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OBJECTIVE: Excessive exercise is a well-known phenomenon in anorexia nervosa, but less is known about its role in bulimia nervosa. In addition, there is little evidence regarding the psychopathological processes that might act as predisposing, triggering, or maintaining factors for such exercise. The present study examined the presence of excessive exercise in different women with eating disorders, and its psychopathological correlates. METHODS: Case notes from 63 anorexia nervosa and 61 bulimia nervosa patients were examined. Two-way multivariate analyses of variance (diagnosis x use of excessive exercise) were used to determine the impact of the two factors upon eating characteristics (EAT-40 and BITE) and psychopathological symptoms (SCL-90-R). RESULTS: While high levels of depression were more likely among all patients who used excessive exercise, levels of anxiety and somatization were particularly high only among those anorexics who exercised excessively. DISCUSSION: Possible explanatory models are advanced to account for this pattern of findings, focusing on the possible use of exercise as an affect regulation strategy among anorexia nervosa patients. Further research is suggested to test and develop this model, and possible clinical implications are outlined. Copyright 2002 by Wiley Periodicals, Inc. [ABSTRACT FROM AUTHOR]

Up until now, no study has looked specifically at epigenomic landscapes throughout twin samples, discordant for Anorexia nervosa (AN). Our goal was to find evidence to confirm the hypothesis that epigenetic variations play a key role in the aetiology of AN. In this study, we quantified genome-wide patterns of DNA methylation using the Infinium Human DNA Methylation EPIC BeadChip array ("850 K") in DNA samples isolated from whole blood collected from a group of 7 monozygotic twin pairs discordant for AN. Results were then validated performing a genome-wide DNA methylation profiling using DNA extracted from whole blood of a group of non-family-related AN patients and a group of healthy controls. Our first analysis using the twin sample revealed 9 CpGs associated to a gene. The validation analysis showed two statistically significant CpGs with the rank regression method related to two genes associated to metabolic traits, PPP2R2C and CHST1. When doing beta regression, 6 of them showed statistically significant differences, including 3 CpGs associated to genes JAM3, UBAP2L and SYNJ2. Finally, the overall pattern of results shows genetic links to phenotypes which the literature has constantly related to AN, including metabolic and psychological traits. The genes PPP2R2C and CHST1 have both been linked to the metabolic traits type 2 diabetes through GWAS studies. The genes UBAP2L and SYNJ2 have been related to other psychiatric comorbidity., (© 2022. The Author(s).)

Parkinson's disease (PD) is a chronic neurodegenerative disorder that affects physical, psychological, and social quality of life. Square Stepping Exercise (SSE) is an effective balance training program to prevent falls and to stimulate cognitive function in the elderly; however, no study has analyzed the effect of SSE in people with PD. The main objective is to investigate whether the application of SSE is safe, applicable, and can improve balance, and is effective in preventing falls, improving cognitive and psychological aspects and thus maximize quality of life in people with PD. Methods/Design: SSE will be performed three times per week for 8 weeks with an additional month follow-up after the intervention. Sixty people with PD will participate, randomly distributed into two groups: experimental group (SSE: n = 30) and control group (Usual care: n = 30). The primary measurements will be: (1) Applicability, (2) Safety, (3) Balance, and (4) Annual number of falls. Secondary measurements will be: (1) Sociodemographic information, (2) Physical condition, (3) Health-related quality of life, (4) Depressive symptoms, (5) Cognitive aspects, (6) Perceived functional social support, and (7) Anticipatory cognition.

The objective was to evaluate the risk of presenting an alcohol use disorder (AUD) in outpatient psychiatric units and compare it with drug addiction outpatient units and with healthy controls in the same administrative health area. An observational, descriptive, multicenter study was carried out in which a total of 1054 participants were evaluated. Data were obtained by means of the camouflaged CAGE questionnaire, which consists of 4 basic questions camouflaged with 8 other questions about healthy lifestyle habits. Cut-off points 1 and 2 were considered.Of the total number of participants, 588 were psychiatric outpatients, 153 outpatients from addiction centers and 313 healthy individuals. The mean age of the total sample was 45.8 years and the percentage of men was 53.2%. Of the total sample, 38.3% scored ≥1, as did 34.2% of psychiatric patients, 72.5% of drug addicts and 29.4% of healthy people. The ≥2 cut-off was reached by 26.6% of the total sample, 22.6% of psychiatric patients, 64.7% of drug addicts and 15.3% of healthy subjects. The participants with the highest percentage of ≥1 scores were men (48.8%), those younger than 30 years (50%), those with a diagnosis of alcohol use disorder (95.9%) and ADHD (83.3%).Psychiatric patients are at a higher risk of having an AUD than the healthy subjects, although lower than those who are drug addicts, and the CAGE questionnaire is a simple and useful tool to detect the risk patients have to suffer the condition under study.

