François Borgeat

Psychosocial predictors of depressive symptomatology level in postpartum women

This study explored a multifactorial model for the prediction of the intensity of depressive symptoms in postpartum women. Data were gathered from 213 pregnant women during the second trimester of pregnancy and at 6 months postpartum. Participants were assessed according to a number of psychosocial variables. A path analysis indicated that four variables had a direct effect on postpartum depressive symptomatology level: lower occupational status, prenatal depression level, more distal stressors and a personal psychiatric history. Eight variables, which reflected past and present experiences, showed an indirect effect. The implications of these findings are discussed.

Evaluation of a cognitive-behavioural program for the management of chronic tic and habit disorders

The aim was to evaluate the efficacy of a manualized cognitive-behavioural program based on habit reversal for the management of chronic tic disorder (CTD) and habit disorder (HD). Forty-seven CTD and 43 HD received a 4-month treatment program. Thirty-eight (22 CTD, 16 HD) were placed on a waitlist control group, which subsequently received treatment. The treatment approach combined awareness training, relaxation (including modification of a tension-producing style of action), and habit-reversal training, with more general cognitive restructuring of anticipations linked to ticcing. Sixty-five percent of completers reported between 75 and 100% control over the tic. At 2-year follow-up, 52% rated 75-100% control. There were also significant changes post-treatment in measures of self-esteem, anxiety, depression and style of planning action. Successful tic/habit modification was associated in CTD and HD groups with successful change in style of planning action. There were no consistent differences in any outcome measures between CTD and HD groups.

Cognitive-behaviour therapy and medication in the treatment of obsessive-compulsive disorder: a controlled study.

Objective: To evaluate the effect of combining cognitive-behaviour therapy (CBT) and medication in the treatment of obsessive-compulsive disorder (OCD). Method: Twenty-nine subjects diagnosed with OCD according to Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R) criteria were recruited through the Anxiety Clinic of Louis-H Lafontaine Hospital. They were evaluated at baseline and after treatment on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) by a psychiatrist who was blind to treatment modality. Subjects rated their degree of resistance to their rituals and the strength of their obsessional beliefs. Subjects then received 1 of 4 treatments: medication and CBT simultaneously (n = 9), CBT only (n = 6), medication while on a wait-list for CBT (n = 6), or no treatment while on a wait-list for CBT (n = 5). Results: Multivariate analysis revealed that Y-BOCS scores and clinical ratings significantly improved posttreatment in all groups except the nontreatment wait-list control group. Subjects in the 2 active treatment groups receiving CBT showed reduced strength in their obsessional beliefs. The subsequent administration of CBT to those groups on the wait-list also decreased the strength of their primary obsessional beliefs and beliefs about the consequences of not performing the rituals. Conclusions: Our results suggest that either CBT or medication alone is more effective than no treatment. The combination of CBT and medication seems to potentiate treatment efficacy, and we found it more clinically beneficial to introduce CBT after a period of medication rather than to start both therapies simultaneously.

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.

Cognitive behaviour therapy and medication in the treatment of obsessive–compulsive disorder

Objective:  To compare cognitive behaviour therapy (CBT) with CBT plus medication; medication alone; and placebo in the treatment of adult obsessive–compulsive disorder (OCD).

PSYCHOSOCIAL FACTORS RELATED TO EMOTIONAL DISTURBANCES DURING PREGNANCY

This study explored a multifactorial model for the understanding of the factors related to the intensity of prenatal emotional disturbances. Data were gathered from 213 pregnant women during the second trimester of pregnancy. Participants were assessed according to a number of psychosocial variables. Two types of prenatal emotional disturbances were examined: depressive symptoms and ambivalence and fears related to maternity. A path analysis indicated that four risk factor domains had a direct effect on depressive symptom level: locus of control; interpersonal relationships; stressors; and psychiatric history. Four risk factor domains also had a direct effect on the level of ambivalence and fears: sociodemographics; depressive symptom level; interpersonal relationships; and family history. Several factors showed an indirect effect on one or both of the disturbances. These results indicate that the study of factors related to prenatal emotional disturbances benefits from a multifactorial model assessing direct and indirect effects.

