Emmanuelle Fresard

Cognitive behavioural therapy for weight gain associated with antipsychotic drugs

BACKGROUND Overweight and obesity are common concerns in individuals with severe mental disorders. In particular, antipsychotic drugs (AP) frequently induce weight gain. This phenomenon lacks current management and no previous controlled studies seem to use cognitive therapy to modify eating and weight-related cognitions. Moreover, none of these studies considered binge eating or eating and weight-related cognitions as possible outcomes. AIM The main aim of this study is to assess the effectivity of cognitive and behavioural treatment (CBT) on eating and weight-related cognitions, binge eating symptomatology and weight loss in patients who reported weight gain during AP treatment. METHOD A randomized controlled study (12-week CBT vs. Brief Nutritional Education) was carried out on 61 patients treated with an antipsychotic drug who reported weight gain following treatment. Binge eating symptomatology, eating and weight-related cognitions, as well as weight and body mass index were assessed before treatment, at 12 weeks and at 24 weeks. RESULTS The CBT group showed some improvement with respect to binge eating symptomatology and weight-related cognitions, whereas the control group did not. Weight loss occurred more progressively and was greater in the CBT group at 24 weeks. CONCLUSION The proposed CBT treatment is particularly interesting for patients suffering from weight gain associated with antipsychotic treatment.

Dietary underreporting in women with schizophrenia requiring dietary intervention: A case control study

Objective The purpose of this study was to evaluate diet underreporting of women treated for schizophrenia undergoing dietary treatment and to compare it with nonpsychiatric women. Methods The study included 23 women (13 with schizophrenia) who had actively sought treatment for weight loss. All subjects were smokers with low activity level. A 24-hour diet recall using standardized food models was used to collect energy intake (EI) reporting. In order to identify participants who reported low EI, we used the Goldberg cut-off methodology. Results The percentage of underreporters was higher in patients with schizophrenia [77%, 95% confidence interval (46–95%)] than in controls [50%, 95% confidence interval (19–81%)]. Conclusions Diet underreporting is a frequent phenomenon in women with schizophrenia requiring dietary intervention.

Psychometric properties of a French-language version of the stage of change readiness and treatment eagerness scale (SOCRATES)

The Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES) is an instrument designed to measure motivation to change behavioural and psychological problems. While the original that described a three-factor structure of the scale has been replicated by some studies, some others found rather a two-factor structure. The factor structure may vary if used in different care settings, as there tends to be considerable differences in the severity of substance abuse problems and in the perception of these problems between individuals. All previously published validation studies have used the scale to assess the motivational status with regard to alcohol consumption. The scale has, however, been used for other drugs, often in mixed samples using different drugs. No study has reported on the utility of SOCRATES for this. Notably, no study has tested whether the factor structure was maintained when using the scale addressing different drugs. The objective of the present study is to address this concern and to establish the factor-structure of a French version of the SOCRATES in different groups of patients presenting different substance-abuse problems. Methods: The study was realised in the French-speaking part of Switzerland. The SOCRATES scores of four groups of patients were included in the present analyses: 90 hospitalised multi-drug dependent patients, 11 cannabis-abusing schizophrenic patients, and 24 tobacco smokers. The terms used in addressing patients’ motivation were “drugs”, “cannabis” or “smoking”. Results: A PCA followed by a varimax rotation revealed a three-factor solution. Only one item was clearly classified as being part of another than the original factor (item 14 in Recognition instead of Taking steps). Cronbachs alpha were 0.90 for Recognition, 0.73 for Ambivalence, and 0.91 for Taking Steps. Conclusions: The factor-structure of the French language version of the SOCRATES applied to different groups of patients presenting different substance abuse problems corresponded almost exactly to that originally proposed by Miller and Tonigan (Miller WR, Tonigan JS. . Assessing drinkers’ motivations for change: The stages of change readiness and treatment eagerness scale (SOCRATES). Psychology of Addictive Behaviours 10:81–89) supporting the internal validity of the SOCRATES. The present data suggest that the type of drug can be changed without changing internal consistency and construct validity of the French version of the SOCRATES.

A Measure of Dysfunctional Eating-Related Cognitions in People with Psychotic Disorders

Obesity and binge eating disorder are common in individuals with psychotic disorders. Eating and weight-related cognitions are known to influence eating behaviors. The study was designed to assess the psychometric properties of the Mizes Anorectic Cognitions Questionnaire (MAC-R) in patients with psychotic disorders. Binge eating disorder (BED), body mass index (BMI), the MAC-R and the three factor eating questionnaire (TFEQ) were assessed in 125 patients with a diagnosis of schizophrenia or schizoaffective disorder. Whereas the MAC-R has not acceptable psychometric properties, a brief version of the MAC-R (BMAC) has good psychometrical properties and is correlated with TFEQ and BMI. Binge eating disorder is also correlated to the Rigid Weight Regulation and Fear of Weight Gain subscale. The BMAC is a useful brief measure to assess eating and weight related cognitions in people with psychotic disorders.

