility of cognitive behaviour group therapy as an effective and efficient treatment of OCD.

Adolescent↗