Objectives: The study aimed to examine whether dissociation and attitudes towards change were associated with the psychopathology in patients with eating disorders (EDs) at 1-year follow-up., Method: The study included 110 females with anorexia nervosa and bulimia nervosa (48 and 62 respectively). At the beginning of the study and 1 year later, they were assessed by means of the following questionnaires: Dissociative Experiences Scale, Attitudes Towards Change (ACTA), State-Trait Anxiety Inventory, Rosenberg Self-Esteem Scale, Beck Depression Inventory, Eating Attitude Test, Bulimic Investigatory Test Edinburgh and Body Shape Questionnaire (BSQ)., Results: No statistically significant differences were found between both diagnostic groups regarding dissociation scores. The ACTA at baseline, specifically for patients in the contemplation stage, mediate the effect of dissociation on the psychopathological outcome., Discussion: These findings suggest that dissociation might be a transdiagnostic feature related to the EDs outcome. The psychotherapeutic framework must take it into account, particularly in patients in the contemplation stage., (© 2020 Eating Disorders Association and John Wiley & Sons Ltd.)

Background: Patients with eating disorders (ED) are very sensitive and responsive to psychosocial stress. Stress response includes changes in immune cell distribution and may be modulated by the capability to cope with stressors. Thus, the present study sought to analyze the association between coping strategies and immune response (natural killer [NK] cell redistribution following psychosocial stress) in patients with anorexia nervosa (AN) and bulimia nervosa (BN) and healthy controls (HC)., Method: Twenty-four AN patients, 29 BN patients, and 58 HC were studied. A multidimensional assessment tool, the COPE Inventory, was used to assess coping strategies. The number of NK cells was quantified in peripheral blood before and after the application of the Trier Social Stress Test (TSST). Potentially mediating variables, such as weight status, severity of eating pathology, depression, anxiety, and impulsivity were controlled., Results: The three groups differed in intensity and direction of cell redistribution: The TSST was followed in BN patients by a significant decrease in the number of NK cells, whereas HC displayed a moderate decrease and AN a clear increase. Specific correlations between coping strategies and NK cell mobilization were found, especially in BN patients (positive for "planning" and negative for "substance abuse")., Conclusion: Recognition and subsequent modification of the dysfunctional coping strategies used by patients with ED could contribute to improving their immune status, strengthening their resilience and increasing their ability to overcome the disease., (© 2020 Wiley Periodicals, Inc.)

Introduction: Patients with bipolar disorder (BD) have a comorbid substance use with high frequency. Our study aims to establish a relationship between substance use and BD, in terms of greater diagnostic difficulty, a worse prognosis and changes in pharmacological prescription., Methods: The sample consisted of 394 subjects over twenty years were hospitalized with a diagnosis of BD in acute psychiatry unit of a general hospital (10.6% of total of 3,704 patients). The medical records were analyzed for demographic, clinical and family group relating to data subjects., Results: Complete data were obtained from 319 patients. Of these 165 (51.7%) had a history of drug consumption (abuse/dependence). This was more frequent in men (79.7% vs. 34.2%), in patients under 65 years (58.4% vs. 16.7%) and BD type I compared to type II (55% vs. 35%). Consumers substance patients had an age of onset of the disease earlier and more diagnostic difficulties. Regarding treatment, receiving discharge more mood stabilizers and antipsychotics than nonusers, and higher doses of most of them., Conclusions: The cases of dual pathology were detected in more than half of the sample, being the most serious and poorer prognosis patients, besides presenting a debut earlier disease. BD / substance use association was more common in men and in patients under 65 years.

Objective: Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied., Methods: Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment., Results: When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients., Discussion: The results support the association between blunted cortisol response and bulimic features., (Copyright © 2018 John Wiley & Sons, Ltd and Eating Disorders Association.)

Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. Case report: An analysis is made of the safety and tolerability of paliperidone palmitate treatment throughout the gestation period in a 34-year-old patient diagnosed with schizoaffective disorder. Discussion: Paliperidone palmitate treatment throughout the gestation period was safe and well tolerated by both mother and foetus, there being no malformations or other perinatal complications in the newborn to date., (© Georg Thieme Verlag KG Stuttgart · New York.)

Introduction: Pharmacotherapy for the management of obesity is primarily aimed at weight loss, weight loss maintenance and risk reduction (reduction in body fat, risk factors for cardiovascular disease and the incidence of diabetes mellitus). Among drugs that have been evaluated for weight loss include antidepressants (fluoxetine) and antiepileptic (topiramate)., Material and Methods: We analyzed eating behavior and weight loss in a sample of morbid obesity patients before bariatric surgery. The patients suffering eating disturbances symptoms were grouped into three groups: one group received 40 mg of flouxetine/day (Group A); another group received topiramate 200 mg/day (Group B); and the third group of patients were treated with fluoxetine 40 mg and 200 mg of topiramate/day (Group C)., Results: Patients treated with fluoxetine plus topiramate lost more weight at 3 and 6 months before surgery., Conclusions: The use of the psychopharmaceutical drug (fluoxetine and topiramate) in morbid obese patients with eating disorders could represent a new approach to the management of eating behavior before bariatric surgery.

The study was aimed at analysing the reciprocal relationships of several clinical and neurobiological items in order to predict alcohol misuse in patients with bulimia nervosa (BN). Seventy BN patients and 70 healthy controls were assessed for depression, impulsivity, borderline personality traits and self-defeating behaviours using specific scales; serum cortisol and 24-hour urinary excretion of serotonin and 5-hydroxiindolacetic acid were also assessed. The study confirmed the implications of these clinical factors for alcohol misuse in BN patients, but the results suggested that depressive symptoms and hypercortisolism could lie behind these relationships., (Copyright © 2015 John Wiley & Sons, Ltd and Eating Disorders Association.)

Introduction: The aim of the study was to identify the relationship between perceived rearing styles and the clinical expression of Eating Disorders (ED)., Methods: One hundred and ninety-six patients diagnosed of an ED and 127 healthy student as controls selected from the Nursing College were evaluated for general psychopathology (STAI, BDI II, RSE), and for abnormal eating attitudes (EAT, EDI-II, BITE). The EMBU (‘my memories of upbringing’) was administered for the assessment of perceived parental rearing styles and was used a questionnaire to assess familial variables., Results: In relation to the control group, patients with ED perceived greater rejection, overprotection and less warmth than the controls. Patients who perceived greater paternal favoritism, maternal overprotection and low paternal emotional warmth, showed higher levels of anxiety. Paternal affection and maternal attitudes of rejection, overprotection and favoritism were related to lower self-esteem. Regarding abnormal eating attitudes, body dissatisfaction inversely correlated with paternal emotional care and maternal favoritism. The EDI subscales: ineffectiveness, perfectionism and ascetism were associated to parental rejection. Maternal rejection also related with drive for thinness, interoceptive awareness and impulse regulation. Perceived emotional warmth was related with perfectionism. Bulimia subscale and BITE scores were inversely associated to paternal overprotection and affection, and scored significantly higher in paternal favoritism and rejection from both parents., Conclusions: Perceived parental bonding is different in the various subtypes of EDs. Patients diagnosed of Bulimia Nervosa or Eating Disorders Not Otherwise Specified perceived greater rejection, less affection and a greater overprotection than Anorexia Nervosa patients and controls.

Objectives: The aims were to see which temperament and character dimensions were associated with depression, mainly with its outcome at two-year follow up in eating disorders (EDs)., Methods: Participants (N=151) were 44 Anorexia nervosa (AN), 55 Bulimia nervosa (BN) and 52 Eating disorders not otherwise specified (EDNOS) patients. The Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), Rosenberg Self Esteem Questionnaire (RSE), Eating Disorder Inventory (EDI-2) and Temperament and Character Inventory (TCI) were administered., Results: Depression at the beginning (t0) was severe in 22% of the cases. Harm Avoidance and Novelty Seeking had an effect on depressed mood at t0, mediated by Ineffectiveness. Responsibility (SD1) was associated with scores on the BDI at two-year follow up (β=-0.37, 95% CI -2.6, -0.6, p<0.01)., Conclusion: The evaluation of personality dimension in EDs has therapeutic and prognostic implications: To enhance self-efficacy and self-directness is crucial for good clinical outcome., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Introduction: The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN)., Materials and Methods: Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis., Results: BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN., (Copyright © 2013 SEP y SEPB. Published by Elsevier España. All rights reserved.)

