Le traitement du trouble délirant et ses aspects cognitifs

Cet article fait état de la phénoménologie cognitive du trouble délirant (TD) et examine les modèles cognitifs actuels. Des études de cas ont mis à jour des résultats forts prometteurs concernant l'utilisation de la thérapie cognitivo-comportementale (TCC) pour traiter le TD, même si cette dernière n'en est qu'à ses débuts dans ce domaine. Bien que les étapes de la TCC pour traiter le TD soient très similaires à ceux de la TCC pour les autres troubles psychotiques, son approche comporte des différences considérables. Toutefois, il est primordial de combiner plusieurs stratégies afin de pouvoir modifier les inférences propres au TD. L'évaluation clinique des délires ainsi que l'application de la TCC comme traitement seront illustrées par deux études de cas comportant des diagnostics de TD à thème prédominant de persécution. Les cas ont requis des périodes de temps différentes lors des diverses étapes de la TCC, suggérant l'importance de poursuivre la TCC au besoin.Cognitive aspects and treatment of delusional disorders This article reviews the cognitive phenomenology of delusional disorders (DD) and examines the current cognitive models. Some case studies have shown considerable promise concerning the utilisation of cognitive behavioral therapy (CBT) for the treatment of DD, even if this approach is in its infancy. Although the stages of CBT to treat DD are very similar to that of other psychotic disorders, there are also considerable differences. However, it is essential to combine several strategies in order to modify inferences specific to DD. The clinical evaluation of delusions as well as the application of CBT as a treatment is illustrated in two cases with a diagnosis of DD with persecutory subtype. The cases required different time periods for different stages of CBT and highlight the importance of tailoring CBT according to need.El tratamiento del trastorno delirante y sus aspectos cognitivos Este artículo tiene en cuenta la fenomenología cognitiva del trastorno delirante (TD) y examina los modelos congnitivos actuales. Investigaciones recientes han puesto al día resultados prometedores referente a la utilisación de la terapia cognitiva-comportamiento (TCC) para tratar el TD, aunque esta última esté empesando en este campo. Aunque las etapas de la TCC para tratar el TD sean similares a los de la TCC para otros trastornos psicóticos, su aproximación comporte diferencias considerables. Sin embargo es primordial combinar varias estrategias para modifiar las inferencias propias al TD. La evaluación clínica de los delirios asi que la aplicación de la TCC como tratamiento son ilustrados por dos estudios de casos incluyendo diagnósticos de TD con tema predominante de persecusión. Los casos han requerido periodas de tiempo diferentes durante las varias etapas de la TCC, sugeriendo la importancia de seguir con la TCC si es preciso

Dysfunctional belief-based subgroups and inferential confusion in obsessive-compulsive disorder

Cognitive-behavioural models emphasize the mediating role of dysfunctional beliefs in obsessive-compulsive disorder (OCD). However, recent studies indicated that beliefs related to responsibility and threat-estimation, Importance and Control of Thoughts, and perfectionism and intolerance of uncertainty were not elevated in a substantial proportion of patients suffering from OCD. This study attempts to replicate these findings, and, in addition, explores the role of a cognitive process characteristic of OCD, i.e., inferential confusion. Participants suffering from OCD (n = 174), completed cognitive- and symptom measures. Cluster-analysis revealed a 2- and a 6-cluster solution, both which contained substantial low belief subgroups. The Perfectionism and Certainty beliefs cluster in the 6-cluster solution was distinct from the other high beliefs clusters, which is in line with the recently proposed distinction between harm related versus 'just right' related OC symptoms. Finally, the assessment of cognitive processes seems to have complimentary value in addition to assessing belief content, and therefore could further our understanding of OCD within a cognitive framework. (C) 2010 Elsevier Ltd. All rights reserved

Targeting Cognitions, Emotions, and Behaviors in a Complex Case of Tourette Syndrome: Illustration of a Psychophysiological Perspective

Recent research stresses that cognitive and affective processes are implicated in Tourette Syndrome (TS) and might influence treatment. The cognitive-behavioral and psychophysiological (CoPs) approach posits that negative appraisals and maladaptive action-planning elicit negative emotions and behaviors that increase muscular tension and thus the urge to tic in TS. Hence, the CoPs targets cognitive-behavioral and affective processes increasing tension prior to tic onset. This article provides clinically novel information in the implementation and utility of the CoPs approach in a severe case of a young man with TS and a range of comorbidities marked by negative cognitions and emotions as well as planning deficits with a long-term follow-up. He received 14 sessions of CoPs therapy. Tic severity significantly decreased post-treatment with maintenance up to 36-months. The process measure of action-planning improved significantly from pre-treatment to 12-months follow-up. Results support the feasibility and acceptability of the CoPs in treating complex TS cases

The Impact of a Cognitive-Behavioral Therapy on Event-Related Potentials in Patients with Tic Disorders or Body-Focused Repetitive Behaviors

Context: Tic disorders (TD) are characterized by the presence of non-voluntary contractions of functionally related groups of skeletal muscles in one or multiple body parts. Patients with body-focused repetitive behaviors (BFRB) present frequent and repetitive behaviors, such as nail biting or hair pulling. TD and BFRB can be treated with a cognitive-behavioral therapy (CBT) that regulates the excessive amount of sensorimotor activation and muscular tension. Our CBT, which is called the cognitive-psychophysiological therapy (CoPs), targets motor execution and inhibition, and it was reported to modify brain activity in TD. However, psychophysiological effects of therapy are still poorly understood in TD and BFRB patients. Our goals were to compare the event-related potentials (ERP) of TD and BFRB patients to control participants, and to investigate the effects of the CoPs therapy on the P200, N200 and P300 components during a motor and non-motor oddball task.Method: ERP components were compared in 26 TD patients, 27 BFRB patients and 27 control participants. ERP were obtained from 63 EEG electrodes during two oddball tasks. In the non-motor task, participants had to count rare stimuli. In the motor task, participants had to respond with a left or right button press for rare and frequent stimuli, respectively. ERP measures were recorded before and after therapy in both patients groups.Results: CoPs therapy improved symptoms similarly in both clinical groups. Before therapy, TD and BFRB patients had lower P300 oddball effect during the non-motor task, in comparison with controls participants. An increase in the P300 oddball effect was observed post therapy. This increase was distributed over the whole cortex in BFRB patients, but localized in the parietal area in TD patients.Discussion: These results suggest a modification of neural processes following CoPs therapy in TD and BFRB patients. CoPs therapy seems to impact patients’ attentional processes and context updating capacities in working memory (i.e. P300 component). Our results are consistent with a possible role of the prefrontal cortex and corpus callosum in mediating inter-hemispheric interference in TD