[Magneto-encephalographic (MEG) brain recordings during traumatic memory recall in women with post-traumatic stress disorder: A pilot study]. / Enregistrement magnéto-encéphalographique (MEG) de réminiscences du trauma chez des femmes souffrant de stress post-traumatique : une étude pilote.

AIM OF THE STUDY: The experiment studied the effects of a short duration exposure to traumatic memories using magneto-encephalography (MEG). PATIENTS: Nine right-handed DSM-4 PTSD patients were recruited from a unit for anxiety disorders and an organisation supporting victims of violence. In order to have a homogeneous sample, we included only women who suffered from civilian PTSD. Exclusion criteria were co-morbid major medical illness, metallic dental prostheses that would interfere in the magnetic measurement, and current drug treatment. All participants were free from neurological disease and had normal hearing. They signed a written informed consent form. An ethics committee accepted the study. METHOD: A tape-recorded voice administered a script-driven imagery. The patients had to imagine, successively, a neutral image, a traumatic memory and rest, while MEG measured brain activities across delta, theta, alpha and beta bands. Each condition lasted three minutes. Heart rate (HR), anxiety and the vividness of mental images were recorded at the end of each phase. MEG power analysis was carried out with Statistical Parametric Mapping (SPM) 8. The signals were averaged for each of the three conditions of threeminutes duration. The dependent variable was a subtracted value: (trauma - rest) - (neutral - rest). The significance threshold was set at P<0.01. RESULTS: Anxiety and HR significantly increased during the trauma condition and returned to the neutral level during rest. The vividness of the mental imagery remained stable across the three conditions. The left-brain demonstrated a statistically significant power decrease in the secondary visual cortex (BA 18-19) in the delta band, the insula (BA13) in the beta band, the insula (BA13), premotor cortex (BA 6), Broca area (BA 44), and BA 43, in the alpha band. DISCUSSION: The symptom provocation protocol was successful in eliciting subjective anxiety and HR response in relation to traumatic memories. Our MEG results are in keeping with previous neuro-imagery studies showing decreased activities in the insula and Broca area during PTSD symptom provocation. However, we did not replicate the activation in the amygdala and the cingulate and prefrontal cortex found in some studies. Moreover, the within-group design, the small sample, and the inclusion of only female patients with milder dissociative symptoms limit our conclusions. The MEG protocol we used may also explain some partial discrepancies with previous MEG studies. However, our aim was to provoke a specific autobiographic recall of a traumatic event unfolding several sequential mental images along three minutes as in exposure therapy for PTSD. CONCLUSION: Despite its limitations, this pilot study is the first to provide MEG data during trauma recall. It suggests that recalling a specific traumatic event along three minutes results in hypo-activations of the brain regions regulating language and emotions. This paves the way to recording whole sessions of specific therapies for PTSD, with MEG using the millisecond resolution. MEG might be of interest to study the suppression of traumatic memories and their activation and habituation through prolonged graduated exposure in imagination across several sessions. MEG could also be used to study the effects of medication on PTSD symptoms. A controlled replication in a larger sample including male and female patients with various traumatic experiences is needed.

[Empirical validation of the Young Schema Questionnaire-Short Form (YSQ-S2) in borderline personality disorder and control subjects]. / Validation empirique du questionnaire abrégé des schémas de Young (YSQ-S2) sur une population de patients présentant un trouble de la personnalitéborderline et de sujets témoins.

