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Original Research Expression of Depressive Symptoms in a Nonclinical Brazilian Adolescent Sample
Clarice Gorenstein, PhD, Laura Andrade, MD, PhD, Elaine Zanolo, Rinaldo Artes, PhD
(PDF)

Posttraumatic Stress Disorder and General Psychopathology in Children and Adolescents Following a Wildfire Disaster
Brett M McDermott, MBBS, Cert Child Psych, FRANZCP, Erica M Lee, BA, Dip Psych, Marianne Judd, BSc Psych, MEd, Peter Gibbon, PhD
(PDF)

Individual Change in Methylphenidate Use in a National Sample of Children Aged 2 to 11 Years
Elisa Romano, PhD, Raymond H Baillargeon, PhD, Isabel Fortier, PhD, Hong-Xing Wu, MSc4, Philippe Robaey, MD, Mark Zoccolillo, MD, Richard E Tremblay, PhD
(PDF)

An Introduction to Economic Evaluation: What’s in a Name?
Jeffrey S Hoch, MA, PhD, Carolyn S Dewa, MPH, PhD
(PDF)

Recherche Originale *Méthadone et Syndrome d’Apnées du Sommeil
Philippe Durst, MD, Jérôme Palazzolo, MD, PhD, Jean-Pierre Peyrelong, MD, Michel Berger, MD, Michel Chalabreysse, MD, Michel Billiard, PhD, André Vialle, MD
(PDF)

Review Paper
Using Metaanalysis to Evaluate Evidence: Practical Tips and Traps
Raymond W Lam, MD, FRCPC, Sidney H Kennedy, MD, FRCPC
(PDF)

Brief Communication
Experimental Affective Symptoms in Panic Disorder Patients
Thea Overbeek, MD, PhD, Koen Schruers, MD, PhD, Ine Docters van Leeuwen, BSc, Tineke Klaassen, MD, PhD, Eric Griez, MA, MD, PhD
(PDF)

Book Reviews
(PDF)

The Treatment of Drinking
Problems: A Guide for the Helping Professions.
Review by
Nady el-Guebaly, MD, FRCPC

Bipolar Disorder: A Clinician’s Guide to Biological Treatments.
Review by
Review by: Rakesh Jain MD, MPH
Shailesh Jain, MD, MPH


Handbook of Female Psychopharmacology
Review by
Laura Calhoun, FRCPC

Sleep and Dreaming: Scientific Advances and Reconsiderations.
Review by
Alan Douglass, MD

Cognitive-Behavioral Treatment of Obesity. A Clinician’s Guide.
Review by
Hany Bissada, MD, FRCPC

Cognitive Therapy of Personality Disorders. Second Edition.
Review by
W John Livesley

Letters to the Editor
(PDF)

Hemorrhages During Escitalopram–Venlafaxine– Mirtazapine Combination Treatment of Depression

Re: Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Reply: Lorazepam-Induced Prolongation of the QT Interval in a Patient With Schizoaffective Disorder and Complete AV Block

Lithium-Associated Anencephaly

Aripiprazole-Induced Seizure

Prevalence of Bipolar Disorder and Major Depression Among Patients Seen in Primary and Secondary Care in Finland

The Need for More Community Nursing for Adults With Intellectual Disabilities and Mental Health Problems

Improvement in Tardive Dyskinesia With Aripiprazole Use

Book Review

Personality Disorders

Cognitive Therapy of Personality Disorders. Second Edition. Aaron T Beck, Arthur Freeman, Denise D Davis, and Associates. New York: Guilford Press; 2004. 412 p. US$46.00.

Review by: W John Livesley

This is a disappointing volume, even though it presents valuable concepts for understanding the cognitive component of personality disorder, as well as many useful interventions. The first edition, published in 1990, was a seminal contribution that offered a new perspective on the treatment of personality disorder, a topic previously dominated almost entirely by therapies based on psychoanalytic theory. In it, Beck and colleagues offered an innovative perspective that had a major impact. The limitation of the first edition was its modest evidential support for both overall approach and specific treatment strategies. Indeed, the authors noted that this was embarrassing in a mode of treatment that advocates empiricism. The widely anticipated second edition was expected to correct this deficiency by offering a theory that was more coherent and solidly grounded in empirical findings and evidence-based interventions. Alas, this volume fails to deliver.

