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A character split into two bodies: the real Arthur Cravan, an eccentric character who moved in the intellectual and artistic circles of the first decades of the 20th century, and Frank Nicotra, the one in charge of interpreting him at the beginning of the second millennium. Both fighters and poets, although separated by decades of difference. Isaki LaCuesta offers a hybrid of documentary and fiction where Cravan’s character engulfs Nicotra’s until the line that separates one from the other is lost. This communication studies the strategies used by its director to achieve this symbiosis between the two main protagonists. The use of recreations of a past time to visualize the life of Oscar Wilde’s nephew in contemporary times to the making of the film and the maneuvers that Lacuesta follows to blur past and present not only in the main characters, but in the rest of the cast are the objective of this article. The forms of acting in this non-fiction film will also be studied according to the Thomas Waugh’s theories and it will be analyzed whether the characters are part of the borderline individuals typical of postmodern cinema that Gérard Imbert has studied.

Ante el avance vertiginoso de la ciencia y la tecnología, las sociedades contemporáneas se han visto afectadas de varias maneras, así por ejemplo, se han logrado avances para mejorar el estilo de vida de las personas, pero también se han profundizado las desigualdades entre los que tienen acceso a la nueva tecnología y aquellos que no tienen acceso, además, estos últimos se han convertido en grupos vulnerables ante organizaciones con poder que hacen uso de la información personal de forma indiscriminada y sin respeto a la privacidad, ni la confidencialidad y ni la autonomía de los individuos, persiguiendo el beneficio solo de unos pocos. Se vive un nuevo colonialismo, esa dependencia irracional y desmedida que plantea varios cuestionamientos éticos, lo que se convierte en una Bioética aplicada (Bioética de intervención), como aquella que facilita el hallazgo de alternativas para apoyar a la solución de realidades como la desigualdad, la discriminación y el abuso; la Bioética de intervención, en este trabajo, se plantea como una herramienta que proteja a la sociedad del uso ilegitimo e ilegal de información por parte de las organizaciones que operan con Big data.

Desde finales del siglo XX el desarrollo de la ciencia y la tecnología ha experimentado un crecimiento exponencial con avances en todas las áreas del conocimiento cuyo propósito final, al menos en teoría, ha sido el de facilitar la vida a cada ser humano en su paso por este planeta. Ha habido avances muy importantes en las comunicaciones, la salud, la informática, el transporte, entre otros, que han sido capaces de producir fuertes impactos en la sociedad, afectando los estilos de vida, los valores, las relaciones de poder etc., incluso, pueden llevar a una transformación total de la sociedad en cortos tiempos, o lo que es peor, aunque es un escenario pesimista, su propia destrucción. En términos de Agazzi (1996) “En la civilización tecnológica que vivimos la tecnología es una red que abarca los más diversos sectores de la actividad humana, un modo de vivir, de comunicarse, de pensar, un conjunto de condiciones por las cuales el hombre es dominado ampliamente, mucho más que tenerlos a su disposición" (p.141). El presente trabajo pretende reflexionar sobre el impacto del desarrollo tecnológico en la sociedad y en las maneras de enfrentar estos nuevos escenarios vistos desde una nueva perspectiva que es la bioética, entendida como un elemento dinamizador que pretende aportar con soluciones a los grandes problemas presentes y futuros de la humanidad. La Bioética nace como una alternativa de pensamiento con propuestas que favorezcan la convivencia armónica de las personas y la naturaleza; de ahí que es de trascendental importancia la ampliación epistemológica de la bioética hacia todos los procesos de la vida a fin de ayudar a construir la ruta por la que debe transitar la ciencia y la tecnología en beneficio de un mejor vivir para la sociedad y su proyección al futuro.

Background A variety of cognitive and emotional processes influence the decision-making deficits observed in pathological gambling (PG). This study investigated the role of immediate/delayed sensitivity to reward and punishment, executive functions, impulsivity and explicit knowledge in relation to decision-making performance on the original Iowa Gambling Task (IGT-ABCD) and a variant (IGT-EFGH). Methods We assessed 131 consecutive patients with a diagnosis of PG by using executive functioning and decision-making tasks, self-report measures of impulsivity and explicit knowledge. Results The majority of pathological gamblers (PGs) showed deficits in decision-making, characterized mainly by myopia for the future. Decisions made under risk showed different predictors. Performance on the IGT-ABCD for decisions made under risk was predicted by medium and high levels of explicit knowledge of the task, as well as by scores on the Disorderliness subscale and the degree of Stroop interference. By contrast, IGT-EFGH results were only associated with self-report impulsivity measures. Conclusions Decision making in PG involves distinct patterns of deficits, and the predictors differ depending on the reinforcement schedule. Decisions made under risk on the IGT-ABCD are associated with explicit knowledge, executive functions and impulsivity traits related to conscious awareness and control processes. On the IGT-EFGH, however, only impulsivity traits predict decision making. (Am J Addict 2013;22:492–499)

Background Partial response and non-response to treatments are common problems in major depression. The identification of biological markers of clinical response may be of special interest for some adjunctive treatments, such as repetitive transcranial magnetic stimulation (rTMS), as it may ultimately improve their cost-effectiveness. Objective To identify pre-treatment functional imaging correlates of clinical response to rTMS in major depression. Methods We evaluated 21 depressed patients. They were randomized to receive 15 sessions of active or sham rTMS on the left dorsolateral prefrontal cortex. Functional magnetic resonance imaging (fMRI) was used to assess pre-treatment regional brain activity evoked by a word generation task. These regional activations were correlated (voxel-wise) with the Hamilton Rating Scale for Depression (HAM-D) reduction between baseline and end of treatment. A group of 13 healthy controls was also assessed using the same fMRI protocol to obtain reference imaging measurements. Results At the end of treatment, the percentage of patients with a HAM-D reduction greater than 50% was larger in the active than in the sham rTMS group (70% vs. 27.3%). In the active rTMS group, larger HAM-D reductions were significantly correlated with smaller deactivations during pre-treatment fMRI assessment in the anterior cingulate, the left medial orbitofrontal and the right middle frontal cortices, in addition to larger activations in the left ventral-caudal putamen. Conclusions These results suggest that brain activity in regions arguably relevant for major depression may predict clinical response to rTMS. This approach may help in identifying the most suitable candidates to undergo rTMS treatment.

