Bertrand Cramer

Abstract: Les effets de psychotherapies breves mere-bebe (maximum de 10 seances) ont ete examines dans des cas de troubles fonctionnels et de troubles du comportement chez des enfants de moins de 30 mois. Soixante-quinze dyades mere bebe ont ete evaluees avant le traitement, a une semaine, et a six mois apres la fin de la therapie. Les mesures de resultats consistaient dans les changements des symptomes du bebe, des interactions des entre la mere et le bebe et des representations matemelles, L'effet de deux formes d'intervention-la Therapie Psychodynamique et la Guidance Interactive-a ete compare. Les resultats indiquent une forte reduction des symptomes, les interactions dyadiques devenant plus harmonieuses (les meres sont devenues moins intrusives et les enfants plus cooperatifs). La confance en soi matemelle a augmente de maniere significative et les affects negatifs ont baisse. Les progres ont dure au moins plusieurs mois, avec une amelioration positive detectee au suivi de 6 mois. Aucune difference significative n'a ete trouvee entre les effets des deux formes d'intervention. Dans les limites de recherches faites dans un contexte clinique, cette etude suggere que les psychotherapies breves mere-bebe sont une methode rentable d'intervention precoce.

Abstract: The emerging field of mother-infant psychotherapy lends itself particularly well to objective measures of change. The improvements are often rapid, involving symptom relief or removal. These improvements can be related to subjective change in mothers and to modifications of various interactive variables. We examined changes due to brief therapy (maximum of 10 sessions) in cases of functional and behavioral disturbances in children less than 30 months old. Evaluations were done before treatment and at 1 week, 6 months, and 12 months after therapy. The outcome measures were changes in the infant's symptoms, the mother's representations, and the behavioral interactions between mother and infant. One group of mothers and infants was seen in a form of psychodynamic brief psychotherapy developed in our Center, and a control group was seen in a noninterpretive form of therapy called interactional guidance. This progress report includes the initial 38 mother-infant dyads who have completed the first three evaluations. Results indicate that the major changes are seen in symptom relief or removal; interactions change in the direction of becoming more “harmonious,” with mothers becoming less intrusive and infants being more cooperative. A better identification between mothers and infants is seen in the measures of the mothers' representations. No major differences between the two forms of therapy have yet appeared. To date, pretreatment predictions show little correlation with actual outcomes. Change proved to be durable, even showing some improvement in the 6-month follow-up evaluations. Results are discussed from the point of view of (1) the challenge of an objective, quantitative evaluation of subjective changes; (2) the issue of specificity of modes of treatment; (3) the difficulties of outcome predictions; (4) the remarkable opportunities for prevention of psychic disturbances in infancy; and (5) the relational nature of early disturbances.

Abstract: L'etude des depressions postpartum est particulierement importante quand on etudie les influences pathogeniques sur le developpement du nourrisson, parce qu'elles se produisent-avec une incidence plutot elevee- au debut du processus d'attachement. Alors que les facteurs mediateurs responsables des effets de depression sur l'enfant ont ete classiquement consideres comme suivant un modele de deficit, nous suggerons que les processus actifs d'attribution de signification et de patterns interactifs concomitants jouent un role important a la fois dans l'etiologie de la depression et dans les effets mediateurs sur l'enfant. Nous utilisons des donnees epidemiologiques, la description clinique d'un cas typique de depression postpartum, et certains resultats d'une etude plus grande des resultats dans la psychotherapie mere-nourrisson, tout ceci pour valider notre principale hypothese: de nombreuses depressions post-partum sont mieux comprises en tant que trouble relationnel

Abstract: In many cases of troubled mother-infant relationships and of infant symptoms, brief forms of interventions addressed to the mother-infant dyad are indicated. A careful evaluation of maternal projections is needed in order to determine on which conflict to focus. An evaluation research of brief mother-infant research is presented; its results validate the use of such early interventions in prevention.