Cognitive behavioral management of Tourette's syndrome and chronic tic disorder in medicated and unmedicated samples.

OBJECTIVE Cognitive behavior therapy (CBT) and medication can be administered in combination in treating tic disorders but there are no studies evaluating the effectiveness of CBT with and without medication. The current study compares the efficacy of CBT in combination with medication and without medication. METHOD CBT was administered in a consecutively referred sample of 76 people diagnosed either with Gilles de la Tourette Syndrome or chronic tic disorder. The sample was divided into a medicated and a non-medicated group. Twenty three were stabilized on medication and 53 were not receiving medication. Measures administered pre- and post-CBT in both groups included: main outcome measure of Tourette Syndrome Global Scale and measures of mood. RESULTS Repeated measures analysis of variance on the initial sample revealed no difference between medicated and non-medicated groups in outcome. A further analysis comparing the 23 receiving medication with 23 not receiving medication matched on baseline clinical variables also yielded no significant group differences, either in treatment outcome on main tic outcome measures or on other clinically relevant questionnaires. DISCUSSION CBT for tic disorders is an effective treatment administered either in combination with medication or alone.

On the pharmacotherapy of obsessive-compulsive disorder : Is a Consensus possible?

Objective: To examine the efficacy and tolerability of clomipramine compared with the selective serotonin reuptake inhibitors (SSRIs) in the treatment of obsessive–compulsive disorder (OCD), bearing in mind the recent Expert Consensus Guidelines recommendation to use clomipramine after 2 to 3 failed SSRI trials. Method: The literature on the pharmacotherapy of OCD was critically examined. Results: The available research evidence is not conclusive but suggests that clomipramine possesses greater antiobsessional efficacy than do the SSRIs. In addition, when clomipramine is presented to patients in a positive way, and properly used in small initial doses with gradual increases, it seems to be tolerated as well as the SSRIs. Conclusion: Recently expressed opinions that clomipramine should be used to treat OCD after 2 to 3 failed SSRI trials are not supported by research evidence. Both clomipramine and the SSRIs may be used as first-line treatments for OCD.

Correlates of pre-partum depressive symptomatology: A multivariate analysis

A sample of 350 French Canadian women were interviewed at the beginning of the second trimester of pregnancy. Their level of depressive symptomatology was assessed with the Beck Depression Inventory (BDI). Several demographic and psychosocial variables were included in a multiple regression analysis in order to identify the variables which contribute to the variance in the BDI score. Results show that employment, higher self-esteem, and satisfaction with social support were related to lower levels of pre-partum depressive symptoms. Prior experiences of emotional difficulties, number of individuals with whom the subject reports a negative relationship, intensity of perinatal stress, as well as the perceived impact of stressful life events, are associated with an increase in the BDI score. It is proposed that a diathesis-stress model can account for this pattern of results. The limitations in generalizing these results to samples of non-francophone women are discussed.

Correlates of gender role orientation during pregnancy and the postpartum

This study was designed to examine the relationship between gender role orientation and psychological adjustment during pregnancy and the postpartum period in a large sample of French-speaking Caucasian mothers. Gender role was assessed with the Bem Sex Role Inventory, which classifies subjects into four categories: androgynous, masculine, feminine, and undifferentiated. A discriminant analysis showed a relationship between androgyny and the following measures of psychological adaptation: self-esteem, satisfaction with social support, and level of apprehension toward perinatal stressors. The masculine gender role was linked with self-esteem, work involvement, age, and severity of perinatal stress. No relationship was found between gender role and the level of antenatal or postnatal depressive symptomatology. Stress, marital support, and social support were among the predictors of postpartum depression, which underlined the importance of taking these variables into account when studying the well-being of mothers during the postnatal period. Results are discussed in light of previous literature on the association between gender role and motherhood. The limitations of Bems model and inventory are also considered.