Editorial Credits/ Crédits éditorials

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Advertising Rates / Tarifs publicitaires (PDF)

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

Eating Disorders

Cognitive-Behavioral Treatment of Obesity. A Clinician’s Guide. Zafra Cooper, Christopher G Fairburn, Deborah M Hawker. New York: The Guilford Press; 2003. 232 p. US$35.00.

Review by: Hany Bissada, MD, FRCPC
Ottawa, Ontario

Many weight-loss programs and manuals have been developed in the last 10 years to address the steady rise in the prevalence of obesity (defined as body mass index between 30 and 40) and its associated medical complications, including diabetes and cardiovascular diseases. The outcome for patients so far has been to achieve weight loss in the short-term, followed by failure to sustain that weight loss in the long term, a frustrating experience for both patients and clinicians treating obesity. The authors of this book addressed the failure to sustain weight loss in the long term by proposing an innovative therapeutic approach that is currently being evaluated in a randomized controlled trial at Oxford University. They acknowledge that proposing this innovative approach remains premature until the research evidence supporting its effectiveness is available. Nonetheless, they produced the book now in response to requests from clinicians seeking guidance for the treatment of patients with obesity, particularly those who are at risk for developing serious medical complications.

The authors are internationally known for their research and experience using cognitive-behavioural therapy (CBT) to treat eating disorders and obesity. The innovative approach they propose in this book addresses the obstacles preventing weight maintenance after the initial weight loss and offers patients the techniques that will allow them to maintain their new weight, an indispensable step that has so far been missing in the long-term management of obesity.

Briefly, the authors suggest that the disappointing long-term results of behavioural treatments for obesity may be explained by the lack of distinction between the immediate weight-loss objective, which requires sustaining an energy deficit and is usually achieved by most patients, and the objective of maintaining the lost weight, which is a long-term activity seldom addressed by most of the behavioural weight-loss programs currently available. The situation is further complicated by the fact that most obese patients join a weight-loss program with the goal of achieving an unrealistically low weight that they believe will allow them to achieve other personally important objectives, such as becoming physically attractive and improving self-confidence and self-esteem. Since most patients experience a decline in the rate of weight loss after 4 to 6 months of attempting to lose weight, they soon realize that they will achieve neither their unrealistic low weight goal nor their other objectives of physical attractiveness and improved self- esteem and self-confidence. Such realization leads them to the erroneous conclusion that their weight-control effort has been a failure; consequently, they abandon all weight- control efforts and return to their prior eating habits. A positive energy balance develops, and they gradually regain the weight they initially lost. A few obese patients insist on maintaining an energy deficit until they achieve their unrealistic low weight goal. Even when they manage to reach that unrealistic low weight, they are unlikely to maintain it for long; some will develop binge eating, and most will gradually regain the lost weight within the next 2 to 3 years.

Based on the foregoing cognitive- behavioural analysis of the processes responsible for weight regain, the authors propose a CBT approach that emphasizes the equal importance of the 2 treatment phases, namely, weight loss and weight maintenance. The book provides a detailed description of the proposed treatment. It comprises 24 sessions spread over 44 weeks and is delivered in 2 phases. Phase 1 requires 17 sessions spread over 30 weeks; its goal is to achieve a gradual weight loss over 4 to 6 months at a caloric intake of 1500 cal daily. Patients are expected to lose about 0.5 to 1 kg weekly and are made aware that weight loss of 10% to 15% yearly should reduce most of the medical problems associated with obesity.

Phase 2 has 7 sessions spread over 14 weeks; it aims to help patients maintain the new weight over time. It does so by identifying and moderating unrealistically low weight goals, by tackling body-image concerns, and by teaching patients about appropriate ways to achieve their objectives of physical attractiveness and improved self-esteem and self- confidence. The ultimate goal of Phase 2 is to help patients appreciate the weight loss achieved during Phase 1, even if it did not meet initial expectations. Such appreciation will motivate patients to maintain their new healthy eating habits, and thus the weight loss already achieved will have a better chance to be maintained long-term.

In conclusion, I highly recommend this well-written and reasonably priced book to all clinicians interested in using CBT in the treatment of patients with obesity. It is the first treatment manual for obesity that describes step by step how to conduct CBT for patients suffering from obesity.

Excellent / Excellent
Very Good / Très bon
Good / Bon
Fair / Passable
Not recommended / Pas recommandé