Background: Environmental stressors are considered to play an important role in the triggering of mental disorders such as obsessive–compulsive disorder (OCD). Although there is extensive literature on traumatic life events, little is known about the role of nontraumatic but nonetheless stressful life events (SLEs) in OCD. The aim of this study was to establish whether OCD preceded by an SLE presents a different clinical pattern compared to non-SLE-preceded OCD. Methods: We interviewed 412 OCD patients to assess both SLEs at onset of OCD and other clinical variables, including OCD symptom dimensions. Logistic regression was then applied to explore the relationship between clinical variables and OCD preceded by an SLE. Results: The SLE-preceded OCD group showed a later onset of the disorder (OR = 1.04, P = .015), a history of complicated birth (OR = 5.54, P

OBJECTIVE: Several studies have reported clinical and biological differences between early- and late-onset (EO and LO) depression, which suggest different underlying aetiological processes. The aim of the present study is to examine whether there are differences between EO and LO depressed patients with melancholy, controlling for current age, with regard to clinical variables, vascular risk factors and family history of affective disorders or suicide. METHODS: One hundred and twenty-one melancholic patients were divided into three groups: patients with current age and onset earlier than 60 (N = 60), patients aged 60 or over and with onset at 60 or later (N = 30) and patients aged 60 or over and with onset before the age of 60 (N = 31). Systematic clinical data were collected with the structured interview 'The Schedule for Affective Disorders and Schizophrenia'. Symptom ratings at admission and at discharge were assessed by means of the 21-item Hamilton Depression Rating Scale, the Hamilton Anxiety Scale and the Widlocher Depression Retardation Scale. Family history of affective disorders or suicide was obtained using the Family History Research Diagnostic Criteria. Vascular risk factors were also recorded. RESULTS: The only symptoms that differed across the groups were feelings of anger and irritability, which scored lower in the LO older group. No other significant differences were found in the variables studied. CONCLUSION: According to this study, LO depression with melancholia should not be considered as a distinct entity. Further studies on EO and LO-depression should consider this diagnostic subtype, among others, as a key variable. Copyright © 2010 John Wiley & Sons, Ltd. Language: en

Although clinical and genetic data for obsessive-compulsive disorder (OCD) support the hypothesis of sexual dimorphism, the neuropsychological findings remain inconclusive. The aim of our study was to determine whether there are differences in cognitive performance between men and women with OCD as compared with healthy controls (HCs). A neuropsychological battery was administered to 50 patients with OCD (31 men and 19 women) and 50 HCs matched by sex, age, and educational level with patients. We evaluated intelligence, attention, episodic memory, and use of organizational strategies during encoding of verbal and nonverbal information. Male patients scored worse than controls did in measures of nonverbal memory tasks, whereas the cognitive performance of women with OCD was consistent with that of their HC counterparts. These results suggest a distinct pattern of cognitive dysfunction specific to the patients' sex.

Disruptions in circadian rhythms have been described in mood disorders (MD), but the involvement of genetic variation in genes pertaining to the molecular circadian machinery in the susceptibility to MD has not been conclusively determined. We examined 209 single-nucleotide polymorphisms (SNPs) covering 19 circadian genes (ADCYAP1, ARNTL, ARNTL2, BHLHB2, BHLHB3, CLOCK, CRY1, CRY2, CSNK1E, DBP, NPAS2, NR1D1, PER1, PER2, PER3, RORA, TIMELESS, VIP, and VIPR2) in a sample of 534 MD patients (335 with unipolar major mood depression (MDD) and 199 with bipolar disorder (BD)) and 440 community-based screened controls. Nominally, statistically significant associations were found in 15 circadian genes. The gene-wide test, corrected for the number of SNPs analyzed in each gene, identified significant associations in CRY1 (rs2287161), NPAS2 (rs11123857), and VIPR2 (rs885861) genes with the combined MD sample. In the MDD subsample, the same SNPs in CRY1 and NPAS2 of the combined sample remained associated, whereas in the BD subsample CLOCK (rs10462028) and VIP (rs17083008) were specifically associated. The association with an SNP located 3′ near CRY1 gene in MDD remained statistically significant after permutation correction at experiment level (p=0.007). Significant additive effects were found between the SNPs that were statistically significant at the gene-wide level. We also found evidence of associations between two-marker haplotypes in CRY1 and NPAS2 genes and MD. Our data support the contribution of the circadian system to the genetic susceptibility to MD and suggest that different circadian genes may have specific effects on MD polarity.

Ninety female outpatients with obsessive-compulsive disorder (OCD) completed a semistructured interview to assess the relationship between different OCD symptom dimensions and the onset of OCD at menarche or during the perinatal period. Patients with hoarding symptoms had an earlier age at menarche than non-hoarders (12.1 +/- 1.3 vs 13.0 +/- 1.5 years, p = 0.019) and were more likely to report OCD onset at menarche (OR = 4.1, p = 0.034). Patients with symptoms of the contamination/cleaning dimension were more likely to report the onset of their disorder during pregnancy or postpartum (OR = 9.3, p = 0.048).