INTRODUCTION: According to Young, Early Maladaptive Schemas (EMS) are deep cognitive structures constituted by beliefs about the word, oneself, and one's relationship with others. Young proposed a first clinical scale to assess EMS: the Young Schema Questionnaire (YSQ-L1). A later version, the YSQ-L2 (205 items), was developed by Young to measure 16 EMS. The Schema Questionnaire-Short Form (YSQ-S2) was designed to measure 15 EMS and is a shorter instrument (75 items). AIM OF THE STUDY: The aim of the present study was to validate the French version of the YSQ-S2 through a comparison of patients with borderline personality disorder (BPD) with control subjects. We used two French versions of the YSQ-S2 for validation purposes in BPD and control samples. The first version (initial French version) is identical to the original YSQ-S2 (75 items, 15 EMS) while the second (modified French version) comprises 68 items grouped into 14 factors. METHOD: The control group was composed of 263 non-clinical subjects (82 males, 181 females) who were mostly university students. The mean age of the sample was 27.92 years (SD=14.26) and age ranged from 17 to 67 years. The pathological group was composed of 37 BPD patients (eight males and 29 females) from the Anxiety Disorder Unit (Neurological Hospital, Lyon) and the Cognitive Behaviour Therapy Unit (Sainte Marguerite Hospital, Marseille). The majority of these patients were employees and senior executives. Age ranged from 19 to 53 years, with an average of 34.45 years (SD=9.74). A psychiatrist diagnosed the patients with the Diagnostic Interview for Borderline-Revised. All participants filled in the French version of the original 205-item YSQ-L2 from which responses of the 75-item YSQ-S2 were extracted. Control subjects anonymously completed the YSQ-L2 in groups of 10 to 40 people and patients completed the YSQ-L2 in a clinical setting. RESULTS: For each version of the YSQ-S2, the total score was analyzed with two-ways ANOVA (Group×Gender) and the sub-scores were analyzed with one-way MANOVA (Group). Our results showed that the two versions of the YSQ-S2 have good discrimination values between BPD patients and control subjects. Statistical comparisons indicated significant differences between the two groups. No difference appeared between males and female's scores. Results showed that BPD patients' total score and sub-scores were significantly higher than those of control subjects. Moreover, for each version of the YSQ-S2, a threshold level of pathology was obtained by the analysis of the intervals of total scores for the two groups. In the initial French version of the YSQ-S2, the scores of 15.59% of the control subjects overlapped with the scores of 94.59% of the BPD patients with a total score higher than 180. In the modified French version, the scores of 15.97% of the control subjects overlapped with the scores of 94.59% of the BPD patients with a total score higher than 160. Therefore, the pathological threshold of BPD could be set at a score of 181 and 161, respectively for the initial French version and the modified French version of the YSQ-S2. DISCUSSION: In spite of the small size of our pathological sample (N=37), the French version (initial or modified) of the YSQ-S2 appears to be a valid measurement allowing the description of the EMS and a quite effective instrument for measuring BPD symptoms. In addition, our results suggest that it is possible to reduce the YSQ-S2, given that the suppression of several items (modified French version of the questionnaire) does not modify the cut-off point and the differences between the BPD patients and the control subjects.

[Personal and social factors associated with the perception of health and the perception of happiness in a nonclinical adolescent population]. / Facteurs personnels et facteurs sociaux associés à la perception de santé et à la perception de bonheur dans une population adolescente non clinique.

INTRODUCTION: A theoretical conceptualization of the relationship between health and happiness and associated factors was studied using a structural equation model. METHOD: Data from the Portuguese part of a World Health Organization collaborative study, health behavior in school-aged children [Currie C, Smith R, Boyce W, et al. HBSC, a WHO cross national study: Research protocol for the 2001/2002 survey. Copenhagen: WHO; 2001], were used. A representative national sample (N=6131) of 11-, 13- and 15-year-old pupils was studied [Matos M.G., Equipa do Projecto Aventura Social. A saúde dos adolescentes portugueses: Quatro anos depois (La santé des adolescents portugais : quatre ans après). Lisboa: Edições FMH; 2003] and data were analyzed for the purpose of this paper. Results showed a significant positive correlation between perception of health and perception of happiness. A group of personal and social factors was associated with this correlation. RESULTS: Results demonstrated that personal factors had more impact on health perception, and social factors had more impact on happiness perception. Adjustment fit indexes were good. Socioeconomic status (SES) was significantly associated with a positive health perception, and SES was also significantly but modestly associated with the perception of happiness. DISCUSSION: Results highlighted the importance of a holistic and positive approach to adolescent health. This study confirmed the importance of family, peer relationship and positive evaluation of the school on adolescents' health and well-being. Results may suggest that preventive interventions in school settings should target both personal factors (e.g., promoting social competence) and social factors (e.g., promoting social support and acceptance). Interventions should also target physical and mental health in order to help adolescents to cope with the daily challenges they meet.