Abstract: Is early preventive intervention effective in enhancing parental sensitivity and infant attachment security, and if so, what type of intervention is most successful? Seventy studies were traced, producing 88 intervention effects on sensitivity (n = 7,636) and/or attachment (n = 1,503). Randomized interventions appeared rather effective in changing insensitive parenting (d = 0.33) and infant attachment insecurity (d = 0.20). The most effective interventions used a moderate number of sessions and a clear-cut behavioral focus in families with, as well as without, multiple problems. Interventions that were more effective in enhancing parental sensitivity were also more effective in enhancing attachment security, which supports the notion of a causal role of sensitivity in shaping attachment.

Abstract: 1 Interventions for cutaneous molluscum contagiosum (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. Main results We found 11 new studies for this update, resulting in 22 included studies with a total of 1650 participants. The studies examined the effects of topical (20 studies) and systemic interventions (2 studies). Among the new included studies were the full trial reports of three large unpublished studies, brought to our attention by an expert in the field. They all provided moderate-quality evidence for a lack of effect of 5% imiquimod compared to vehicle (placebo) on shortterm clinical cure (4 studies, 850 participants, 12 weeks after start of treatment, risk ratio (RR) 1.33, 95% confidence interval (CI) 0.92 to 1.93), medium-term clinical cure (2 studies, 702 participants, 18 weeks after start of treatment, RR 0.88, 95% CI 0.67 to 1.14), and long-term clinical cure (2 studies, 702 participants, 28 weeks after start of treatment, RR 0.97, 95% CI 0.79 to 1.17). We found similar but more certain results for short-term improvement (4 studies, 850 participants, 12 weeks after start of treatment, RR 1.14, 95% CI 0.89 to 1.47; high-quality evidence). For the outcome ’any adverse effect’, we found high-quality evidence for little or no difference between topical 5% imiquimod and vehicle (3 studies, 827 participants, RR 0.97, 95% CI 0.88 to 1.07), but application site reactions were more frequent in the groups treated with imiquimod (moderate-quality evidence): any application site reaction (3 studies, 827 participants, RR 1.41, 95% CI 1.13 to 1.77, the number needed to treat for an additional harmful outcome (NNTH) was 11); severe application site reaction (3 studies, 827 participants, RR 4.33, 95% CI 1.16 to 16.19, NNTH over 40). For the following 11 comparisons, there was limited evidence to show which treatment was superior in achieving short-term clinical cure (low-quality evidence): 5% imiquimod less effective than cryospray (1 study, 74 participants, RR 0.60, 95% CI 0.46 to 0.78) and 10% potassium hydroxide (2 studies, 67 participants, RR 0.65, 95% CI 0.46 to 0.93); 10% Australian lemon myrtle oil more effective than olive oil (1 study, 31 participants, RR 17.88, 95% CI 1.13 to 282.72); 10% benzoyl peroxide cream more effective than 0.05% tretinoin (1 study, 30 participants, RR 2.20, 95% CI 1.01 to 4.79); 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone (1 study, 30 participants, RR 3.50, 95% CI 1.23 to 9.92); and iodine plus tea tree oil more effective than tea tree oil (1 study, 37 participants, RR 0.20, 95% CI 0.07 to 0.57) or iodine alone (1 study, 37 participants, RR 0.07, 95% CI 0.01 to 0.50). Although there is some uncertainty, 10% potassium hydroxide appears to be more effective than saline (1 study, 20 participants, RR 3.50, 95% CI 0.95 to 12.90); homeopathic calcarea carbonica appears to be more effective than placebo (1 study, 20 participants, RR 5.57, 95% CI 0.93 to 33.54); 2.5% appears to be less effective than 5% solution of potassium hydroxide (1 study, 25 participants, RR 0.35, 95% CI 0.12 to 1.01); and 10% povidone iodine solution plus 50% salicylic acid plaster appears to be more effective than salicylic acid plaster alone (1 study, 30 participants, RR 1.43, 95% CI 0.95 to 2.16). We found no statistically significant differences for other comparisons (most of which addressed two different topical treatments). We found no randomised controlled trial evidence for expressing lesions or topical hydrogen peroxide. Study limitations included no blinding, many dropouts, and no intention-to-treat analysis. Except for the severe application site reactions of imiquimod, none of the evaluated treatments described above were associated with serious adverse effects (low-quality evidence). Among the most common adverse events were pain during application, erythema, and itching. Included studies of the following comparisons did not report adverse effects: calcarea carbonica versus placebo, 10% povidone iodine plus 50% salicylic acid plaster versus salicylic acid plaster, and 10% benzoyl peroxide versus 0.05% tretinoin. We were unable to judge the risk of bias in most studies due to insufficient information, especially regarding concealment of allocation and possible selective reporting. We considered five studies to be at low risk of bias. Authors’ conclusions No single intervention has been shown to be convincingly effective in the treatment of molluscum contagiosum. We found moderatequality evidence that topical 5% imiquimod was