Introduction Pathological gambling shows high comorbidity rates, especially with substance use disorders, although affective, anxiety and other impulse control disorders, as well as personality disorders, are also frequently associated. Objectives To explore comorbidity in pathological gambling with other mental disorders in a consecutive sample of patients attending a unit specialized in pathological gambling, and specifically the relationship between substance-related disorders, on the one hand, and personality and clinical variables in pathological gamblers, on the other. Method A total of 498 patients with a DSM-IV-TR diagnosis of Pathological Gambling (11.8% women) were assessed with a semi-structured clinical interview and several clinical and personality scales. Results Higher comorbidity with affective disorders was found in women (30.5%), while higher comorbidity with substance-related disorders was found in men (11.2%). A positive association was also detected between a history of psychiatric disorders and current comorbidity with substance-use disorders, as well as between alcohol abuse and age. Finally, some personality traits such as low reward dependence (OR = 0.964) and high impulsivity (OR = 1.02) predicted other substance abuse (not alcohol). High selftranscendence scores predicted both alcohol and other substance abuse (OR = 1.06). Conclusions Our results suggest a high prevalence of comorbid disorders in pathologic gambling, mainly with affective and substance-related disorders. The results of the present study, conducted in a broad sample of consecutively admitted pathologic gamblers, may contribute to understanding of this complex disorder and treatment improvement.

The aim of our study was to assess the role of gender in OCD symptom dimensions with a multivariate analysis while controlling for history of tic disorders and age at onset of OCD. One hundred and eighty-six consecutive outpatients with a DSM-IV diagnosis of OCD were interviewed. Yale-Brown Obsessive-Compulsive Scale (YBOC-S), YBOC-S Symptom Checklist, and Hamilton Depression and Anxiety Scales were administered to all patients. Lifetime history of tic disorders was assessed with the tic inventory section of the Yale Global Tic Severity Scale. Age at onset of OCD was assessed by direct interview. Statistical analysis was carried out through logistic regression to calculate adjusted female:male odds ratios (OR) for each dimension. A relationship was found between gender and two main OCD dimensions: contamination/cleaning (higher in females; female:male OR=2.02, P=0.03) and sexual/religious (lower in females; female:male OR=0.41, P=0.03). We did not find gender differences in the aggressive/checking, symmetry/ordering, or hoarding dimensions. We also found a greater history of tic disorders in those patients with symptoms from the symmetry/ordering, dimension (P

P 5 0.001] and rs7176429 (OR 5 2.78; P 5 0.0001), although only the latter remained significant after Bonferroni correction. Although the haplotype analysis did not show significant results, a more extended block of LD in the OCD hoarders with respect to the control group was observed, suggesting a lower haplotype diversity in these individuals. Our findings suggest that NTRK3 may contribute to the genetic susceptibility to hoarding in OCD and may constitute an interesting gene to focus on in studies of the genetic basis of obsessive–compulsive hoarding.

This study sought to examine the effectiveness of group and individual cognitive-behavioral treatment (CBT) and to compare the results with those of a wait-list control group among a sample of patients with obsessive-compulsive disorder (OCD). Fifty-seven individuals diagnosed with OCD were evaluated pre- and posttreatment with the Yale-Brown Obsessive Compulsive Scale and the Hamilton Rating Scales for Anxiety and Depression. Both group and individual CBT obtained statistically significant reductions in anxiety and depressive symptoms. Patients in individual treatment achieved a statistically significant reduction in OCD symptoms compared with those in group treatment, but their dropout rate was twice as high. Patients with symmetry and order rituals presented less improvement in anxiety symptoms than those with other rituals. Associated general symptoms were lower in patients receiving either mode of CBT compared with wait-list participants. The authors found that individual treatment is more effective in reducing obsessive-compulsive symptoms than group treatment.

Poor insight has been reported in 15% to 36% of patients with obsessive-compulsive disorder (OCD), but little is known about its clinical correlations. This study examines insight among patients with OCD using a standardized instrument, the Brown Assessment of Beliefs Scale, and analyzes its relationship with clinical factors. Insight was assessed in 132 patients with OCD, before and after pharmacologic treatment, using the Brown Assessment of Beliefs Scale. Differences between patients with good and poor insight on sociodemographic variables, OCD severity, comorbidity, and treatment response were studied. Stability of insight after pharmacologic treatment was also examined. Thirty-nine patients (29.5%) exhibited poor insight. They showed more depressive symptoms (P = .001) and personality disorders (P = .001), especially the schizotypal form, than did good insight subjects, but there were no significant differences in treatment response. Insight significantly improves after treatment (P < .001). Our results suggest that insight in OCD varies widely and constitutes a dynamic phenomenon that can improve after treatment and is influenced by clinical conditions such as affective status or personality.

Memory deficits have been reported in several neuropsychological studies of obsessive-compulsive disorder (OCD). Dysfunction in nonverbal memory has been consistently reported, whereas findings on verbal memory are more heterogeneous. The authors studied 50 patients with OCD who were matched for sex, age, educational level, and hand dominance with 50 healthy controls (HC). Cognitive performance in both groups was assessed on verbal and nonverbal memory tasks, and several clinical variables were also assessed in the patient group. Patients with OCD showed a pattern of cognitive dysfunction with alterations in areas of nonverbal memory (recall and recognition), and verbal memory (learning and recall). Older age at onset of OCD was associated with poorer performance on verbal memory tasks. Low scores on some verbal memory tasks were associated with severity of OCD, and nonverbal memory was influenced by depressive symptoms. The study suggests the existence of dysfunction in the execution of verbal and nonverbal memory tasks in OCD; the influence of clinical variables depends on the specific neuropsychological function.