[Post-traumatic stress disorder in an anxiety disorder unit and in a victims support association]. / Etat de stress post-traumatique dans une unité de traitement de l'anxiété et dans une association d'aide aux victimes.

The post-traumatic stress disorder (PTSD) represents an original and frequent pathological entity concerning people confronted with one or more significant traumatic events. We present here a comparative study concerning subjects who present a post-traumatic stress disorder received in an anxiety disorder unit (ADU) or in a victims support association (VSA). One hundred and twenty seven people have been included in the study, according to DSMIV for PTSD, during three years. Fifty-seven came from a victim support association, 54 came from an anxiety disorder unit and 16 were common to both structures. The PCL-S (PTSD Checklist Scale) was used to rate the intensity of the PTSD. Age, sex, marital statute, type of traumatism, comorbidity and previous traumatisms were compared. PCLS scores were equivalent in the two settings. More women, younger subjects and more aggression were received in the victim support association. In the anxiety disorder unit more psychiatric comorbidity and more frequent antecedents of traumatism were seen. In the whole sample, two thirds of the people lived alone. Our results show that a victim support association receives people suffering from a definite post-traumatic stress disorder as intense on the PCL-S as in an anxiety disorder unit. More work has to be done on support association in the community, as they are confronted with significant PTSD problems.

[Evaluation of Post-traumatic Stress Disorder: validation of a measure, the PCLS]. / Evaluation des états de stress post-traumatique: validation d'une échelle, la PCLS.

Post-Traumatic Stress Disorder (PTSD) is a psychiatric disorder frequently found in psychiatric clinic and in the population of victims of traumatic events. PTSD, characterized by an intense fear, helplessness or horror, resulting from exposure to a traumatic event, is clinically manifested with three main syndromes: reexperiencing, avoidance behavior and numbing of emotion, and physiological hyperarousal. The Post-Traumatic Checklist Scale (PCLS) is a brief and self-report questionnaire for evaluating the severity of three main syndromes of PTSD. The scale can be divided into three sub-scores corresponding to the three main syndromes of the disorder: reexperiencing (items 1-5), avoidance (items 6-12) and hyperarousal (items 13-17). The validation studies in English version (Weathers et al., 1993, Blanchard et al., 1996) and French version (Ventureyra et al., 2001) showed that the PCLS possesses good psychometric properties. But the discriminating validation with another pathological group and the sensitivity of the scale to change of treatment have not yet been studied up to now. The aim of this study is the validation of the French version of the PCLS in Post-Traumatic Stress Disorder (PTSD) subjects compared with subjects suffering from other anxiety disorders and non-clinical subjects. The sensitivity of the PCLS after a cognitive behavioral therapy (CBT) for PTSD was studied for the first time. Fifty-seven outpatients suffering from PTSD according to DSM IV criteria, 23 patients suffering from other anxiety disorders and 28 non-clinical subjects were included in this study. All subjects were assessed with the PCLS. The Beck Depression Inventory--13 items (BDI-13) and the Fear Questionnaire (FQ) were used for the two groups of patients. Fifty-five PTSD patients were administered the PCLS twice over an interval of one to two weeks without any intervention in order to determine the test-retest reliability of the PCLS. And 24 PTSD patients were reassessed with the PCLS after 16 sessions of cognitive behavioral therapy (CBT) in order to study the sensitivity to treatment of the PCLS. The CBT technique for PTSD consisted of relaxation, exposition, recital, cognitive restructuration and stress management. The total score and the subscores on the PCLS were found to be significantly higher in PTSD patients than in two control groups: suffering from other anxiety disorders subjects (61.2/41.4, p<0.0001) and non-clinical subjects (61.2/28.8, p<0.0001). The correlation between the PCLS total score and the others measures showed that the PCLS correlated significantly with the depression measure, the BDI-13 (p<0.001), and the sub-scores of Fear Questionnaire (agoraphobia: p<0.001; anxiety-depression: p<0.001; distress: p<0.001), but not with the social phobia sub-score of the FQ. The PCLS showed a satisfactory test-retest reliability in 55 patients (the total score: r=0.75, p<0.0001; the sub-score of reexperiencing: r=0.844, p<0.0001; the sub-score of avoidance: r=0.702, p<0.0001; the sub-score of hyperarousal: r=0.712, p<0.0001). The t-test showed that the total score of the PCLS was significantly reduced in 24 patients after 16 sessions of CBT (the mean gain=13.1, t=5.63, p<0.0001). The results of our study confirm that the PCLS possesses good empirical and discriminating validity and a good sensitivity. The fact that the PTSD patients reported significantly higher total scores on the PCLS and its three subscores than other anxiety disorder subjects and non-clinical subjects indicates that the PCLS differentiates well the patients presenting PTSD from other anxiety disorder subjects and non-clinical subjects. The PCLS total score also correlates significantly with the other measures of psychopathology used in the study, such as measures of phobia (the Fear Questionnaire agoraphobia subscale), depression (the Beck Depression Inventory -13) and distress (the Fear Questionnaire distress subscale). This may be explained by the fact that some PTSD symptoms overlap with those of depression and of anxiety or phobia. The PCLS showed anxiety or phobia. The PCLS showed a satisfactory test-retest reliability. The PCLS is therefore a valid and effective measurement of PTSD. It may be a useful tool for screening and assessing PTSD in clinical practice and research in psychiatry.