no more effective than vehicle in terms of clinical cure, but led to more application site reactions, and high-quality evidence that there was no difference between the treatments in terms of short-term improvement. However, high-quality evidence showed a similar number of general side effects in both groups. As the evidence found did not favour any one treatment, the natural resolution of molluscum contagiosum remains a strong method for dealing with the condition. P L A I N L A N G U A G E S U M M A R Y Treatments for molluscum contagiosum, a common viral skin infection in children Review question 2 Interventions for cutaneous molluscum contagiosum (Review) Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd. We reviewed the evidence for the effect of any treatment on the common viral skin infection molluscum contagiosum. We excluded people with a repressed immune system or sexually transmitted molluscum contagiosum. Background Molluscum contagiosum in healthy people is a self limiting, relatively harmless viral skin infection. It mainly affects children and adolescents and is rare in adults. It occurs worldwide, but seems much more frequent in geographic areas with warm climates. Molluscum contagiosum usually presents as single or multiple pimples filled with an oily substance. People may seek treatment for social and cosmetic reasons and because of concerns about spreading the disease to others. Treatment is intended to speed up the healing process. Study characteristics We searched the literature to July 2016. We included 22 trials (total of 1650 participants). Twenty of the studies evaluated topical treatment, and two studies evaluated treatment taken by mouth (oral). Comparisons included physical therapies, as well as topical and oral treatments. Most studies were set in hospital outpatient or emergency departments, and were performed in North America, the UK, Asia, or South America. Participants were of both sexes and were mainly children or young adults. Follow-up duration varied from 3 to 28 weeks after randomisation. Only five studies had longer than 3 months’ follow-up. Five studies reported commercial funding, three studies obtained medication for free from pharmaceutical companies, 12 studies did not mention the source of funding, one study reported charity funding, and one study reported they had had no financial support. Key results We found that many common treatments for molluscum, such as physical destruction, have not been adequately evaluated. Some of the included treatments are not part of standard practice. We found moderate-quality evidence that topical 5% imiquimod is probably no more effective than vehicle (i.e. the same cream but without imiquimod) in achieving short-, medium-, and long-term clinical cure. High-quality (and thus more certain) evidence showed that topical 5% imiquimod is no better than placebo at improving molluscum up to three months after the start of treatment. High-quality evidence showed that 5% imiquimod differed little or not at all in the number of side effects compared to vehicle. However, moderate-quality evidence suggests that there are probably more application site reactions when using topical 5% imiquimod compared with vehicle. Low-quality evidence, based on one or two mostly small studies, revealed the following results for the outcome short-term clinical cure: 5% imiquimod less effective than cryospray or 10% potassium hydroxide; 10% Australian lemon myrtle oil more effective than olive oil; 10% benzoyl peroxide cream more effective than 0.05% tretinoin; 5% sodium nitrite co-applied with 5% salicylic acid more effective than 5% salicylic acid alone; and iodine plus tea tree oil more effective than tea tree oil or iodine alone. We found more uncertain (low-quality) evidence to suggest that 10% potassium hydroxide is more effective than saline; homeopathic calcarea carbonica is more effective than placebo; 2.5% solution of potassium hydroxide is less effective than 5% solution of potassium hydroxide; and 10% povidone iodine solution and 50% salicylic acid plaster are more effective than salicylic acid plaster alone. Except for the severe application site reactions of imiquimod, none of these treatments led to serious adverse effects (low-quality evidence). Pain during treatment application, redness, and itching were among the most reported adverse effects. We found no differences between the treatments assessed in the other comparisons. We found no randomised trials for several commonly used treatments, such as expressing lesions with an orange stick or topical hydrogen peroxide. Since most lesions resolve within months, unless better evidence for the superiority of active treatments emerges, molluscum contagiosum can be left to heal naturally. Quality of the evidence For topical imiquimod, the quality of the evidence for clinical cure, short-term improvement, and adverse effects was moderate to high. For all other comparisons, the quality of the evidence for short-term clinical cure and adverse effects was low. Common limitations of the included studies were that the numbers of participants were small, the investigators were not blinded, and participants who did not complete the study (numerous in some studies) were not included in the analyses. 3 Interventions for cutaneous molluscum contagiosum (Rev

