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.

Dreams in obsessive-compulsive disorder: an analysis of semantic and emotional content compared to controls.

OBJECTIVE: We sought to investigate the content of the dreams of obsessive-compulsive outpatients in the light of the following postulate: if dreams play a role in the processing of information and mental storage of events of the day, the dream recollections of obsessive-compulsive disorder (OCD) patients should present evidence of diurnal obsessive or ritual themes. METHOD: On seven successive mornings, immediately after awakening in their home environment, 10 nondepressed OCD patients and 11 controls recorded their recollections of the night's dreams on an audiotape. After randomization of dreams, two judges were asked to carry out a blind evaluation of the emotional characteristics perceptible in these dreams and the presence of obsessive or ritual themes. RESULTS: 47 dreams were collected in the OCD group and 55 in the control group. No differences were found between the two groups regarding anxiety, sadness, the theme of failure, or the presence of obsessive or ritual themes. About 60% of OCD patients and 73% of the control group recounted dreams expressing anxiety, sadness, or failure. Most surprisingly, in the control group as well as in the OCD group, about one-third of subjects presented obsessive or ritual themes in their dreams. CONCLUSION: These data suggest that there is no evident link between diurnal mental activity and the morning recollection of nocturnal dreams regarding anxiety, failure, sadness, and obsessive-compulsive themes.

[Occurrence and management of psychiatric pathology in travelers]. / Survenue et prise en charge de la pathologie psychiatrique du voyageur.

The relationship between mental disorders and travel are complex and multiple. Several clinical patterns can be distinguished. Travel is a key feature in the symptomatology of some psychiatric illnesses. Psychiatric manifestations can be induced by local living conditions in subjects with declared mental illness. Disorders can occur during travel in subjects with no previous history of mental illness. Most subjects have a previous history of mental illness prior to leaving France. Attending physicians should warn patients of the possible risks of traveling and advise them concerning prevention and management. The purpose of this study is to describe the relationship between travel and mental illness and to discuss practical measures for management and medical evacuation.

[Cognitive psychotherapy for depression in adolescents: a new therapeutic perspective]. / Psychothérapie cognitive de la dépression de l'adolescent: nouvelle perspective thérapeutique.

The nosological concept of depression in adolescents is still relatively poorly understood. Clinical expression varies greatly although behavioural disorders and suicidal acts are frequent signs. As an alternative to drug therapy, cognitive psychotherapy appears to be a promising approach offering a structured therapeutic tool applicable within a short period of time. We report the case of a 18-year-old girl who suffered from chronic depression and had attempted suicide several times in spite of previous hospitalization and psychoanalytic therapy. She was successfully treated with 16 sessions of cognitive psychotherapy conducted according to the Beck method in combination with fluvoxamine which had been insufficient given alone. The different phases of the therapeutic approach are discussed during hospitalization then as an out patient. Cognitive psychotherapy is technically feasible treatment for depression in the adolescent and has been demonstrated to be effective in our case.

[Psychotic disorders. Higher incidence during travels in Asia]. / Troubles psychotiques. Fréquence plus élevée lors des voyages en Asie.

Psychiatric disorders in French travellers accounted for 15 to 20 percent of medical repatriations arranged by medical assistance companies. The authors of this study dealt with the cases recorded during a 1-year period by one of these companies, and they analysed the psychiatric episodes in relation to the main features of the subject's journey. These episodes usually occurred in summer and affected young or middle-aged people. More than half of them were psychotic disorders which were significantly more frequent in Asia than elsewhere and were unrelated to drug addiction or anti-malarial prophylaxis. The management of these patients by the medical assistance company has been discussed.