[Inferiority in normal and anxious populations]. / Le sentiment d'infériorité entre population normale et anxieuse.

BACKGROUND: The construct of inferiority can be defined as an intimate, unrealistic and persistent conviction to be always low-ranking in merit, value, intellectual and/or physical capacities (Weiner et Mohl, 1996; Yao et al., 1996). This can be considered as an important cognitive factor in anxiety disorders. But, does a feeling of inferiority also exist in normal subjects? We hypothesized that the feeling of inferiority might be a normal phenomenon if it is a transient experience, in relation to external events, and represents an aspect of self esteem. The Inferiority Scale (Yao et al., 1998), aimed at measuring the feeling of inferiority in anxiety, is a self-report instrument including 17 items assessing self-appraisal of inferiority and 17 items assessing inferiority linked to others' judgements. It showed good psychometric properties of reliability and validity in previous studies. The aim of our study was to confirm the existence of inferiority feeling in non-clinical subjects, and its continuity between normal and anxious populations. Method - We included 264 non-clinical subjects in the study. The mean age of the sample was 30.38 years old (SD=10.25) and 36% (94 Ss) were men. The anxious population was composed with 57 subjects suffering from obsessive compulsive disorder (OCD) and 43 patients with social phobia according to DSM IV. The mean age of this population was 34.0 years old (SD=10.6) and 51% of them were men. The Inferiority Scale was used in our study for evaluating the feeling of inferiority. RESULTS: Most of non-clinical subjects reported low inferiority feelings and a part of the non-clinical subjects (15%) presented a moderate or strong feeling of inferiority, on the Inferiority Scale. The non-clinical subjects group was divided into two sub-groups (Low and High Inferiority) with the median of the Inferiority Scale total score. The total score and the sub-scores of the Inferiority Scale were all significantly higher in the two anxiety groups than in the two non-clinical sub-groups (p<0.0001) and higher in non-clinical subjects with high inferiority, compared to those with low inferiority (p<0.0001). Noting that the social phobic group presented higher scores of the Inferiority Scale than the OCD group (p=0.0058). There was a significant and negative correlation between age and the Inferiority Scale in non-clinical subjects, but there was no between-sex difference on the scale. CONCLUSION: Our results confirm the existence of inferiority feeling in non-clinical subjects and suggest the existence of continuity of inferiority feeling as a psychological trait between normal and pathological populations.

