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Objectives: To identify factors that predict which patients, when referred by their GP, make a first appointment at a Mental Health Centre and then fail to attend. Method: Sequential observational study in which data was collected for one year on all the people (1311) with an arranged date for an initial appointment at an urban Community Mental Health Centre. Results: Approximately 25% of patients who request an initial appointment fail to attend. The variables that predict nonattendance are: the lack of a telephone number for contact, the time lapse before the appointment, and when drug-addiction is the reason for requesting the appointment. One variable that results in a specific kind of behaviour is the timing of the initial appointment, since males and females tend to miss at different times. We also found that missing the appointment followed a seasonal pattern. Conclusions: In order to optimise the service, it is necessary to discover the proportion of probable misses, and aim to arrange the appointment with the shortest possible time lapse and to take into consideration the sex of the patient when fixing the time of the interview.

Introduction It is known the relationship between mental disorders such as bipolar disorder and metabolic disorders such as dyslipidemia, and therefore, increasing comorbid pathologies such as heart disease. Objectives Determine in patients diagnosed with bipolar disorder and dyslipidemia, which are the epidemiological characteristics, the diagnostic subtype and drug treatment prevalent. Aims Determine the profile of patients with bipolar disorder and dyslipidemia. Methods Creation of a database and conduction of a descriptive study with statistical analysis of the data extracted from the medical records of 100 patients from a public hospital. Results Higher prevalence of diagnosis of bipolar disorder type I on II (74% and 26%), male (54%) over female (46%), the age range of 40–50 years, treated with antipsychotics more mood stabilizers (62%) compared to mood stabilizer monotherapy (38%) ( Fig. 1 ). Conclusions Interventions should be conducted screening character and in patients with a diagnosis of bipolar disorder type I, male, age between 30–50 years, treated with mood stabilizers plus antipsychotics (with a preference for lithium association with olanzapine). [ABSTRACT FROM AUTHOR]

Munchausen syndrome is a subtype included in factitious disorders in which somatic signs and symptoms predominate. The patient self-inflicts damage with the only objective of assuming a "sick role." This is an underdiagnosed disorder characterized by numerous hospital admissions and history of visits to different medical specialists. Early diagnosis would avoid high health care costs caused by unnecessary explorations, and social, work and familial deterioration of the patient. We report a case with two affected brothers, rare in the literature reviewed, and we analyze suspicion criteria in the daily clinical practice. [ABSTRACT FROM AUTHOR]

significantly increase during puberty. The goal of this research is to evaluate changes during puberty which could have genetic and environmental influences on a broad spectrum of disordered eating attitudes and behaviors. Methods. Participants were 158 pairs of adolescent female twins, categorized in two groups according to menarche stage (pre or post). ED measures: Disordered eating attitudes and behaviors were assessed by means of the Children’s Eating Attitudes Test and four sub-scales of the Eating Disorders Inventory: Drive for thinness, Body dissatisfaction, Ineffectiveness, and Perfectionism. Intra-class correlations in monozygotic (MZ) and dizygotic (DZ) twins were calculated separately in premenarche and premenarche group for each ED subscale Results. 48 premenarche twins (30 MZ twins and 18 DZ twins) and 110 premenarche twins (66 MZ and 44 DZ twins) were included. The intra-class correlations suggested no genetic influence on the total ChEAT score of participants at the premenarche stage. For the premenarche participants, however, sources of variance suggested a very high heritability. Regarding the EDI sub-scales, only the trait “Ineffectiveness” exhibited a moderate heritability among premenarche subjects, while all the four eating sub-scales showed moderate heritability estimates in the premenarche stage group. Conclusions. Our findings reveal that there are significant differences in genetic and environmental effects on eating attitudes and behaviors depending on being in a premenarche or premenarche stage. Therefore, clinicians should pay attention to female adolescents at high risk of developing ED, especially during the critical period of menarche.