Objective: This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme., Method: One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment., Results: Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage., Discussion: The clinician's challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals., (Copyright © 2012 John Wiley & Sons, Ltd and Eating Disorders Association.)

Objective: To investigate whether the subtype of anorexia nervosa (AN) could influence the bulimic syndrome and treatment response in bulimia nervosa (BN) patients with a history of AN (BN/AN+)., Method: Seventy female BN patients were assessed for eating disorder, psychopathology and personality, and treated for 6 months., Results: BN/AN+ patients retained some traits of their past condition: lower body weight, higher perfectionism, and higher reward dependence. They also had more severe symptoms, longer evolution time, and worse response to treatment. A history of restricting AN was associated to higher age, longer evolution time, higher impulsivity, and greater tendency to use diet pills and diuretics. A history of binge-purging AN was associated to more severe vomiting, lower body dissatisfaction and less depressive symptoms, as well as better outcome., Discussion: The influence of the AN subtype in BN/AN+ patients is worthy of further study as it might have clinical implications., (Copyright © 2010 Wiley Periodicals, Inc.)

Objective: To analyze the capability of a set of neurobiological and psychopathological variables to discriminate bulimia nervosa (BN) patients from healthy controls., Method: Seventy-five female patients with purging BN and 30 healthy controls were compared for psychopathology (impulsivity, borderline personality traits, depressive symptoms and self-defeating personality traits) and neurobiological parameters reflecting hypothalamic-pituitary-adrenal axis activity (morning serum cortisol before and after dexamethasone) and monoamine activity (24-hour urinary excretion of norepinephrine, serotonin, dopamine, and their main metabolites: 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, and homovanillic acid). Furthermore, the relationships between the 2 sets of variables were compared in the 2 samples., Results: BN patients displayed higher impulsivity, more severe depressive features, and more borderline and self-defeating personality traits than controls. The 4 psychopathological variables were strongly interrelated in patients, whereas only depressive features correlated with self-defeating personality traits in controls. Patients had lower 24-hour excretion of serotonin and dopamine than controls, as well as lower ability to suppress cortisol. The relations between the biochemical and the psychopathological variables were only significant in the BN patients, but not in the control group. When discriminant analysis methods were applied, patients and controls differed for psychopathology (impulsive behaviors and borderline personality traits) and biological parameters (baseline cortisol and dopamine excretion), but when the variables were analyzed together, the differences in neurobiological parameters appeared as mediated by the psychopathological status., Discussion: Our results suggest that hypothalamic-pituitary-adrenal axis activity, dopamine activity and other biological parameters are worthy of further study as potential dimensional markers of BN, although they seem to depend on the psychopathological status of the patients, in such a way that the psychopathological items associated with emotional instability (impulsivity and borderline personality traits) seem to be more reliable as clinical markers at the time being., (Copyright © 2011 S. Karger AG, Basel.)

The association between lymphocyte subsets and several psychopathological variables which had proved to be able to affect immune cell count in other conditions was investigated in bulimia nervosa patients. Sixty-seven female bulimia nervosa patients and 29 female healthy controls were assessed for nutritional status (weight, blood cells, lymphocyte subsets, biochemical parameters and hormones) and psychopathology (anxiety, depression, hostility, impulsivity and borderline personality traits). A negative correlation between impulsivity and helper T-cells (CD4(+)) was found in controls. In the bulimia nervosa group, the patients with higher anxiety had the lower lymphocyte count, and anxiety and hostility were negatively related to CD4(+) count. In addition, helper/cytotoxic T-cell ratio negatively correlated in this group with impulsivity, hostility and depression. In the light of these results, the potential influence of psychopathology on lymphocyte subset counts seems to be specific in bulimia nervosa patients, and more relevant than in healthy controls.

We present the case of a woman who requested psychiatric evaluation because she had been taking pemoline for six months at a dose between 100-150 mg/day, and was finding it difficult to discontinue taking this substance. Initiation of 300 mg/day of bupropion solved the patient's dependence problem. We propose using antidepressants such as bupropion for the treatment of addictive behaviors due to central nervous system stimulants.