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.

[Validation of a scale for responsibility (Salkovskis Responsibility Scale)]. / Etude de validation d'une échelle de responsabilité (Responsability Scale de Salkovskis).

Appraisal of inflated responsibility for harm is the cornerstone of Salkovskis's cognitive theory for obsessive compulsive disorder. The aim of our study is to present the validation study of the French translation of the R scale. The present study compared 50 subjects with obsessive compulsive disorder, 37 patients suffering from social phobia and 183 control subjects on a responsibility questionnaire (R scale). The cognitive hypothesis of Obsessive Compulsive Disorder (OCD) specifies two levels of responsibility-related cognitions: responsibility assumptions (attitudes) and responsibility appraisals (interpretations). The R scale evaluates the responsibility assumptions. Such attitudes should reflect the more generalized tendency to assume responsibility in a given situation, particularly situations involving intrusions and doubts. It is possible that such assumptions may be less specific to OCD. The inclusion of social phobia subjects in the present study allows evaluation of the specificity of any findings to OCD. Patients were diagnosed and classified according DSM IV criteria. The control subjects were taken in the general population. No formal interview was conducted. The three groups were compared for sex, age and educational level. Before treatment, all the participants filled in the Responsibility Scale of Salkovskis (27 items), the Beck Depression Inventory (21 items), the Beck Anxiety Inventory and the Bouvard's Obsessive Compulsive Thoughts Checklist. The results indicate that the two anxious groups scored significantly higher than the control group on Beck Depression and Anxiety Inventories but no significant difference was observed between the two anxious groups. OCD patients scored significantly higher than both social phobic patients and control subjects on the Obsessive Compulsive Thoughts Checklist (OCTC). The social phobic group scored this checklist significantly higher than the control group. In sum, the three groups were different on obsessive compulsive thoughts. On the washing subscale of the Obsessive Compulsive Thoughts Checklist, the OCD patients differed significantly from the control group and the social phobia patients. No difference was observed between the social phobia subjects and the control group. On the two other subscales of the OCTC, the checking and the responsibility scales, the three groups were different: OCD patients scored significantly higher than both social phobic patients and control subjects; the social phobic patients scored higher than the control group. Results support the reliability (test retest) and the internal consistency of the questionnaire. Patients with obsessive compulsive disorder (OCD) and social phobia subjects had significantly elevated score on the total scale compared to control subjects. However social phobia patients did not differ from patients with OCD. So, the responsibility for harm, evaluated by the R-scale seems not to be specific of OCD. This finding does not support the results of two studies (28, 30). But these two studies compared OCD patients with an anxious group including panic disorder with agoraphobia, generalized anxiety disorder and social phobia. The correlations with a measure of OCD symptoms were higher than the correlations with anxiety and depression. Finally, the factor structure was only studied on the control group. The exploratory factor analysis indicates that the R scale is a two-dimensional scale, reflecting a need to prevent risks and the belief that one has power to harm. The first dimension is less specific to the pathology than the second. Only patients with OCD had significantly elevated score on the "need to prevent risks" compared to the non-clinical group. The two anxious groups differed on "the belief that one has power to harm" from the non-clinical group but social phobia patients did not differ from patients with OCD. In sum, the two subscales of the R scale did not discriminate OCD patients and social phobic subjects. Further research is needed to replicate the present findings and to confirm the two dimensions of the R scale. Overall, the results are consistent with the hypothesis that responsibility beliefs are important in the experience of obsessional problems. However, responsibility assumptions such as the belief that one has the power to harm are shared with social phobia.