Introduction: The heritability of eating disorders has been estimated to range from 22% to over 62%.The aim of this study is to determine the relative influence of genetics and environment that contribute to the drive for thinness, body dissatisfaction, perfectionism, and ineffectiveness, by evaluating sex differences in a sample of adolescent twins from Valencia, Spain., Material and Methods: Five hundred eighty-four pairs of adolescent twins between 13 and 18 years of age completed the study. To determine zygosity, teachers responded to a questionnaire on physical similarity. Psychological traits of eating disorders were assessed with four sub-scales of the Eating Disorder Inventory (EDI); drive for thinness, body dissatisfaction, perfectionism, and ineffectiveness. Twin models were used to assess genetic and environmental (common and unique) factors affecting these four psychological traits., Results: All four traits showed significant genetic contributions among girls, with heritability estimates of 37.7% for ineffectiveness, 42.8% for perfectionism, 56.9% for drive for thinness, and 65.5% for body dissatisfaction. Among boys, body dissatisfaction showed no additive genetic contributions, indicating significant shared and individual specific environment effects. The three other traits in boys showed significant additive genetic contributions, but were lower than in girls., Conclusions: With the exception of body dissatisfaction in boys, psychological traits of eating disorders show heritability patterns that differ according to sex., (Copyright © 2014 SEP y SEPB. Publicado por Elsevier España, S.L.U. All rights reserved.)

The aim of this study was to examine the relationship between nutritional intake and depressive symptoms in Valencian schoolchildren. The ANIVA (Antropometria y Nutricion Infantil de Valencia) study is a descriptive cross-sectional study. During academic year 2013-2014, 710 schoolchildren aged 6-9 years were selected from eleven primary schools in Valencia (Spain). Children's dietary intake was measured on three-day food records, completed by parents/guardians; children completed the 20-item Center for Epidemiologic Studies Depression Scale for Children (CES-DC) Questionnaire to measure depressive symptoms. Weight, height, and body mass index (BMI), and z-scores were evaluated in all subjects. Nutrient adequacy was assessed using Spanish dietary recommended intakes (DRIs); 20.70% of the sample presented depressive symptoms. We identified a positive association between children with depressive symptoms and non-depressive symptoms for thiamin, vitamin K, and bromine (p < 0.05), and a negative association for protein, carbohydrates, pantothenic acid, biotin, vitamin B12 and E, zinc, manganese, cobalt, and aluminum (p < 0.05). Statistically significant differences were found between both groups according to the DRIs for intakes of total energy (p = 0.026), fiber (p < 0.001), vitamin C (p < 0.001), vitamin E (p = 0.004), magnesium (p = 0.018), and iron (p = 0.013). Our results demonstrated that carbohydrates were the most closely associated factor with depressive symptoms, and highlight the potential significant public health implications of inadequate nutritional intake on schoolchildren's mental health.

Background and Objective: Twin and family studies support large genetic influences on variability in body mass index (BMI), with heritability estimates ranging from 47% to over 90%. Our objective was to study the relative contributions of genetics and environment to BMI, evaluating sex differences, in an adolescent twin sample from Valencia, Spain., Material and Methods: Five hundred eighty-four pairs of adolescent twins between 13 and 18 years of age completed the study (82 monozygotic [MZ] and 87 dizygotic [DZ] pairs of male twins, 118 MZ and 102 DZ pairs of female twins, and 195 opposite-sex pairs of DZ twins). To determine zygosity, teachers responded a questionnaire on physical similarity. They also measured the participant's height and weight. BMI was calculated and weight status was determined according to age. We used twin models to assess genetic and environmental (common and unique) factors affecting BMI., Results: There was a 7.1% frequency of overweight and 2.8% of obesity. The estimated heritability of BMI was 88.0% in boys and 72.1% in girls, with the remaining variance attributable to non-shared environment in boys (12.0%) and 8.8% in girls. It was only in girls that common environment had an effect on BMI., Conclusions: Genetics appears to play an important role in explaining the variability in BMI in the adolescence, with slight variations between boys and girls. Common environmental factors exert their influence on BMI only in girls., (Copyright © 2014 Elsevier España, S.L.U. All rights reserved.)