Objective: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN)., Method: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment., Results: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items., Conclusions: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Introduction: The level of expressed emotion (EE) in the family members has been related to several clinical and outcome related factors in patients with eating disorders. This study aimed to study the levels of EE in families of patients with eating disorders using the Camberwell Family Interview (CFI) in order to determine whether they were similar to those reported in other studies developed outside Spain., Methods: Seventy-one parents of 43 eating disorders patients were evaluated using a Spanish version of the CFI., Results: In our sample, 46.5 % of the families had EE high levels. There were no significant differences between mothers and fathers in global scores, but mothers tended to have higher emotional overinvolvement with the patient., Conclusions: The percentage of families that had high EE in our sample was lower than that reported for families with a member with schizophrenia and slightly higher than that detected in other studies on eating disorders. Mothers tended to have higher EE levels than fathers.

Objectives: To establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injec tion and psychological features in patients suffering from erectile dysfunction., Methods: Forty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultra sonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed an penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90)., Results: 29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5 cm/s and penile tumescence grade III) and were classified as good responders with probably psy chogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vas cular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. Th more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography., Conclusions: Psychological features and dysfunctional personality traits accompany psychogenic and organic erectile dys function, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an usefu method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort an dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.

Introduction: Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria., Methods: Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history., Results: Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample., Conclusions: The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.

Aims: To determine the psychological characteristics of a group of morbidly obese patients with binge eating disorders and to investigate whether the psychopathological status of binge eaters is different from that of other morbidly obese patients., Methods: We used the Binge Eating Scale, the Three-Factor Eating Questionnaire and the Millon Clinical Multiaxial Inventory-II (MCMI-II) to interview 140 morbidly obese patients 18 months after bariatric surgery (vertical banded gastroplasty), and compared the results obtained in binge eaters (n = 25) and non-binge eaters (n = 115)., Results: The binge eaters had more eating disturbances (more binge eating, less restriction, more disinhibition, more hunger) and psychopathological characteristics (passive-aggressive traits, aggressive-sadistic traits, manic disorders, alcohol dependence and major depression) than the non-binge eaters. They were also younger and achieved a lower percentage of weight loss., Conclusions: After bariatric surgery, our obese binge eaters reported significantly more psychiatric symptoms, especially those relating to eating disorders, depression, alcohol dependence and personality disturbances. Their weight loss was less satisfactory, and they sought bariatric surgery at a younger age.

The eating behavior, the psychopathological status, and the personality were analyzed in a group of patients with morbid obesity, 18 months after surgery, isolating psychopathological factors associated with a poor response.

Objective: To determine whether different eating disorders are associated with being born at different points in the year. Based on previous research, it was hypothesised that being born during warm months (June-August) is likely to be associated with restrictive anorexia, rather than bulimic disorders (bulimia nervosa, binge-purge anorexia)., Method: Case notes from 105 eating-disordered women were used to yield dates of birth and diagnosis. Associations were calculated between diagnostic group and birth period (month, quarter of year, high-risk quarter)., Results: Restrictive anorexics were significantly more likely than the bulimics (42.6% vs. 24.1%) to be born during the warmest quarter (June-August) than during the remainder of the year., Conclusions: This preliminary study suggests that being born during warmer periods may form a small risk factor for the development of a restrictive eating disorder. Further research is suggested to test and extend the hypothesis.

Introduction: In recent years, a number of studies have been carried out with the intention of isolating clinical dimensions in the psychopathology of bulimia nervosa. Although borderline personality has been considered a core element of the bulimic psychopathology by most of the authors, it has not been incorporated into any of these models. In this context, the present study was aimed at testing the consistence of the more complex model proposed until now, including in the analysis borderline personality as a clinical variable., Sample and Methods: A group of 66 female patients fulfilling DSM-IV criteria for bulimia nervosa were assessed using a set of clinical instruments. The isolated items were processed using factor analysis techniques., Results: Five basic dimensions of bulimia nervosa were obtained: 1. body disatisfaction; 2. restrictive eating behaviors; 3. purging behaviors; 4. emotional instability; and 5. disocial behavior., Conclusions: Our results support the idea that bulimia nervosa is a multidimensional condition. In our model, the dimension emotional instability incorporated borderline features, which tended to be strongly associated to self-defeating behaviors and depressive symptoms.

