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Summary: Some investigators argue that treating epi lepsy with several antiepileptic drugs (AEDs) simulta neously (polytherapy) may give rise to more adverse ef fects than monotherapy, but this argument lacks support ing quantitative data, To reexamine this issue, we recruited a cohort of patients from the outpatients of the Special Centres for Epilepsy in The Netherlands and from the outpatients of the Department of Neurology, Nij megen University, The Netherlands. Two tools were used for analysis. All daily doses of antiepileptic drugs (AEDs) were standardized by the ratio of prescribed daily dose to defined daily dose (PDD/DDD). The DDD is the assumed average effective daily dose for a drug used for its main indication in adults. The assignment of DDD val ues is the task of the World Health Organization (WHO) Collaborating Centre for Drugs Statistics Methodology and Nordic Council on Medicines, which regularly pub lishes Guidelines for Defined Dally Doses. The severity of adverse effects (AE) was assessed by using the Neu rotoxicity Index and the Systemic Toxicity Index as de veloped by the VA Cooperative Study Group for their recent studies comparing the efficacy and tolerability of AEDs. One hundred sixty-one patients received mono therapy; all had a PDD/DDD ratio ^2/day; 128 of 262 patients receiving poly therapy also had ^2 PDD/DDD ratios/day. The mono-and poly therapy groups were stratified according to the PDD/DDD ratio. The prevalence of neurological AE for patients with similar PDD/DDD ra tios was 50-80% for monotherapy patients and 50-82% for poly therapy patients. The difference between the mono-and polytherapy groups was not significant. The prevalence of neurological AE for patients receiving poly therapy with a PDD/DDD ratio > 2 .0 was 71-100%, whereas all patients with a PDD/DDD ratio > 4.0 had neu rological AE. This difference between patients with a PDD/DDD ratio ^2.0 and those with > 2.0 was statisti cally significant; p < 0.05. The severity of neurological AE also increased with dose, but appeared to peak at -3.5 PDD/DDD ratio. Our study underscores the useful ness of applying quantitative methods to the analysis of drug AE, Comparison of monotherapy and polytherapy showed no difference for equipotent doses. Because dis tribution of the AED doses was uneven between the groups receiving mono-and poly therapy, our study per mits only a tentative statement that the frequency and severity of AE is independent of the use of either. In addition, frequency and intensity of AE apparently are not very sensitive to changes in dose. An experimental prospective study is planned to verify or refute the con clusions of this observational pilot study. Key Words: Ep ilepsy-Antiepileptic drugs-Adverse effectsMonotherapy-Polytherapy-Clinimetrics.Remaining seizure-free is sufficiently important for many patients with epilepsy for them to accept the adverse effects (AE) of continual use of antiep ileptic drugs (AEDs). The problem of toxicity of AEDs has been reviewed repeatedly (1-4). There is a long tradition ...

Background: Current guidelines recommend cognitive behavior therapy (CBT) as the treatment of choice for binge eating disorder (BED). Although CBT is quite effective, a substantial number of patients do not reach abstinence from binge eating. To tackle this problem, various theoretical conceptualizations and treatment models have been proposed. Dialectical behavior therapy (DBT), focusing on emotion regulation, is one such model. Preliminary evidence comparing DBT adapted for BED (DBT-BED) to CBT is promising but the available data do not favor one treatment over the other. The aim of this study is to evaluate outcome of DBT-BED, compared to a more intensive eating disorders-focused form of cognitive behavior therapy (CBT+), in individuals with BED who are overweight and engage in emotional eating. Methods: Seventy-four obese patients with BED who reported above average levels of emotional eating were quasi-randomly allocated to one of two manualized 20-session group treatments: DBT-BED (n = 41) or CBT+ (n = 33). Intention-to-treat outcome was examined at post-treatment and at 6-month follow-up using general or generalized linear models with multiple imputation. Results: Overall, greater improvements were observed in CBT+. Differences in number of objective binge eating episodes at end of treatment, and eating disorder psychopathology (EDE-Q Global score) and self-esteem (EDI-3 Low Self-Esteem) at follow-up reached statistical significance with medium effect sizes (Cohen's d between .46 and .59). Of the patients in the DBT group, 69.9% reached clinically significant change at end of the treatment vs 65.0% at followup. Although higher, this was not significantly different from the patients in the CBT+ group (52.9% vs 45.8%).

Although effective behavioral techniques have been developed, what aspects of the patient-therapist interaction affect treatment outcome remain largely unknown. This study hypothesized that the interaction between patient and therapist develops over several phases. Further, the association between behavior modes and treatment outcome was expected to alter as that interaction developed. Thirty patients diagnosed with panic disorder with agoraphobia were treated with a standardized behavioral treatment program of 12 sessions. The interpersonal verbal therapist and patient behavior modes were studied at Sessions 1, 3, and 10, using an observational instrument. It was found that behavior modes change over the course of treatment, in line with predictions derived from social-psychological models. The hypothesis that establishing a therapeutic relationship requires an empathic and nondirective stance by the therapist in Session 1 was partly confirmed.