Amazing advances have been made in medical sciences since the first international conference on eating disorders (ED) was held in the 1970s, and there have been remarkable changes in the field of ED itself. Back then, virtually all that was talked about was anorexia nervosa; clinicians and researchers were mainly concerned about the possible hypothalamic and endocrine factors that seemed to be involved and there had been no epidemiological studies or controlled trials with psychiatric drugs or psychotherapy. Although the picture today is quite different, there are still significant gaps which even affect the classification of these disorders, as well as their neurobiological bases and both the pharmacological and psychological treatments which should be used. This paper gives a brief summary of these gaps and discusses the need to find endophenotypes which may help in categorising and directing research into these disorders. Mention is made of possible contributions from other fields for the benefit of greater progress in understanding eating disorders. Specific reference is made to the addictive model, out of which neuropsychology and animal models may provide data transferable to our area of expertise. Lastly, the current state of ED treatment is discussed with pointers as to from what perspective it would be most useful to seek improvements., (Copyright © 2011 SEP y SEPB. Published by Elsevier Espana. All rights reserved.)

Objectives: Nowadays, the use of the Life-Chart Methodology is common in bipolar disorder clinics. Our aim was to present a chart from the Archives of the University Heidelberg (Germany)., Methods: The clinical case records dating from Emil Kraepelin's direction of the Psychiatric Clinic at Heidelberg were systematically screened., Results: Among the clinical records of patients suffering from manic depressive illness we located one record with a detailed charting of the clinical course., Conclusions: The chart reviewed shows that the Life-Chart Method was used more than a hundred years ago and for the same purpose, as an aid to clinicians.

Introduction: The aim of the present study is the translation, adaptation and validation in the Spanish environment of a self-rating of mania scale, the Altman Self-Rating Scale for Mania (ASRM), to fulfill a need in our environment in the self-rating of mania., Methods: The scale was translated, and then a back translation was done. This was sent to the author of the original scale. The scale was administered to a sample of 74 patients with bipolar disorder, divided into two groups, one formed by patients with acute mania (n=35) and the other one constituted by asymptomatic patients (n=39). Concurrently we applied the Clinician Administered Rating Scale for Mania (CARS-M) and the Numeric Evaluation Scale (NES)., Results: High internal consistency, high and significant correlation with the CARS-M mania sub-scale, as well as with the NES and very significant differences between the two groups in the scale score were found. The ROC curve indicates excellent adjustment of the scale, when discriminating among bipolar patients with and without manic symptoms. The factorial analysis provided a single factor that accounts for 62% of the total variance., Conclusions: The Altman Self-Rating Mania Scale is shown to be a reliable and valid self-rating instrument to assess the presence and intensity of manic symptoms. It makes it possible to carry out simple and quick assessments of the patient's state, can be used for research as clinical objectives and can also be a screening instrument.

Introduction: The use of new mood stabilizers in the treatment of bipolar disorder has supposed a revolution, especially due to its more favorable profile in many aspects. Nevertheless, therapeutic decisions on treatment during pregnancy and the breastfeeding period are still being debated. Since these new anticonvulsants appeared in the decade of 1990, less naturalistic experience in its use exists during these periods than with other older anticonvulsants., Methods: A Medline and Embase search was conducted from 1970 to 2003 to review the articles published on the use of the new mood stabilizers during pregnancy and breastfeeding, and its effects on contraception. Neurology and psychiatry text chapters and abstracts of the Annual Meeting of the American Psychiatric Association (years 2001-2003) were also reviewed., Results: Although some recent articles suggest that new mood stabilizers could have a smaller risk of congenital defects, and therefore could be used with smaller risks in women in fertile age, most of articles reviewed indicate that there is not enough knowledge on the safety of the new mood stabilizers in pregnancy and breastfeeding., Conclusions: The risks and benefits of continuing with the new mood stabilizers during pregnancy and breastfeeding must be weighed carefully, and the severity of the disease and the previous answer to treatment should be taken into account.