Sustained attention in patients with obsessive-compulsive disorder: a controlled study.

Studies on attentional processes in obsessive-compulsive disorder (OCD) have been inconsistent. The present study focused on the question of sustained attention in OCD, using the 'Degraded Stimulus Continuous Performance Test' (DS-CPT) sensitivity index over time. This study included 20 OCD patients and 25 control subjects, comparable in sex, age and educational level. All subjects had a neuropsychiatric structured diagnostic interview, as well as a psychometric battery. The DS-CPT evaluated sustained attention. The sensitivity decrement during DS-CPT was significant in both controls and OCD subjects. Contrary to our expectations, OCD patients did not show a greater decrease in sensitivity over time, compared to controls: thus, OCD patients presented a no more important attention decrease than controls. Controls and OCD subjects became more conservative in their response criteria throughout the DS-CPT test. Comparing OCD with and without pharmacological treatment did not reveal any difference in CPT outcome. Moreover, we observed, in OCD, a positive significant correlation between the Y-BOCS compulsion score and the CPT sensitivity index. A significant negative correlation of the Y-BOCS compulsive score with the CPT false alarm score was also found. In conclusion, OCD patients did not present any disturbance in sustained attention during a task requiring an increased processing load.

Visuo-spatial attention processes in panic disorder with agoraphobia: a pilot study using a visual target discrimination task.

Panic attacks can be observed in a wide range of situations, but most common are those providing complex and unstructured stimulations, suggesting an impairment in attentional processing of visuo-spatial information. This study evaluated agoraphobics' attentional processing of neutral (i.e., not anxiety-provoking) visuo-spatial stimulation. Twelve patients suffering from panic attacks with agoraphobia were compared with 22 normal controls on a computerized visual target discrimination task specifically designed for this study. Psychometric measures assessed the phobic avoidance, the level of depression and anxiety. The numbers of errors and reaction times were analysed with a three-way ANOVA (Group x target modality x number of stimulations). No between-group significant difference was found for the reaction time performance and the mean number of detection errors. However, an interaction effect was observed for this last variable depending on the target modality: agoraphobic patients made fewer omission errors than control subjects when the target was present among distractors, while they made more commission errors when the target was absent. Outcomes are discussed in terms of attentional hyperactivation related to anxiety and perseverative decision process in agoraphobic patients.

Cognitive behavior therapy versus supportive therapy in social phobia: a randomized controlled trial.

BACKGROUND: The efficacy of cognitive behaviour therapy (CBT) in social phobia has been demonstrated in several controlled trials and meta-analyses, but no comparison of CBT with supportive therapy (ST) can be found in the literature. METHOD: The aim of the trial was to study the effectiveness of CBT versus ST carried out 'as usual'. Sixty-seven DSM-4 social phobic patients (89% generalized subtype, most with avoidant personality) were randomly allocated into two groups. Group 1 (CBT) received 8 1-hour sessions of individual cognitive therapy (CT) for 6 weeks, followed by 6 2-hour sessions of social skills training (SST) in group weekly. Group 2 received ST for 12 weeks (6 half-hour sessions), then the patients were switched to CBT. All patients agreed not to take any medication during the whole trial. In group 1, 29 patients reached week 6, 27 reached week 12, and 24 weeks 36 and 60 (endpoint). In group 2, 29 patients reached week 6, 28 reached weeks 12 and 18, 26 week 24, and 23 reached weeks 48 and 72 (endpoint). RESULTS: At week 6, after CT, group 1 was better than group 2 on the main social phobia measure. At week 12, after SST, group 1 was better than group 2 on most of the measures and demonstrated a significantly higher rate of responders. This finding was replicated after switching group 2 to CBT. Sustained improvement was observed in both groups at follow-up. Compliance with abstinence from medication increased over time. CONCLUSIONS: CBT was more effective than ST and demonstrated long-lasting effects. This may suggest that social phobia management requires more than a simple and inexpensive psychological intervention.

