Psychotherapy Research Today is a free monthly online journal that collates and summarizes the latest research about Psychotherapy, including details on psychiatry, psychoanalysis, methods, outcomes.

Weight and metabolic outcomes after 2 years on a low-carbohydrate versus low-fat diet: a randomized trial.

Foster GD, Wyatt HR, Hill JO, Makris AP, Rosenbaum DL, Brill C, Stein RI, Mohammed BS, Miller B, Rader DJ, Zemel B, Wadden TA, Tenhave T, Newcomb CW, Klein S

Center for Obesity Research and Education, Temple University, Philadelphia, Pennsylvania 19140, USA. gfoster@temple.edu

BACKGROUND: Previous studies comparing low-carbohydrate and low-fat diets have not included a comprehensive behavioral treatment, resulting in suboptimal weight loss. OBJECTIVE: To evaluate the effects of 2-year treatment with a low-carbohydrate or low-fat diet, each of which was combined with a comprehensive lifestyle modification program. DESIGN: Randomized parallel-group trial. (ClinicalTrials.gov registration number: NCT00143936) SETTING: 3 academic medical centers. PATIENTS: 307 participants with a mean age of 45.5 years (SD, 9.7 years) and mean body mass index of 36.1 kg/m(2) (SD, 3.5 kg/m(2)). INTERVENTION: A low-carbohydrate diet, which consisted of limited carbohydrate intake (20 g/d for 3 months) in the form of low-glycemic index vegetables with unrestricted consumption of fat and protein. After 3 months, participants in the low-carbohydrate diet group increased their carbohydrate intake (5 g/d per wk) until a stable and desired weight was achieved. A low-fat diet consisted of limited energy intake (1200 to 1800 kcal/d; <or=30% calories from fat). Both diets were combined with comprehensive behavioral treatment. MEASUREMENTS: Weight at 2 years was the primary outcome. Secondary measures included weight at 3, 6, and 12 months and serum lipid concentrations, blood pressure, urinary ketones, symptoms, bone mineral density, and body composition throughout the study. RESULTS: Weight loss was approximately 11 kg (11%) at 1 year and 7 kg (7%) at 2 years. There were no differences in weight, body composition, or bone mineral density between the groups at any time point. During the first 6 months, the low-carbohydrate diet group had greater reductions in diastolic blood pressure, triglyceride levels, and very-low-density lipoprotein cholesterol levels, lesser reductions in low-density lipoprotein cholesterol levels, and more adverse symptoms than did the low-fat diet group. The low-carbohydrate diet group had greater increases in high-density lipoprotein cholesterol levels at all time points, approximating a 23% increase at 2 years. LIMITATION: Intensive behavioral treatment was provided, patients with dyslipidemia and diabetes were excluded, and attrition at 2 years was high. CONCLUSION: Successful weight loss can be achieved with either a low-fat or low-carbohydrate diet when coupled with behavioral treatment. A low-carbohydrate diet is associated with favorable changes in cardiovascular disease risk factors at 2 years. PRIMARY FUNDING SOURCE: National Institutes of Health.

Published 3 August 2010 in Ann Intern Med, 153(3): 147-57.
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Articles on Psychotherapy published 21 July 2010:

Multicenter, placebo-controlled trial of lorcaserin for weight management.   N Engl J Med, 363(3): 245-56.

BACKGROUND: Lorcaserin is a selective serotonin 2C receptor agonist that could be useful in reducing body weight. METHODS: In this double-blind clinical trial, we randomly assigned 3182 obese or overweight adults (mean body-mass index [the weight in kilograms divided by the square of the height in meters] of 36.2) to receive lorcaserin at a dose of 10 mg, or placebo, twice daily for 52 weeks. All patients also underwent diet and exercise counseling. At week 52, patients in the placebo group ... [Abstract] [Full-text]

Articles on Psychotherapy published 19 July 2010:

Long-term outcome of brief augmented psychodynamic interpersonal therapy for psychogenic nonepileptic seizures: seizure control and health care utilization.   Epilepsia, 51(7): 1169-76.