Binge eating symptomatology in overweight and obese patients with schizophrenia: a case control study

ObjectiveThe purpose of this study was to assess whether severe overweight schizophrenic treated patients differ from controls and from pairs in binge eating symptomatology.MethodCurrent body mass index (BMI) and the binge eating status were assessed cross- sectionally in 40 schizophrenic outpatients and 40 non-psychiatric controls. In each group half of the subjects were severe overweight (BMI ≥ 28) or obese.ResultsPearson Chi-square analysis shows a higher number of subjects with binge symptomatology in the group of patients with schizophrenia having BMI ≥ 28 (Pearson Chi-square = 8.67, p = 0.034). Among subjects with BMI ≥ 28, 60% of patients with schizophrenia and 30% of controls have binge eating symptomatology.ConclusionThis result may odds to the understanding of weight gain associated with antipsychotics and underscores the importance of assessing binge eating behaviour during treatment and prevention of obesity in this population.

Effects of expertise on football betting

BackgroundFootball (soccer) is one of the most popular sports in the world, including Europe. It is associated with important betting activities. A common belief, widely spread among those who participate in gambling activities, is that knowledge and expertise on football lead to better prediction skills for match outcomes. If unfounded, however, this belief should be considered as a form of “illusion of control.” The aim of this study was to examine whether football experts are better than nonexperts at predicting football match scores.MethodsTwo hundred and fifty-eight persons took part in the study: 21.3% as football experts, 54.3% as laypersons (non-initiated to football), and 24.4% as football amateurs. They predicted the scores of the first 10 matches of the 2008 UEFA European Football Championship. Logistic regressions were carried out to assess the link between the accuracy of the forecasted scores and the expertise of the participants (expert, amateur, layperson), controlling for age and gender.ResultsThe variables assessed did not predict the accuracy of scoring prognosis (R2 ranged from 1% to 6%).ConclusionsExpertise, age, and gender did not appear to have an impact on the accuracy of the football match prognoses. Therefore, the belief that football expertise improves betting skills is no more than a cognitive distortion called the “illusion of control.” Gamblers may benefit from psychological interventions that target the illusion of control related to their believed links between betting skills and football expertise. Public health policies may need to consider the phenomenon in order to prevent problem gambling related to football betting.

Exposition aux substances addictogènes, réponses conditionnées et traitements d'exposition avec prévention de la réponse

Resume Objectif L’exposition aux drogues ou a des stimuli relatifs a celles-ci est associee a une reactivite psychophysiologique. Ces reponses sont conditionnees durant les periodes de consommation active. L’exposition avec prevention de la reponse (EPR) est un traitement etabli des troubles anxieux qui vise une diminution de l’anxiete et l’extinction des reponses conditionnees. Les conditionnements constates dans les processus addictifs conduisent a rechercher le potentiel therapeutique de l’EPR dans le traitement des addictions. Cet article propose une revue des principales etudes portant sur la reactivite aux stimuli et l’EPR, ceci specifiquement pour les dependances a l’alcool, aux opiaces, a la cocaine et au tabac. Methode - Cette revue se base sur les donnees issues de la consultation de la base de donnees Medline, abordant la reactivite aux stimuli, les biais attentionnels lors de l’exposition aux stimuli et les traitements d’exposition pour les dependances en general et pour chacune des substances mentionnees en particulier. Conclusion - L’exposition aux stimuli associes aux drogues est clairement en relation avec une reactivite psychophysiologique et des biais attentionnels. L’EPR a ete la plus etudiee pour l’abus et la dependance a l’alcool. Des rapports de cas montrent des resultats favorables. Les resultats des etudes controlees sont plus mitiges. Les etudes sur les patients presentant une dependance a la cocaine ou a l’heroine sont encore limitees et peu concluantes. Les differentes etudes ayant evalue de maniere controlee l’EPR dans le traitement du tabagisme ne permettent pas de conclure a l’interet de ce traitement. De maniere generale, les procedures d’EPR utilisees different d’une etude a l’autre. Une amelioration des conditions d’application de l’EPR pourrait permettre de changer le potentiel therapeutique de cette approche.