[The evaluation of perceived responsibility among obsessive-compulsive patients]. / Evaluation de la responsabilité perçue chez les patients obsessionnels-compulsifs.

Although many authors agree that excessive responsibility is associated with Obsessive-Compulsive Disorder (OCD), some believe that the manifestations of responsibility are more easily observed among patients suffering from checking compulsions (36, 42). This study compares a group of obsessive-compulsive patients that have been sub-divided into three groups (washers, checkers, ruminators) with a group of normal volunteers that are healthy with regards to responsibility. The sample consisted of 58 adults who meet diagnostic criteria for OCD and 20 normal individuals. During an individual interview, a clinician administered the ADIS III-R (section on OCD) as well as other instruments in order to precise the diagnosis. The participants then filled out questionnaires that assess symptoms, responsibility, perfectionism and general functioning. The results confirm that OC patients obtain higher scores than the normal group with regards to responsibility. However, no significant difference was found between the three sub-groups of OC patients. Thus, it seems to be pertinent of consider excessive responsibility as a characteristic of OC clients, for checkers and washers, as well as ruminators.

[Social anxiety in patients with social phobia: validation of the Liebowitz social anxiety scale: the French version]. / L'anxiété sociale chez les phobiques sociaux: validation de l'échelle d'anxiété sociale de Liebowitz (version française).

The Liebowitz's Social Anxiety Scale (LSAS) (Liebowitz, 1987) is a rating scale of fear and avoidance in social interaction (12 items) and performance-oriented situations (12 items). This paper present the study of empirical and concurrent validation of the LSAS. Ninety-six patients suffering from social phobia according to DSM IV were included and compared with 64 non-clinical control subjects. Both patients and controls were divided into two sub-groups: the LSAS passation by hetero-evaluation or auto-evaluation. Social phobics had much higher scores on anxiety and avoidance of the LSAS than control subjects, whatever the method. There were no differencies between hetero and auto-evaluation in both groups of patients and non-clinical subjects, either on anxiety or on avoidance. The LSAS correlated better with social anxiety and negative cognition in social situations than with anxiety-depression in social phobics. The French version of the LSAS showed a good empirical and concurrent validity and the scale presents a good sensitivity to change after cognitive behavioral therapy in social phobics.

[Preliminary studies of the structured diagnostic interview for personality disorders: SCID II]. / Etude préliminaire d'un entretien structuré des troubles de la personnalité: le SCID II.

The aim of the study was to compare control subjects and consultant patients with the SCID II (interview and questionnaire), then to compare clinical diagnosis with the SCID II (interview and questionnaire). The preliminary study was carried out to assess the feasibility of the procedure. This appraisal was conducted with a group of patients (n = 26) and a control group (n = 16). Only the patients were diagnosed according to DSM IV criteria. The patients and the control group completed the Mini-Mult and the SCID II (questionnaire and interview). The two groups were matched on sex, age and educational level. The two groups were discriminated on all Mini-Mult scales but one: the internalization index. The results showed that the SCID questionnaire and the SCID interview differentiate the two groups. The SCID questionnaire showed high sensitivity in the group of patients. It is a more efficient instrument to screen control subjects except one personality disorder (obsessive-compulsive). The diagnostic agreement between the clinical diagnosis and the structured interview was poor. However our results are comparable to the other studies.

[A controlled study of irrational interpretations of intrusive thoughts in obsessive-compulsive disorder]. / Une étude contrôlée sur les interprétations irrationnelles des pensées intrusives dans les troubles obsessionnels compulsifs.