The authors sought to examine short- and mid-term effectiveness of a group cognitive–behavioral therapy (CBT) in pathological gambling (PG) and to analyze predictors of therapy outcome. Two hundred ninety PG patients participated in the current study, all diagnosed on the basis of Diagnostic and Statistical Manual of Mental Disorders (4th edition) criteria, and were given manualized outpatient group CBT (16 weekly sessions). Specific assessment before and after the therapy and at 1, 3, and 6months follow-up was conducted. Logistic regression and survival analyses were applied. Outpatient group CBT was found to be effective, with abstinence rates of 76.1% by the end of therapy and 81.5% at 6months follow-up. The dropout rate during treatment decreased significantly after the fifth treatment session. Psychopathological distress (p=.040) and obsessive–compulsive symptoms were identified as factors predicting relapse and dropout, respectively. These findings suggest that group CBT is effective for tr...

Objective: The objective of the study was to assess the predictive value of personality profiles to classify individuals with bulimia nervosa (BN), pathological gambling (PG), and a nonpsychiatric comparison group while controlling for sex. Methods: The sample comprised 270 BN (241 women, 29 men), 429 PG (42 women, 387 men), and 96 comparison (nonpsychiatric) subjects (35 women, 61 men). All patients were consecutively admitted to our Psychiatry Department and were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria. We administered the Temperament and Character Inventory–Revised as well as other clinical indices. Multinomial and binary logistic regression models adjusted for age and stratified by sex were used to assess the predictive value of personality in relation to group status. Results: In comparison to controls, high Novelty Seeking (P < .001) was specifically associated with a diagnosis of PG. Independently of sex, low Self-Directedness was associated with both BN (P < .001) and PG (P < .001). Some sex-specific differences were also observed; namely, women with BN and PG displayed higher Harm Avoidance and Cooperativeness than control women, whereas men with PG reported higher Reward Dependence and Persistence than control men. Conclusions: Our results suggested that, whereas there are some shared personality traits between BN and PG when compared with healthy controls, there are also some sex- and diagnostic-specific personality traits that weigh against the consideration of BN as an impulse control disorder.

Background The dexamethasone suppression test (DST) is the main hormonal disturbance in psychotic depression compared to non-psychotic depression. However, although there have been many studies of individual hormonal axes in depression, few multi-axial studies have been reported. This study aims to examine hormonal differences between these groups of patients through three functional hormonal tests: DST, thyroid stimulating hormone response to thyroid releasing hormone (TSH–TRF) and growth hormone response to growth hormone releasing factor (GH–GRF). Methods Forty inpatients meeting DSM-III-R criteria for major depressive episode with melancholia (21 non-psychotic and 19 psychotic) were studied. Dexamethasone suppression test, TSH–TRF and GH–GRF tests were undertaken for all patients. Results In the whole melancholic sample, 80.0% showed disturbances in at least one hormonal axis, 40.0% in two axes and 5.0% in all three axes. Basal and post-dexamethasone cortisol levels were significantly higher in psychotic than in non-psychotic patients. An association between post-dexamethasone cortisol and blunted GH–GRF response was demonstrated in those with psychotic depression. In the whole sample, GH blunting was found in 62.5% of patients, DST non-suppression in 37.5% and TSH blunting in 25.0% (no differences were found between psychotic and non-psychotic patients). Limitations Sample was restricted to melancholia and unknown factors may influence hormonal responses to stress. Conclusions Hormonal disturbances in depression are more evident when studying several axes, being the HPA and the GH axes the most prominents. Psychotic depression showed more HPA disturbance than non-psychotic depression. Influence of the HPA on the GH axis is discussed.

We report a young patient with phenotypic, cognitive and behavioural features consistent with a diagnosis of Lujan-Fryns syndrome. He exhibited a severe eating disorder with food refusal and psychogenic loss of appetite, which led to a serious state of malnutrition. Behavioural difficulties including shyness, hyperactivity and emotional instability are present in almost 80% of the described patients with Lujan-Fryns syndrome but eating disorders have not been previously reported in this condition. A review of the behavioural problems in Lujan-Fryns syndrome and an approach to their management is discussed.

Introduccion El dolor es una experiencia subjetiva dificilmente evaluable por su variada expresion. Actualmente, la resonancia magnetica funcional (RMf) permite objetivar la respuesta cerebral al estimulo doloroso. Objetivo Evaluar la respuesta cerebral al dolor en pacientes con dolor cronico esencial generalizado diagnosticados de fibromialgia (FM). Sujetos y metodos Se administro un estimulo doloroso por presion mecanica a 15 pacientes con FM y 11 controles durante la adquisicion de RMf. Se realizaron diversos ensayos de activacion variando la presion ejercida sobre una superficie de 1 cm 2 del dedo pulgar. Resultados Durante la adquisicion de RMf, la aplicacion de una presion mecanica de 4 kg no ocasiono molestias relevantes en ningun sujeto control. Contrariamente, todos los pacientes, excepto uno, refirieron dolor moderado-grave con este estimulo. La RMf puso de manifiesto que, con poca presion (4 y 5 kg), es excepcional la activacion de regiones distintas al area sensitivomotora primaria contralateral al dedo estimulado en los sujetos control. Sin embargo, 5 pacientes (p = 0,027), a 4 kg de presion, y 7 (p = 0,030), a 5 kg, activaron las regiones cerebrales conocidas como mediadoras de la respuesta al dolor (area sensitivomotora primaria, corteza parietal, insula y region del cingulo anterior). Conclusiones Los resultados sugieren que una proporcion significativa de pacientes diagnosticados de FM y con bajo umbral doloroso presentan una consistente respuesta cerebral al dolor con estimulos mecanicos de baja intensidad, mientras que en otra parte de los casos el cerebro responde de forma similar a los sujetos control.