Abstract: Postpartum depression (PPD) is a common and serious mental health problem that is associated with maternal suffering and numerous negative consequences for offspring. The first six months after delivery may represent a high-risk time for depression. Estimates of prevalence range from 13% to 19%. Risk factors mirror those typically found with major depression, with the exception of postpartum-specific factors such as sensitivity to hormone changes. Controlled trials of psychological interventions have validated a variety of individual and group interventions. Medication often leads to depression improvement, but in controlled trials there are often no significant differences in outcomes between patients in the medication condition and those in placebo or active control conditions. Reviews converge on recommendations for particular antidepressant medications for use while breastfeeding. Prevention of PPD appears to be feasible and effective. Finally, there is a growing movement to integrate mental health screening into routine primary care for pregnant and postpartum women and to follow up this screening with treatment or referral and with follow-up care. Research and clinical recommendations are made throughout this review.

Abstract: Background Postnatal depression is associated with adverse child cognitive and socio-emotional outcome. It is not known whether psychological treatment affects the quality of the mother—child relationship and child outcome. Aims To evaluate the effect of three psychological treatments on the mother—child relationship and child outcome. Method Women with post-partum depression ( n =193) were assigned randomly to routine primary care, non-directive counselling, cognitive—behavioural therapy or psychodynamic therapy. The women and their children were assessed at 4.5, 18 and 60 months post-partum. Results Indications of a positive benefit were limited. All three treatments had a significant benefit on maternal reports of early difficulties in relationships with the infants; counselling gave better infant emotional and behaviour ratings at 18 months and more sensitive early mother—infant interactions. The treatments had no significant impact on maternal management of early infant behaviour problems, security of infant—mother attachment, infant cognitive development or any child outcome at 5 years. Conclusions Early intervention was of short-term benefit to the mother—child relationship and infant behaviour problems. More-prolonged intervention may be needed. Health visitors could deliver this.

Abstract: Background The efficacy of psychodynamic therapy is controversial Previous meta-analyses have reported discrepant results Objective To test the efficacy of short-term psychodynamic psychotherapy (STPP) in specific psychiatric disorders by performing a meta-analysis of more recent studies We assessed outcomes in target problems, general psychiatric symptoms, and social functioning Design We identified studies of STPP published between January 1, 1970, and September 30, 2004, by means of a computerized search using MEDLINE, PsycINFO, and Current Contents Rigorous inclusion criteria, included randomized controlled trials, use of treatment manuals and ensurance of treatment integrity, therapists experienced or specifically trained in STPP, treatment of patients with specific psychiatric disorders, reliable and valid diagnostic measures, and data necessary to calculate effect sizes Studies of interpersonal therapy were excluded Seventeen studies fulfilled the inclusion criteria The information was extracted by 3 raters Effect sizes were calculated for target problems, general psychiatric symptoms, and social functioning using the data published in the original studies To examine the stability of outcome, we assessed effect sizes separately for end of therapy and follow-up assessment The effect sizes of STPP were compared with those of waiting-list control patients, treatments as usual, and other forms of psychotherapy Results Short-term psychodynamic psychotherapy yielded significant and large pretreatment-posttreatment effect sizes for target problems (139), general psychiatric symptoms (090), and social functioning (080) These effect sizes were stable and tended to increase at follow-up (157, 095, and 119, respectively) The effect sizes of STPP significantly exceeded those of waiting-list controls and treatments as usual No differences were found between STPP and other forms of psychotherapy Conclusions Short-term psychodynamic psychotherapy proved to be an effective treatment in psychiatric disorders However, further research of STPP in specific psychiatric disorders is needed, including a study of the active ingredients of STPP Effectiveness studies should be included