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Biomedical subjects

J Cottraux

Publications and source records attributed to J Cottraux.

At least 19 recordsLinked to original sources
PubMed1998

A meta-analysis of the effects of cognitive therapy in depressed patients.

BACKGROUND: Cognitive therapy (CT) has been studied in 78 controlled clinical trials from 1977 to 1996. METHOD: The meta-analysis used Hedges and Olkin d+ and included 48 high-quality controlled trials. The 2765 patients presented non-psychotic and non-bipolar major depression, or dysthymia of mild to moderate severity. RESULTS: At post-test CT appeared significantly better than waiting-list, antidepressants (P < 0.0001) and a group of miscellaneous therapies (P < 0.01). But, CT was equal to behaviour therapy. As between-trial homogeneity was not met, the comparisons of CT with waiting-list or placebo, and other therapies should be taken cautiously. In contrast, between-trial homogeneity was high for the comparisons of CT with behaviour therapy and antidepressants. A review of eight follow-up studies comparing CT with antidepressants suggested that CT may prevent relapses in the long-term, while relapse rate is high with antidepressants in naturalistic studies. CONCLUSION: CT is effective in patients with mild or moderate depression.

Adult↗
PubMed1997

Study and course of the psychological profile in 77 patients expressing panic disorder with agoraphobia after cognitive behaviour therapy with or without buspirone.

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 R). Two groups of patients are compared: a 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.

Adult↗
PubMed1996

A controlled positron emission tomography study of obsessive and neutral auditory stimulation in obsessive-compulsive disorder with checking rituals.

Ten nondepressed patients with obsessive-compulsive disorder (OCD) who were characterized by predominant checking rituals were compared with 10 age- and sex-matched control subjects. Hemispheric and regional cerebral blood flow levels (rCBF) were measured with positron emission tomography (H2 15O) across four 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 responses to obsessive than to neutral stimulation were found in both groups; subjective response was higher in OCD patients when obsessive stimulation was presented first. A four-way analysis of variance (group x stimulation order x hemisphere x condition [neutral or obsessive stimulation]) was performed on stimulation minus rest normalized rCBF values. Control subjects had significantly higher rCBF in the thalamus and putamen. A trend toward higher rCBF in OCD patients was found in the superior temporal regions. When neutral stimulation was presented first, rCBF was significantly higher in the caudate region of control subjects. Obsessive stimulation was associated with higher rCBF than neutral stimulation in orbitofrontal regions in both groups of subjects. Under obsessive stimulation, superior temporal and orbitofrontal activities were correlated in OCD patients but not in control subjects. Our study suggests specific abnormalities of information processing in the basal ganglia and temporal structures of compulsive checkers.

Adult↗
PubMed1996

Double-blind comparison of fluoxetine versus clomipramine in the treatment of obsessive compulsive disorder.

There is evidence of the clinical efficacy and safety of clomipramine and the newer selective serotonin reuptake inhibitors (SSRIs) for the treatment of obsessive-compulsive disorder (OCD). In the present study, we have compared the efficacy and safety of 40 mg/day of fluoxetine and 150 mg/day of clomipramine in patients with OCD, diagnosed according to DSM-IIIR. A total of 55 patients entered this 8-week, double-blind controlled study. Efficacy for both drugs was comparable. The primary efficacy criterion, the Y-BOCS Total score, did not show any significant differences between treatment arms. Response rate was higher with clomipramine, using a 25% decrease in Y-BOCS Total score as response threshold, but there were no significant differences between treatment arms using a 35% threshold. Overall safety and tolerability were good for both drugs, being slightly better for fluoxetine.

Adult↗
PubMed1996

Improved appraisal of the quality of life in patients with automatic implantable cardioverter defibrillator: a psychometric study.

BACKGROUND: Patients with an implanted cardioverter defibrillator (ICD) may experience a certain degree of suffering. A sample of 32 patients was surveyed to determine the psychological benefit resulting from this treatment. METHODS: Hamilton Anxiety Scale, Beck Depression Inventory and a shortened version of the Minnesota Multiphasic Personality Inventory were used. A 10-item scale and a global index of quality of life were especially designed to assess cardioverter defibrillator tolerance and the effect of its implantation on patients' current well-being. RESULTS: Both quality of life index scores were negatively correlated with anxiety and depression. Occurrence of shocks had no influence on psychological well-being. CONCLUSIONS: The questionnaires provided a simple and reliable measure of quality of life in ICD patients. Prior to implantation, technical explanations should be accompanied by stress management techniques adapted to the patients' psychological background.

Adaptation, Psychological↗
PubMed1996

[The role of psychotherapy in managing panic disorder].

This general presentation reviews briefly the various psychotherapies proposed for panic attacks and agoraphobia treatment. Cognitive-behaviour therapy (CBT) is the only validated therapy. Behavioural model of agoraphobia and cognitive model of panic attacks are detailed. The main techniques are described. The results of controlled studies and meta-analyses demonstrate that CBT represents an alternative to anxiolytics and antidepressants. CBT is a brief form of therapy (10-20 sessions) which has been compared with waiting list, placebo, relaxation, antidepressants, anxiolytics or supportive therapy. Four meta-analyses agree on that in vivo exposure is a core element of the treatment of panic attacks and agoraphobia. They demonstrate also that agoraphobia is more difficult to treat than panic attacks in which placebo effect is quite powerful. Cognitive therapy centered on panic attacks demonstrated a significant effectiveness in controlled studies. CBT facilitates benzodiazepines withdrawal. Combination of in vivo exposure with high doses of benzodiazepines is counter-productive in the long term. Controlled studies are favorable to the combination of CBT with imipramine, SSRI (paroxetine, fluvoxamine) or buspirone. But the positive effects of these combinations are only found in the short term. CBT possesses the advantage of stable long term effects.

Agoraphobia↗
PubMed1995

Visual memory impairment in patients with obsessive-compulsive disorder: a controlled study.

Memory processes were compared in 26 patients presenting DSM-III-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 significant between-group differences in verbal memory were observed. A subsample 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 word processing did not modify implicit and explicit memory performances.

Adult↗
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

Behavioral psychotherapy applications in the medically ill.

Behavioral psychotherapy may promote physical health and treat some behavior-linked medical conditions. Prevention of risk factors, and relapse through self-management, the development of a healthy life-style and the possibility to use its technology in the community at a relatively low cost are emphasized. Controlled studies suggest its effectiveness in cardiovascular diseases, headaches, stuttering, alcoholism, pain and bulimia nervosa. Cancer, psychoneuroimmunology and AIDS are under investigation. Psychogeriatrics in an emerging field. More basic research is needed to establish firmly the theoretical underpinnings of behavioral medicine including a cognitive component and to extend its practice to medical staff.

Behavior Therapy↗
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↗
PubMed1988

[Evaluation using DSM-III of the clinical activity of a psychiatry department at a general hospital].

The DSM-III multiaxial classification was used to evaluate the one-year clinical activity of a psychiatry and medical psychology department in a general hospital. Compared to the general population, the patients (n = 1,071) corresponded to a sample of professionally active subjects in which top and middle executives as well as students were over=represented. Fifty-one per cent of the patients suffered from anxiety or affective disorders, while 9 per cent presented somatoform disorders. Histrionic and dependent personalities were more frequent in women. Thirty six per cent of the subjects had a concurrent physical illness. Psychosocial stress and altered adaptation were higher in unemployed people and in patients with physical illness. Specific diagnostic and socioprofessional patterns corresponded to the various types of mental care: psychoanalytically oriented psychotherapy, behaviour therapy, psychopharmacological treatments, consultation-liaison, pain consultation.

Adult↗