The purpose of this study was to examine whether men and women with obsessive-compulsive disorder (OCD) demonstrate differences in neuropsychological functioning compared to healthy men and women. Participants were 56 consecutive patients (33 male, 23 female) and 40 healthy control participants (20 male, 20 female) of comparable characteristics. Male and female patients had comparable symptom severity, illness duration, comorbidity, in- or out-patient status, and medication usage. An extensive neuropsychological test battery was administered including tests of general nonverbal intelligence, attention, verbal and nonverbal memory, and executive functions. Male and female OCD patients showed comparable neuropsychological performances on most cognitive domains. However, we found some evidence for cross-sex shifts in verbal fluency tasks (FAS and Category Alternation Test [CAT]), the reading component of the Stroop test, and the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Digit Span-Forward test. Post hoc analyses revealed that female patients showed reduced performance on these tests compared to healthy women, in the male-typical direction. Among OCD women only, there were significant negative correlations between OCD symptom severity and performance on the CAT and the reading Stroop. We conclude that sex does not seem to be a major determinant of neuropsychological function in OCD, but the observed cross-sex shifts on some tasks deserve further examination.

Objective This study was conducted to analyse the onset of action of antidepressants in naturalistic conditions. Method Multicenter, prospective, open-label, non-comparative naturalistic study among 582 depressed outpatients treated with mirtazapine. The patients were assessed at screening, and after 1, 2 and 4 weeks by the 17-item Hamilton depression rating scale (17-HAM-D) and clinical global impression (CGI). Onset of action was measured by traditional analyses based on the time to a persistent reduction of more than 50% from baseline on the 17-HAM-D. Patients were grouped into four groups: very fast responders, fast responders, traditional responders and partial or non-responders. The non-parametric Kruskall–Wallis test was used to assess differences between the groups and logistic regression to predict response after 1 week of treatment. Results 16% of patients had a very fast response, 42.1% a fast response, 26.5% a traditional response and 15.5% a partial or non-response. There were no significant differences between these groups with regard to dose of mirtazapine or sociodemographic characteristics. The baseline total 17-HAM-D was lower in the faster groups than in the slower groups. The evolution of 17-HAM-D items was similar in each responder group. Conclusion Time to response varied from early faster response to late slower response. The evolution of 17-HAM-D for each type of response was similar, but occurred at a different time in each group. Copyright © 2005 John Wiley & Sons, Ltd.

Anorexia nervosa (AN) and bulimia nervosa (BN) are eating disorders (ED) with complex genetic and environmental components. Genetic studies and animal models support the participation of brain-derived neurotrophic factor (BDNF) in the vulnerability to AN and BN. We investigated the genetic contribution of the BDNF-specific receptor neurotrophic tyrosine kinase receptor type 2 (NTRK2) to the susceptibility to ED. We have screened the entire NTRK2 gene in 91 patients with ED and have identified 14 single-nucleotide polymorphisms (SNPs). A population-based association study with six SNPs from the NTRK2 locus was performed in 164 ED patients and 121 controls. Significant evidence of association for markers –69C>G and IVS13+40G>A was detected. We also observed a strong association between the C-A-insC haplotype (–69/IVS13+40/2784–2785) and binge-eating/purging AN (ANP, P=0.006; OR=2.27), and a reduced frequency of haplotype G-A-delCl in BN patients (P=0.034; OR=0.6). The analysis of ED-related phenotypes revealed a clear association between NTRK2, high scores of Harm avoidance measured by the temperament and character inventory (TCI-R; P=0.003) and minimum body mass index (minBMI; P

Objective To determine the importance of self-injurious behaviour in people with eating disorders (ED) and to analyse the possible differences between ED subtypes. Method 109 patients with ED (51 anorexia nervosa (AN) and 58 bulimia nervosa (BN)), according to DSM-IV diagnostic criteria, who were consecutively referred to our unit, participated in this study. All cases were female. Assessment Subjects were assessed by means of a semi-structured clinical interview and self-report questionnaires (Eating Attitudes Test, EAT-40; Eating Disorders Inventory, EDI; Bulimic Investigatory Test Edinburgh, BITE; Body Shape Questionnaire, BSQ; Beck Depression Inventory, BDI; Social Anxiety Scale, SAD). Design Comparison of cases by considering the factors diagnosis and self-injurious behaviour. Results The presence of self-injurious behaviour (SIB) (32% of cases) was not associated with the diagnosis (p = 0.28). There was no association between SIB, suicide attempts, alcohol abuse and stealing, but a positive correlation between SIB and drug abuse was found (r = 0.284, p

Objectives The aim of this study was to determine whether or not there are gender differences in personality, clinical features and associated traits in people with an eating disorder (ED) Method The participants consisted of 40 ED patients (20 males and 20 females) consecutively admitted to our hospital. The two groups were matched in terms of age, diagnosis and duration of illness. All patients fulfilled DSM-IV-R criteria for those pathologies. Assessment Assessment measures included the Eating Disorders Inventory-2 (EDI-2), the Symptom Check List (SCL-90-R) and the Temperament and Character Inventory-R (TCI-R), as well as a number of other clinical and psychopathological indices. Results In terms of personality traits, the males demonstrated less harm avoidance (p