PURPOSE: Most neurologists endorse psychotherapy as the treatment of choice for psychogenic nonepileptic seizures (PNES), but its effectiveness remains unproven, and there are no previous reports of long-term outcome after psychotherapy. This study aimed to establish the outcome of brief augmented psychodynamic interpersonal therapy (PIT) for 47 patients with PNES in terms of seizures and health care utilization 31-65 months (median 50 months) after diagnosis. METHODS: Participants completed ... [Abstract] [Full-text]

Evaluation of a brief cognitive intervention in patients with signs of postnatal depression: a randomized controlled trial.   Acta Obstet Gynecol Scand, 89(8): 1100-4.

The effectiveness of a brief intervention based on individual cognitive behavioral counseling in mothers with signs of postnatal depression was evaluated. Patients undergoing a complicated delivery were invited to participate. Women who scored above a cut-off level (>12) on Edinburgh Postnatal Depression Scale (EPDS) were randomized to either a brief individual cognitive behavioral counseling comprising three weekly 1 hour sessions (n = 33) or standard care (n = 34). Measures of postnatal ... [Abstract] [Full-text]

Articles on Psychotherapy published 12 July 2010:

Candidate performance measures for screening for, assessing, and treating unhealthy substance use in hospitals: advocacy or evidence-based practice?   Ann Intern Med, 153(1): 40-3.

The Joint Commission recently proposed candidate performance measures addressing unhealthy substance use in hospitalized patients. The proposed measures of screening and brief intervention (SBI) assume that interventions that work in one setting (primary care outpatient practice) would work in another (hospital); treatment would have the same benefits for persons identified by screening as for those with symptoms who seek help; treatments that work for persons less severely affected by ... [Abstract] [Full-text]

Lowering postdialysis plasma sodium (conductivity) to increase sodium removal in volume-expanded hemodialysis patients: a pilot study using a biofeedback software system.   Am J Kidney Dis, 56(1): 69-76.

BACKGROUND: Extracellular fluid expansion is common in hemodialysis patients. Aggressive fluid removal may lead to intradialytic complications. High dialysate sodium concentrations may lessen complications, but may increase extracellular volume. We hypothesized that decreasing plasma sodium concentration during dialysis will increase sodium removal and decrease extracellular volume. STUDY DESIGN: Pilot clinical trial. SETTING & PARTICIPANTS: 16 patients with end-stage kidney disease treated ... [Abstract] [Full-text]

Articles on Psychotherapy published 8 July 2010:

Does the cognitive dispute of psychotic symptoms do harm to the therapeutic alliance?   J Nerv Ment Dis, 198(7): 478-85.

We examined whether the cognitive dispute of psychotic symptoms has a negative impact on the course of the therapeutic alliance. Sixty-seven patients with persistent psychotic symptoms received either cognitive behavioral therapy (CBT) or supportive therapy. Questionnaire-based alliance ratings were repeatedly obtained throughout the course of therapy. Patient and therapist alliance ratings were examined separately. Data analyses comprised repeated measurement analyses of variance and cluster ... [Abstract] [Full-text]

Combined pharmacotherapy and psychological therapies for post traumatic stress disorder (PTSD).   Cochrane Database Syst Rev, 7: CD007316.

BACKGROUND: PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re-experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.Guidelines suggest a combination of both psychological therapy and pharmacotherapy may enhance treatment response, especially in those with more severe PTSD or in those who have not responded to either intervention alone. OBJECTIVES: To assess whether the combination of ... [Abstract] [Full-text]

Music therapy for acquired brain injury.   Cochrane Database Syst Rev, 7: CD006787.

BACKGROUND: Acquired brain injury (ABI) can result in impairments in motor function, language, cognition, sensory processing and emotional disturbances. This may severely reduce a survivor's quality of life. Music therapy has been used in rehabilitation to stimulate brain functions involved in movement, cognition, speech, emotions and sensory perceptions. A systematic review is needed to gauge the efficacy of music therapy as a rehabilitation intervention for people with ABI. OBJECTIVES: To ... [Abstract] [Full-text]

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