[Psychotherapy of obsessivecompulsive disorder]. / Psychothérapie du trouble obsessionnel-compulsif.

Psychotherapy of obsessive-compulsive disorder. Obsessive-compulsive disorder (OCD) benefits from the large efficiency of cognitive behavior therapy (CBT). The core technique of CBT consists in repetitive exercices of exposure with response prevention. For the patient, six months to one year daily exercises during one hour per day is the standard ambulatory format. Therapist time devoted to the patient is around 15 to 20 hours, divided into half an hour to one hour sessions. CBT is as much efficient as serotonin reuptake inhibitor (SRI), the major recommended drug treatment of OCD. Significant improvement is observed in 50 to 70 % of patients and remission in 10 to 20% of them. Most patients finally received association of drug and CBT (when available) but stability/improvement in patients treated by CBT appears to be better than in patients treated only by drugs.

Psychothérapie du trouble obsessionnel-compulsif. Le trouble obsessionnel-compulsif (TOC) bénéficie de l'efficacité majeure de la psychothérapie comportementale et cognitive (TCC). L'ingrédient actif indispensable à la TCC est la technique d'exposition avec prévention de la réponse. La TCC du TOC consiste en 6 mois à 1 an de psychothérapie centrée sur des exercices quotidiens. Ceux-ci sont pratiqués environ 1 heure par jour par le patient traité en ambulatoire. Le temps de thérapie pour le thérapeute est d'environ 15 à 20 heures, au cours de séances de 30 minutes à une heure. La TCC du TOC est d'efficacité équivalente à celle des médicaments de référence, les inhibiteurs de la recapture de la sérotonine (IRS) : elle permet d'obtenir l'amélioration du trouble dans 50 à 70 % des cas et sa rémission chez 10 à 20 % d'entre eux. La majorité des patients reçoit à terme l'association médicaments et TCC (lorsque celle-ci est disponible), mais la stabilité/amélioration des patients qui ont bénéficié de la TCC s'avère meilleure que celle des patients seulement sous médicaments.

Trust and acceptance of a virtual psychiatric interview between embodied conversational agents and outpatients.

Virtual agents have demonstrated their ability to conduct clinical interviews. However, the factors influencing patients' engagement with these agents have not yet been assessed. The objective of this study is to assess in outpatients the trust and acceptance of virtual agents performing medical interviews and to explore their influence on outpatients' engagement. In all, 318 outpatients were enroled. The agent was perceived as trustworthy and well accepted by the patients, confirming the good engagement of patients in the interaction. Older and less-educated patients accepted the virtual medical agent (VMA) more than younger and well-educated ones. Credibility of the agent appeared to main dimension, enabling engaged and non-engaged outpatients to be classified. Our results show a high rate of engagement with the virtual agent that was mainly related to high trust and acceptance of the agent. These results open new paths for the future use of VMAs in medicine.

Virtual human as a new diagnostic tool, a proof of concept study in the field of major depressive disorders.

Embodied Conversational Agents (ECAs) are promising software to communicate with patients but no study has tested them in the diagnostic field of mental disorders. The aim of this study was 1) to test the performance of a diagnostic system for major depressive disorders (MDD), based on the identification by an ECA of specific symptoms (the MDD DSM 5 criteria) in outpatients; 2) to evaluate the acceptability of such an ECA. Patients completed two clinical interviews in a randomized order (ECA versus psychiatrist) and filled in the Acceptability E-scale (AES) to quantify the acceptability of the ECA. 179 outpatients were included in this study (mean age 46.5 ± 12.9 years, 57.5% females). Among the 35 patients diagnosed with MDD by the psychiatrist, 14 (40%) patients exhibited mild, 12 (34.3%) moderate and 9 (25.7%) severe depressive symptoms. Sensitivity increased across the severity level of depressive symptoms and reached 73% for patients with severe depressive symptoms, while specificity remained above 95% for all three severity levels. The acceptability of the ECA evaluated by the AES was very good (25.4). We demonstrate here the validity and acceptability of an ECA to diagnose major depressive disorders. ECAs are promising tools to conduct standardized and well-accepted clinical interviews.

Validation of the French version of the Acceptability E-scale (AES) for mental E-health systems.

Despite the increasing use of E-health systems for mental-health organizations, there is a lack of psychometric tools to evaluate their acceptability by patients with mental disorders. Thus, this study aimed to translate and validate a French version of the Acceptability E-scale (AES), a 6-item self-reported questionnaire that evaluates the extent to which patients find E-health systems acceptable. A forward-backward translation of the AES was performed. The psychometric properties of the French AES version, with construct validity, internal structural validity and external validity (Pearson's coefficient between AES scores and depression symptoms on the Beck Depression Inventory II) were analyzed. In a sample of 178 patients (mean age=46.51 years, SD=12.91 years), the validation process revealed satisfactory psychometric properties: factor analysis revealed two factors: "Satisfaction" (3 items) and "Usability" (3 items) and Cronbach's alpha was 0.7. No significant relation was found between AES scores and depression symptoms. The French version of the AES revealed a two-factor scale that differs from the original version. In line with the importance of acceptability in mental health and with a view to E-health systems for patients with mental disorders, the use of the AES in psychiatry may provide important information on acceptability (i.e., satisfaction and usability).