Obsessive-compulsive disorder (OCD) runs in families, but the specific contribution of genetic and environmental factors to its development is not well understood. The aim of this study was to assess whether there are differences in perceived parental child-rearing practices between OCD patients and healthy controls, and whether any relationship exists between parental characteristics, depressive symptoms and the expression of particular OCD symptom dimensions. A group of 40 OCD outpatients and 40 matched healthy controls received the EMBU (Own Memories of Parental Rearing Experiences in Childhood), a self-report measure of perceived parental child-rearing style. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Hamilton Depression Rating Scale (HDRS) were used to assess the severity of obsessive-compulsive and depressive symptoms. The Y-BOCS Symptom Checklist was used to assess the nature of obsessive-compulsive symptoms, considering the following five symptom dimensions: contamination/cleaning, aggressive/checking, symmetry/ordering, sexual/religious and hoarding. Logistic and multiple linear regression analyses were conducted to study the relationship between parental style of upbringing, depressive symptoms and OCD symptom dimensions. Severe OCD (Y-BOCS: 27.0+/-7.4) and mild to moderate depressive symptoms (HDRS: 14.0+/-5.4) were detected in our sample. Compared with healthy controls, OCD patients perceived higher levels of rejection from their fathers. No differences between the groups with respect to perceived levels of overprotection were detected. The seventy of depressive symptoms could not be predicted by scores on any perceived parental characteristics. Hoarding was the only OCD symptom dimension that could be partially predicted by parental traits, specifically low parental emotional warmth. Social/cultural variables such as parental child-rearing patterns, in interaction with biological and genetic factors, may contribute to the expression of the OCD phenotype.

ResumenAntecedentes:El propósito de este estudio era evaluar la evolución de las afecciones comórbidas del trastorno de angustia después de 1 año de tratamiento, poniendo de relieve la detección de los síntomas residuales y su relación con otras variables clínicas.Métodos:Se evaluó a los sujetos (n = 64) por la Entrevista Clínica Estructurada para el DSM-III-R y el Cuestionario de Personalidad de Eysenck. La comorbilidad con otros trastornos, las puntuaciones en la Escala de Ansiedad de Hamilton (HRSA) y la Escala de Depresión de Hamilton (HRSD) se evaluaron en la línea de base y después de 12 meses. Se definieron criterios para la ansiedad/los síntomas somáticos residuales.Resultados:La reducción en las tasas de trastorno de ansiedad generalizada explicaba una disminución significativa en la comorbilidad en el seguimiento anual con respecto a la evaluación de línea de base. Cuando los síntomas más intensos del trastorno habían remitido, un tercio de los pacientes refería síntomas físicos, con cierta preocupación por un estado fluctuante de ansiedad. Los síntomas mencionados no eran una recurrencia del trastorno de angustia ni daban cuenta de otros trastornos de ansiedad o somatomorfos. Las puntuaciones más bajas en extraversión predicen un riesgo más alto de síntomas residuales.Discusión:La persistencia de los síntomas residuales de ansiedad/somáticos en un tercio de los pacientes que aparentemente lograron una buena respuesta al tratamiento de trastorno de angustia podría caracterizar una forma menor de persistencia crónica de esta afección.Conclusiones:El subgrupo de pacientes con síntomas residuales no sería detectable por los estudios de seguimiento, que se centran en la evaluación de la recaída del trastorno de angustia por medio de criterios diagnósticos definidos estrictamente.

Background: To investigate whether there are some differences in Event-Related Potentials (ERP) between melancholic patients and healthy controls. To establish whether there is a relationship between abnormalities of ERP and severity of depression and psychomotor retardation. Method: Melancholic depressed patients (N=50) and normal comparison subjects (N=31) were assessed for latencies and interlatencies of N100, N200, N400, latency and amplitude of P300. The ERPs were studied with an ‘oddball paradigm’ in the auditory modality. Severity of depression was measured by the Hamilton Depression Rating Scale (HDRS) and psychomotor retardation with the Depressive Retardation Rating Scale (DRRS). Results: The melancholic group showed a significantly higher latency in N100 (P

Resumen El objetivo de este estudio fue la evaluacion de cambios en el flujo sanguineo cerebral regional (FSCR) en pacientes trastorno obsesivo-compulsivo (TOC) y controles sanos durante la ejecucion de la tarea cognitiva torre de Hanoi (TH). Material y metodo Se comparo los resultados de la ejecucion del test de la TH en 30 pacientes con TOC y una poblacion comparable de voluntarios sanos. Se realizaron medidas psicologicas de la inteligencia y ansiedad a todos los sujetos del estudio. En el grupo de pacientes se evaluo ademas la severidad de los sintomas y la posible presencia de depresion. El FSCR se estimo mediante SPECT cerebral con hexamethylpropylamina- oxima (HMPAO). Los valores regionales se determinaron usando la actividad cortical como referencia. Resultados Los pacientes y controles se diferenciaron significativamente en cuanto a la presencia de ansiedad. La ejecucion de la prueba de la TH fue peor en los pacientes con TOC que en los controles. La prueba de la t de Student para medidas apareadas puso de manifiesto diferencias significativas (p = 0,039) entre pacientes y controles en cuanto a la activacion del nucleo caudado izquierdo. Los controles activaron dicho nucleo durante la ejecucion de la TH y los pacientes no. No aparecieron diferencias en otras regiones cerebrales. Conclusion Estos resultados sugieren una modificacion en los sistemas de activacion de los ganglios basales en pacientes con TOC comparados con controles.