Aim: To determine the psychological response in children undergoing short-stay ambulatory surgery., Patients and Methods: < psychological responses (CDS, STAIC-E); factor 2: personality (EPQ-J and STAIC-R) and adaptability (TAMAI); factor 3: anxiety and hospital fears (HFRS). Student's paired t-test was used to compare clinical variables., Results: < 8.17 +/- 2.10). The most frequent diagnosis in boys was phymosis and that in girls was inguinal hernia. Forty-one children had previously been hospitalized, of which 29 had undergone surgery. Factorial analysis of the variables explained 46.8% of variance. STAIC-E and STAIC-R scores significantly decreased in the postoperative period. Girls had higher HFRS scores than boys. STAIC-R scores were lower in previously hospitalized children. FILE values in the previous 12 months correlated with increased STAIC-R scores., Conclusions: Elective ambulatory surgery in children minimizes emotional disruption to the child. In this study no differences were observed in the STIC-R and STAIC-E scores before and after surgery. Girls had higher levels of anxiety and fear of surgery. Previously hospitalized children, with or without surgery, had lower anxiety levels. Family problems during the 12 months prior to surgery increased the children's anxiety and depression.

Introduction: We examined the subtyping criteria for bulimia nervosa by comparing atypical and full-blown syndrome patients., Methods: Sixty-one bulimic patients were compared on a number of demographic, clinical, and psychopathological variables. Thirty-nine patients met definite DSM-IV diagnostic criteria for bulimia nervosa and twenty-two had a subclinical form of this disorder., Results: Although patients with less severe eating disorder experienced substantial distress and impairment, the study revealed some interesting clinical differences between the two groups., Discussion: Subclinical bulimia nervosa may be more common in young women than now believed, and seems to be associated with persistent body image dissatisfaction, higher weight, non-purgative methods for controlling weight gain, and lower associated psychopathology.

A group of 24 eating-disordered female subjects (10 anorexia nervosa--AN--and 14 bulimia nervosa--BN--patients) were interviewed, using a semistructured interview for DSM-III-R Axis-II Personality Disorders (SCID-II). A group of 54 subjects without eating disorder acted as a control group. A high rate of personality disorder (PD) diagnoses occurred in eating disordered subjects (AN and BN patients), with a high prevalence of borderline, dependent, and self-defeating PD. Avoidant and obsessive-compulsive PD were more common in AN patients, whereas BN was associated with histrionic PD. Findings have implications for the assessment and diagnosis of eating-disordered patients and for treatment planning.

The present paper summarizes the results of a clinical investigation developed on 35 depressed outpatients. Several clinical and psychosocial variables were isolated with the aim of establishing which of them could be related with a premature treatment withdrawal. The results are discussed and the responsibility of psychosocial factors in treatment compliance is stressed. Personality traits, family support, and negative life events seem to be the most significant factors associated to non-adherence. In the author's opinion, these factors could be related to the treatment compliance not only in depressive disorders but also in many other medical and psychiatric diseases.

Metatherapy (a psychotherapeutic procedure based upon parental couple collaboration) is a technique useful for working with severely disorganized family contexts, in which psychopathological diseases (such as psychotic or psychosomatic disorders, suicide attempts of the children etc.) can appear. The management of the family has two definite phases: (a) case evaluation, with the participation of the whole family group and (b) case treatment, with exclusive participation and active collaboration of the parental couple. The usefulness of this therapeutic tool proceeds from the restructuration and boundary delimitation that it provides, stressing the recuperation of parental executive capacity. Thus, metatherapy can be used in the treatment of suicide attempts and severe depression of children and early adolescents, because the patients can see themselves free of the mark of illness, and the parents (usually suffering from a very strong anxiety and powerful feelings of guilt) can be confirmed in their role and be pleased to give their collaboration for the treatment of their family. These interactional changes improve the clinical outcome of these cases.

The effect of antidepressant treatment was evaluated in a group of outpatients with symptoms of depressive illness ("dysthymic disorder" and "major depression", according to DSM-III criteria) with regard to the expectations they had for the results of the therapy. Therefore, patient ideas about the efficacy of the treatment, psychiatrist capability, duration of illness and other factors were analyzed. The clinical status of the patients was studied at the 1st visit, 2nd visit (a week later), and 3rd visit (3 weeks later). The patients were included in one of the followings three groups: "good responders", "moderate responders", and "bad responders". Data were analyzed statistically to show the correlation between patients expectations and attitudes toward the treatment, and clinical outcome.