The present paper focuses on two patients suffering from delusional jealousy with an uncommon feature. Both cases are women who developed a homosexual delusional jealousy, that is, 'the phantom other' is a person of the same gender as the individual supposedly having an affair. The discussion centres on the possible sociological aspects and changes in the 'Zeitgeist' that may have favoured the onset of the two reported cases., (Copyright 2003 S. Karger AG, Basel)

Introduction: [corrected] Psychoeducation programs for bipolar patients try to give them a theoretical and practical system to understand and cope with the consequences of this disorder. The published studies reviewed support the idea that patients included in this therapeutic approach present higher treatment compliance., Methodology: The purpose of our study is to specify the benefits of the psychoeducation programs, comparing the degree of knowledge of the illness (Measured by means of the Understanding Mood Disorder Questionnaire Gavazzi et al, 1997, Spanish version of Livianos and Rojo, 1998) of 10 patients included in our program with that of another 10 patients who attended the same lithium clinic, but were not included in the psychoeducation program., Results: There are statistically significant differences in the total of the scale as well as on the mania scale and known facts, but no differences on the depression scale., Conclusion: The results allow us to stress the impact of the psychoeducation programs on the knowledge of illness.

Introduction: There is no Nursing-staff Mania Rating Scale adapted to the Spanish language. The present work is the result of the adaptation we have carried out., Methodology: The scale has been translated and the back-translation compared with the original version. It has been applied on 670 occasions to a sample of 59 patients. Simultaneously the patients were rated with the Manic Interpersonal Interaction Scale, two versions of the Visual Analogue Scale and the Numeric Rating Scale., Results: The coefficient Alpha of Cronbach is 0.94. The interrater's correlation coefficient for the total of the scale is 0.84. The factorial analysis gives a single factor that explains 65% of the variance. The Area under the ROC Curve is 0,87., Conclusions: The scale shows excellent psychometric properties, with great homogeneity of the scale items and good discriminate properties between bipolar patient and those affected by other psychoses.

Introduction: This work seeks to know the state of the Burnout syndrome among Spanish psychiatrists' with the purpose of having some national reference values. It also sought to elucidate the sociodemographic and work-related variables which can influence the burnout syndrome., Methods: A survey (which includes sociodemographic, work-related variables and the Maslach Burnout Inventory) is applied to a sample of psychiatrists assisting at the National Congress of Psychiatry held in Valencia. The statistical analysis comprises parametric, non parametric and multivariate methods., Results: The results of the three subscales included in the Maslach Burnout Inventory is offered along their relationship with the sociodemographic and work-related variables studied. The multivariate analysis shows that only the variable sex can influence the probability of obtaining high scores in the depersonalization subscale., Conclusions: The scores obtained in the three subscales of the of Maslach Burnout Inventory are higher than those published to date. These prior studies were carried out with autonomous samples. The possible relationship of these high scores with the current spanish situation is considered.

A common idea is the that the patients with affective and anxiety disorders recover in a partial way their memories in function of their state. This particular fact can influence the remembrance of the upbringing so that the memory is facilitated for facts congruent with their current affects. The authors apply a questionnaire of upbringing (PBI) to a group of anxious and depressive patients at the beginning of the treatment and when the improvement has taken place. There are not variations for the punctuations in the scale of upbringing, which is invariant with the changes of the humour.

The utility of the SRQ on the mental health screening in a general population sample is tested on this paper. In terms of a better sensibility/specificity adjustment, and greater adequacy the results show that the best cut-off point is found on 3 affirmative answers. The results are discussed in relation to some others found at the literature.