Objectives: This study attempts to understand the clinical impact of marital status on the psychopathology and symptomatology of anorexia (AN) and bulimia nervosa (BN) patients. Method: Eating disorder (ED) patients (n=332, 198 BN and 134 AN) consecutively admitted to our unit participated in the study. All subjects met DSM-IV criteria for those pathologies and were female. Our sample was divided retrospectively into three subgroups based on their marital status. For the assessment, commonly applied questionnaires in the field of ED were used [Eating Attitudes Test (EAT-40), Eating Disorder Inventory (EDI), Bulimic Investigatory Test Edinburgh (BITE), Body Shape Questionnaire (BSQ), Beck Depression Inventory (BDI) and Social Avoidance and Distress Scale (SAD)]. Results: 2×3 (Diagnostic×Marital status) ANOVA and ANCOVA (with age as covariance) designs were applied in the current study. Our results suggested that ED patients who lived with a partner were significantly different with respect to the other ED patients in the following variables: higher age (P

SummaryBackgroundThe aim of this study was to assess the outcome of the comorbid conditions of panic disorder after 1 year of treatment, emphasizing the detection of residual symptoms and their relationship to other clinical variables.MethodsSubjects (N=64) were assessed by the Structured Clinical Interview for DSM-III-R and the Eysenck Personality Questionnaire. Comorbidity with other disorders, scores on Hamilton Anxiety Rating Scale and Hamilton Depression Rating Scale were assessed at baseline and after 12 months. Criteria for residual anxiety/somatic symptoms were defined.ResultsReduction in generalized anxiety disorder rates accounted for a significant decrease in comorbidity at 1-year follow-up, with regard to baseline assessment.When the more severe symptoms of the disorder had remitted, a third of the patients referred physical symptoms with some concern over a fluctuating state of anxiety. The said symptoms were neither a recurrence of panic disorder nor did they account for other anxiety or somatoform disorders. Lower scores on extraversion predict higher risk of residual symptoms.DiscussionThe persistence of residual anxiety/somatic symptoms in a third of the patients who apparently achieved a good response to treatment of panic disorder might characterize a minor form of chronic persistence of this condition.ConclusionThe subgroup of patients with residual symptoms would not be detectable by follow-up studies, which focus on the assessment of relapse of panic disorder by means of strictly defined diagnostic criteria.

Objectives: This study attempts to understand the effects of a parental history of alcohol abuse on the psychopathology and symptoms of bulimia nervosa (BN). Method: The study involved 121 female BN patients consecutively admitted to the Eating Disorders Unit of the University Hospital of Bellvitge. The sample was divided post hoc into two subgroups on the basis of the presence (PAA, n=25) or not of parental abuse of alcohol (NPAA, n=96). All of the patients fulfilled the DSM-IV criteria for BN. Evaluation: The assessment measures were the Eating Attitudes Test (EAT-40), the Eating Disorders Inventory (EDI), the Bulimic Investigatory Test Edinburgh (BITE), the Body Shape Questionnaire (BSQ) and Beck Depression Inventory (BDI), as well as clinical and psychopathological variables. Results and Conclusions: Only 7.4% of the patients reported current alcohol abuse and this correlated positively with the presence of other impulsive behaviours (p

To date, there have been no formal investigations of neuropsychological performance in patients with obsessive- compulsive disorder (OCD) taking psychotropic medications. The purpose of this study was to determine whether medicated and unmedicated patients with OCD demonstrate differences in neuropsychological functioning. Fifty-two patients with a primary DSM-IV diagnosis of OCD participated in the study; 28 were taking serotonin reuptake inhibitors (SRIs), and 24 were treatment-naive (ns8) or had finished a washout period prior to their inclusion in ¨ other studies (ns16). The groups were well matched with regard to demographic and clinical variables, including symptom severity. Each group was administered a comprehensive neuropsychological battery to assess general intelligence, attention, verbal and non-verbal working memory, declarative and procedural learning, visuo-constructive skills, and executive functions. SRI-medicated did not differ from SRI-free patients on any neuropsychological measure. Benzodiazepines seemed to improve the patients' functioning on a semantic verbal fluency test. In addition, there were significant interactions between SRIs and benzodiazepines on the perseverative errors of the Wisconsin Card Sorting Test and on reaction times. SRI-medicated patients with OCD are able to perform on cognitive functioning tests at a comparable level with that of SRI-free patients, and these results have positive implications for OCD patients who respond to SRIs. The interactions between SRIs and benzodiazepines and their effect on cognition in OCD are likely to be complex and deserve further study. 2002 Elsevier Science Ireland Ltd. All rights reserved.

Objective Orlistat (tetrahydrolipstatin) is an intestinal lipase inhibitor that was approved recently for the management and treatment of obesity. This is the first report of the misuse of orlistat in two normal-weight purging bulimia nervosa (BN) patients. Method and Results We report two diagnosed cases of BN in two Spanish women who used orlistat as a purging mechanism after binge episodes. In both cases, the onset of the eating disorder was in adolescence. From the beginning, a restrictive diet, binging, and purging behavior (vomiting and using laxatives) were present. Both patients misused this substance as their only purging mechanism after every binge episode. Conclusion BN patients have used many substances and bizarre behaviors as purging mechanisms. Nevertheless, to the authors' knowledge, these are the first reported cases of orlistat misuse as the only purging mechanism in two BN patients. © 2001 by John Wiley & Sons, Inc. Int J Eat Disord 30: 458–461, 2001.