This edition has 16 chapters. The first 5 offer an overview of cognitive therapy for personality disorder, present the rudiments of a theory of personality disorder, discuss issues of assessment, outline general principles and specialized techniques, and explore the important issue of the therapeutic relationship. They are followed by 10 chapters, each describing the psychopathology and cognitive therapy of a specific disorder. All the DSM-IV personality disorders are considered, except for schizotypal and passive-aggressive personality disorder. The last chapter offers a brief synthesis and comments on prospects.

Chapter 2 purports to describe a theory of personality disorder. The first edition offered a sketchy framework comprising a somewhat loosely arranged set of constructs and ideas. Although many of these ideas were useful, and probably essential, components of any theory, they were not systematically articulated. The corresponding chapter in this second edition offers little that is new. It combines the first edition’s Chapters 2 and 3 and offers almost identical layout and subheadings—as if the field of personality disorder had remained unchanged for the last 15 years. In fact, ideas about the disorder’s nature, origins, and classification have changed markedly and continue to do so. Many of these developments are barely referenced, let alone incorporated into the model or into intervention strategies. This is part of a more general problem: the book is written with scant attention to the context of scholarship in related fields. Particularly problematic is its neglect of current work on normal personality, especially research on cognitive approaches to personality. This research provides a body of knowledge about personality processes that could have greatly enriched the reviewed volume’s framework and contributed to a more solid conceptual model.

As with the first edition, much of this volume is organized in terms of DSM-IV diagnoses. Although this arrangement is understandable, given the influence of the DSM, it is nevertheless surprising that the DSM model was followed so uncritically, because there is overwhelming evidence of its limitations and an emerging consensus that radical change is needed in the classification of personality disorder. Each disorder is conceptualized in terms of self-view, beliefs, threats, strategy, and affect, and intervention strategies based on this conceptualization are then proposed. This approach implies that disorders are discrete entities, despite evidence to the contrary. Because each disorder is considered distinct and each is discussed in similar depth, most chapters offer relatively superficial accounts. Consequently, the text as a whole fails to address the problems encountered in treating severe disorder. Throughout, readers are left with the impression that personality disorder is relatively easy to treat and that change is easily achieved. Despite disclaimers throughout the volume that note the challenges of treating personality disorder, many of the case examples create the impression that this is not so—probably because many appear to be less severe than those typically seen in general clinical settings and many seem to involve dysfunctional personality traits rather than personality disorder per se. These problems do not apply to all chapters, however, some of which thoughtfully discuss problems encountered during treatment. For example, the chapter on antisocial personality disorder discusses useful ideas and offers more detailed analysis of the issues. Many of these ideas and cautions could have been usefully included in a general chapter on the principles of treating all forms of personality disorder.

The volume’s limitations reside in its structure and mode of approach. The text is clearly written, well laid-out, and easy to read. The editors have done a good job of maintaining consistency, despite the many authors involved.

Perhaps the major limitation of this book stems from the fact that, while the authors represent the crPme de la crPme of cognitive therapy, they are not primarily students of normal and disordered personality. As a result, they have created a volume that is rich in its account of Beck’s model of cognitive therapy but weak when it comes to understanding and treating personality pathology. Some contributors to specific chapters have published on personality disorder, but they do not seem to have been part of the core writing and editorial team.

When reading this book, readers should bear in mind the findings of studies of treatment outcome. The evidence indicates that various treatments, both psychotherapeutic and pharmacologic, are effective in treating personality pathology but that no single form of psychotherapy stands out as better than the rest. A recent metaanalysis indicated that cognitive and psychodynamic therapies are approximately equally effective. Cognitive interventions derived from the Beck model are important ingredients of a comprehensive and integrated approach to treatment, but they are not the whole story.

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Not recommended / Pas recommandé