[Psychopathology of obesity. Therapeutic contract]. / Psychopathologie de l'obèse. Contrat thérapeutique.

Multiple mechanisms lead to the establishment and maintenance of obesity. A better understanding and analysis of theses factors should help to design improved therapies. The therapeutic constract is based upon the hypothesis that many subjects have an "empathic" type of psychological structure and builds a physician-patient relationship allowing the patient to be supported during its dietary effort and to feel confident enough to express his difficulties, and the physician to better understand his patient and anticipate on an eventual relapse. The ideal weight notion is a key element, as it should not be considered as an established target based upon standards, but rather be progressively adapted between physician and patient.

[Weight gain and antipsychotic drug treatment]. / Prise de poids et traitement antipsychotique.

Like the classical neuroleptic drugs, most of the new antipsychotic agents can cause weight gain in patients receiving long-term treatment. However, it remains difficult to rank the different compounds according to their propensity to cause this unwanted side-effect. Recent data suggest that weight gain appears to be essentially related to an increase in appetite in these patients. Thus, it is a fact that the patients' diet represents the main predictive factor for weight gain, independently of the antipsychotic compound prescribed. In contrast to the other and often more disabling side-effects of these treatments, overweight can be effectively prevented by simple hygienic and dietetic measures. It would therefore be advisable to discuss the possibility of this side-effect of antipsychotic treatment with the patient, and to suggest appropriate preventive measures, as part of the therapeutic partnership.