UNLABELLED: Recent research suggested that the irrational interpretations of intrusive thoughts might be cognitive structures underlying obsessive compulsive disorder (OCD). We present a study on intrusive thoughts and their interpretations in 36 patients suffering from OCD (DSM IV criteria), compared with 36 sex and age matched non clinical subjects, with the Intrusive Thoughts and their Interpretations Questionnaire-revised version (ITIQ-r). This questionnaire measures intrusive thoughts intensity and three types of interpretation: responsibility, guilt and inferiority. The measures of OCD, of depression, of social phobia and of anxiety have been used. RESULT: OCD patients reported more frequent intrusive thoughts and higher irrational interpretations than controls. The higher the intrusive thoughts, the higher the irrational interpretations. The multiple regression showed that both intrusive thoughts and irrational interpretations were respectively predicted by obsessional compulsive pathology (the Obsessive Thoughts Checklist or the Y-BOCS). The Y-BOCS was the only predictor for inferiority interpretation, but there was no significant predictor for responsibility or for guilt interpretations. Responsibility correlated only with aggressive intrusive thoughts. Guilt was related to intrusions about fear of loss. Inferiority was highly correlated with intrusive thoughts about perfectionism and sexuality.

[Dyspnea and panic attacks]. / Dyspnées et attaques de panique.

Patients with panic attacks (or acute anxiety episodes) often present respiratory symptoms, especially dyspnea. Biological, behavioral and cognitive models of panic attacks are presented. The "false suffocation alarm model" is outlined. Biological and cognitive-behavioral treatments which use, among other techniques, respiratory regulation and hyperventilation, are described. Controlled studies and several meta-analyses show that cognitive-behavioral therapies represent an alternative to anxiolytics and antidepressants in panic attacks with or without agoraphobia, and have long lasting effects, while most of the patients under medication alone relapse when pharmacological treatments are stopped.

Psychometric appraisal of the Scale for Interpersonal Behavior (SIB) in France.

The present study was carried out in France to evaluate the reliability and validity of the Scale for Interpersonal Behavior (SIB), a multidimensional measure of difficulty and distress in assertiveness that was originally developed in The Netherlands. This appraisal was conducted with a clinical sample (N = 166) and a general population sample (N = 150). The clinical series comprised 115 patients with social phobia and 51 patients with personality disorder, 28 of whom were of the avoidant type. Support was found for internal consistency and test-retest reliability of the French SIB. Compared to controls, both social phobics and patients with an avoidant personality disorder had significantly lower mean scores on all performance scales and significantly higher ones on all distress scales, with the social phobics occupying a position in between. Findings in relation to convergent and divergent validity were quite satisfactory. Sensitivity of the French SIB for detecting change was demonstrated in a subgroup of the clinical Ss who had undergone 15 sessions of cognitive-behavioral group therapy for underassertiveness.

Validation of the French translation of the agoraphobic cognitions questionnaire.

BACKGROUND: The goal of the present study was to validate the French version of the Agoraphobic Cognitions Questionnaire (ACQ). METHODS: Subjects consisted of 115 patients with panic disorder and agoraphobia, 54 obsessive-compulsive patients and 72 normal controls. Patients were referred for outpatient treatment. They filled in the questionnaire before and after entering treatment. The control group consisted of people taken from the general population. It was matched with the clinical groups on age, sex and education. RESULTS: The ACQ appears to have a constant factor structure across US, Dutch and French samples. Results support the validity of the total score of the ACQ. Patients with panic disorder and agoraphobia scored significantly higher than obsessive-compulsive patients and control subjects. On the ACQ physical concerns subscale agoraphobic patients were significantly different from obsessive-compulsive patients and control subjects. On the social/behavioural subscale agoraphobic patients and obsessive-compulsive patients were significantly different from control subjects. The French translation of the ACQ was found to be stable over an interval of 15 days in the control group. The Cronbach coefficients of both subscales were also satisfactory. These results support the stability and the internal consistency of the questionnaire. In addition, the French translation of the ACQ was sensitive to changes with cognitive-behavioural therapy. CONCLUSIONS: These results support the findings of Chambless and Gracely [Cogn Ther Res 1989;13:9-20]. The ACQ physical concerns subscale is a specific feature for the anxiety status experienced by patients with panic disorder and agoraphobia. The ACQ social/behavioural subscale seems to be a more general feature of anxious patients.