Universitat de Barcelona, SpainAbstract. The question of which cut-off point would be more appropriate in the selectionof sub-clinical obsessive-compulsive (OC) samples is an important methodological issue thathas not been formally addressed, hence prompting the current study. Three groups of sub-clinical OC subjects, scoring 1, 1.5, and 2 standard deviations (SD) above the mean on thePadua Inventory, and a matched non-OC control group, were compared on various clinicaland personality measures. As expected, the three sub-clinical groups had higher scores thanthe non-OC group on measures of OC symptoms (including obsessional slowness), depres-sion, anxiety, and on personality measures of neuroticism, psychoticism, and obsessionaltraits. However, no significant differences were observed between the three sub-clinicalgroups on most measures, although the 2 SD group had higher scores on neuroticism andobsessional personality traits. It is concluded that a wide range of selection criteria can yieldsimilar results that are interpretable within the current theoretical models of Obsessive-Compulsive Disorder (OCD). It is suggested that subjects with a diagnosis of OCD shouldbe carefully excluded from sub-clinical studies. [A Spanish abstract follows the references.]Keywords: Obsessive-Compulsive Disorder, sub-clinical, non-clinical, selection criteria.

(2000). Transsexuialism and anorexia nervosa: A case report. Eating Disorders: Vol. 8, No. 1, pp. 63-66.

Background: Functional imaging studies have demonstrated abnormal patterns of brain activity in obsessive–compulsive disorder, which consistently suggest the alteration of frontal lobe functioning. We performed a brain activation study in obsessive–compulsive disorder using a cognitive task involving the frontal lobes. Methods: Twenty patients and 20 healthy control subjects were assessed with functional magnetic resonance imaging during a phonologically guided word generation task. The study analysis was based on the comparison of group average time-course functional changes occurring at the site of largest frontal cortex activation during alternating rest and task periods. Results: In terms of relative signal changes, patients showed a significantly greater activation during word generation and a defective suppression of this activation during the following rest period. Both abnormal imaging findings significantly correlated with the severity of the clinical process assessed by the Yale–Brown Obsessive–Compulsive Scale. Conclusions: The results indicate that functional magnetic resonance imaging during cognitive challenge may be useful to reveal distinctive features of latent brain dysfunction in obsessive–compulsive disorder.

The serotonin reuptake complex labelled with [3H]imipramine and [3H]paroxetine, the 5-HT2A postsynaptic receptor labelled with [3H]ketanserin and the inositol trisphosphate (IP3) concentrations were simultaneously determined in several human brain regions. An inverse distribution was found between the pre and postsynaptic receptors. Thus, while the serotonin reuptake complex labelled with either [3H]imipramine and [3H]paroxetine displayed a maximum density in subcortical areas and basal ganglia, the 5-HT2A postsynaptic receptor labelled with [3H]ketanserin showed higher binding values in cortical areas. The apparent affinity constants for the three radioligands were similar over the 12 regions studied (approx 1nM for [3H] imipramine, approx 0.06 nM for [3H]paroxetine and approx 1nM for [3H]ketanserin). IP3 levels were highest in frontal cortex (6.3 ± 2.4 pmol/gr) followed by substantia nigra (4.6 ± 1.5 pmol/gr). The remaining regions exhibited approximately the same concentration range (two or three fold lower than frontal cortex values). Frontal cortex was the only brain region showing a significant correlatioin between the 5-HT2A maximum binding and the levels of its second messenger IP3.

Serotonergic system alterations were studied in 51 depressed patients classified according to DSM-III-R criteria for major depression with melancholia compared to 31 healthy controls.[3H]Imipramine and [3H]paroxetine binding sites and the 5HT2 receptor were simultaneously determined in blood platelet membranes.A significantly lower maximum binding in [3H]imipramine binding was observed in depressed patients compared to controls (1134+/-74 vs. 1712+/-106 fmol/mg protein, P0.0001) without changes in the equilibrium dissociation constant (1.10+0.05 vs. 1.25-/+0.09 nM). [3H]Paroxetine binding did not differ between the two groups (Bmax, 1441+/-55 vs. 1280+/-81 fmol/mg protein; Kd, 0.060+/-0.002 vs. 0.062+/-0.002 nM). The K(d) value of 5HT2 binding was lower in depressed patients than controls (0.95+/-0.04 vs. 1.15+/-0.09 nM, P0.039) without changes in maximum binding (140+/-11 vs. 127+/-14 fmol/mg protein).Taken together, these results suggest that [3H]imipramine and 5HT2 receptors may be good biological markers for serotonergic dysfunction in depressive disorders.

Both the [3H]imipramine and [3H]paroxetine binding sites and the 5-HT2A receptor were simultaneously determined in frontal cortex, cingulate cortex, hippocampus and amygdala from 17 control subjects and 17 depressed suicide victims. A significant decrease in the maximum binding (Bmax) of [3H]imipramine was observed in the hippocampus of suicide victims as compared to control subjects (160 +/- 25 vs. 328 +/- 52 fmol/mg protein; P = 0.007) without changes in the apparent affinity constant (Kd). Furthermore, a significant decrease in the number of 5-HT2A binding sites, together with a significantly lower Kd, was also observed in the hippocampus of suicides as compared to control subjects (129 +/- 18 vs. 225 +/- 32 fmol/mg protein; P = 0.02 and 0.91 +/- 0.07 vs. 1.38 +/- 0.08 nM, respectively; P = 0.006). [3H]Paroxetine binding did not display modifications between the two groups in either Bmax or Kd from any of the brain regions studied. When all four brain regions were taken together, a down-regulation was noted between presynaptic [3H]imipramine binding and the postsynaptic 5-HT2A receptor (r = -0.40; P = 0.0013) in the control group. This correlation did not appear in the suicide group. No correlation was observed between [3H]paroxetine binding and the 5-HT2A receptor in either control subjects or suicides. Taken together, these results suggest that the 5-HT uptake site measured with [3H]imipramine and the 5-HT2A receptors are reliable markers of serotonergic dysfunction.