Characteristics of patients in an eating disorder sample who dropped out: 2-year follow-up.

OBJECTIVE: This manuscript explores the characteristics of individuals diagnosed with an eating disorder who dropped out of treatment, compared with those who completed it. METHOD: The participants were 196 patients diagnosed with eating disorders (according to DSM-IV-TR criteria) who consecutively began treatment for the first time in an eating disorders unit. They were assessed at baseline with a set of questionnaires evaluating eating habits, temperament, and general psychopathology. During the follow-up period, patients who dropped out were re-assessed via a telephone interview. RESULTS: In the course of a 2-year follow-up, a total of 80 (40.8%) patients were labeled as dropouts, and 116 (59.2%) remaining subjects were considered completers. High TCI scores in the character dimensions of Disorderliness (NS4) (p < .01) and total Novelty Seeking (NST), along with low scores in Dependency (RD4), were significantly associated with dropout in the course of 2 years. Once the results were submitted to logistic regression analysis, dropout only remained associated with high scores in Disorderliness (NS4) and, inversely, with an initial Anorexia Nervosa (AN) diagnosis (p < .05). Reasons for dropout stated by the patients included logistic difficulties, subjective improvement of their condition, and lack of motivation. DISCUSSION: Clinicians should handle the first therapeutic intervention with particular care in order to enhance their understanding of clients and their ability to rapidly identify those who are at risk of dropping out of treatment. LEVEL OF EVIDENCE: Level III: Cohort Study.

Enjaulad a dodo, por favor. El cuento de que todas las psicoterapias son igual de eficaces / No disponible

El veredicto del pájaro Dodo afirma que cuando las psicoterapias son comparadas entre sí ofrecen resultados similares, lo que sería consistente con la visión de que los factores comunes son los ingredientes más potentes para conseguir los beneficios de las psicoterapias. Este trabajo revisa el debate en torno a este asunto, resalta algunas cautelas en las conclusiones que se pueden extraer de él y discute, con el reconocimiento de las debilidades de la investigación en este campo, los motivos por los que el debate sigue vivo. Finalmente, se sugiere cómo esto puede contribuir a la investigación y a la atención a los pacientes

The Dodo bird verdict states that when the psychotherapies are compared with each other they yield similar outcomes, which is consistent with the view that common factors are the most potent ingredients for producing the benefits of psychotherapy. This paper reviews the debate around the issue, highlights some caveats in the conclusions that can be drawn from it, and discusses, with recognition of the weaknesses of the research in this field, the reasons for the debate still being alive today. Finally, a number of suggestions are offered with regards to how this can contribute to research and to patient care

Planning Abilities in Patients with Anorexia Nervosa Compared with Healthy Controls.

OBJECTIVE: Altered cognitive functioning could have an important role in the development and maintenance of Anorexia Nervosa (AN). The majority of previous research has focused on flexibility and global-detail processing. The aim of this study was to explore planning abilities in women with AN. METHOD: Women with AN (n = 32) were compared to healthy controls (n = 42) using two different types of neuropsychological tasks for the assessment of planning abilities: Tower of London (ToL), a classic measure of planning abilities, and Zoo Map test, a more ecologically valid planning measure. Measures of AN psychopathology, anxiety, depression, and obsessive compulsivity were also collected. RESULTS: The AN group did not differ from controls in the ToL (all p-values p > .05), although they performed significantly worse than controls in the main score of the Zoo Map (p = .02). A worse performance in the Zoo Map test More was associated with more eating disorders (rho = -.44, p = .018) and depressive (rho = -.42, p = .026) symptoms in the AN group. CONCLUSIONS: Our study suggests the presence of subtle planning difficulties in women with AN which might be better detected using tasks with increased ecological validity.

Cognitive flexibility, central coherence and social emotional processing in males with an eating disorder.

OBJECTIVES: Females are more likely to develop an eating disorder (ED) than males. Studies of affected men may therefore inform models of risk and resilience to EDs. The aim of this study was to examine putative neurocognitive intermediate phenotypes of EDs in affected males. METHODS: Cognitive flexibility, central coherence (global/detail processing), complex emotion recognition and social-threat sensitivity were investigated in men with EDs and healthy men. Measures of distress, perfectionism, and obsessive compulsivity were collected. RESULTS: Men with EDs were more cognitively inflexible across tasks and had more difficulty integrating global information than healthy men. Unexpectedly, there were no group differences on a visuospatial task of detail processing or on social-emotional processing tasks. Men with EDs had higher scores on measures of distress, perfectionism and obsessive compulsivity than healthy men. CONCLUSIONS: Men with EDs share some of the intermediate cognitive phenotype present in women with EDs. Like their female counterparts, males with EDs show an inflexible, fragmented cognitive style. However, relative to healthy men, men with EDs do not have superior detail processing abilities, poor emotion recognition or increased sensitivity to social-threat. It is possible that gender differences in social-threat processing contribute to the female preponderance of EDs.

The Spanish validation of an Eating Disorders Symptom Impact Scale (EDSIS) among caregivers.

The aim of this study was to examine the psychometric properties of the Spanish version of the Eating Disorders Symptom Impact Scale (EDSIS-S), which is designed to evaluate an eating disorders-specific caregiving experience. A cross-sectional study was conducted among 187 Spanish caregivers of relatives with an eating disorder. Measures included the Experience of Caregiving Inventory (ECI) and General Health Questionnaire (GHQ-12). Socio-demographic variables of the carers and clinical variables of the patients were collected. Results supported the factorial structure, reliability and convergent validity of the instrument and the instrument was acceptable for assessing the eating disorders-specific experience of caregiving in Spain. Almost all of the factor loadings were >0.40. Cronbach's alpha coefficients were mostly superior to 0.70. The EDSIS-S instrument has good psychometric properties and is similar to the original in terms of validity and reliability. Further examination of the factor structure of this instrument among adult samples is indicated. From a clinical perspective, the EDSIS allows for tailoring caregiver interventions to address the specific impact of symptoms on individual carers.

Preserved orbitofrontal function in first-episode schizophrenia: further evidence from the object alternation paradigm.

Neuropsychological literature indicates that performance on Object Alternation Task (OAT) can be linked to the orbitofrontal cortex (OFC). Patients with chronic schizophrenia perform poorly on behavioral and neuropsychological tasks related to OFC functions. In a previous study using the Iowa Gambling Task, we found unimpaired performance in a sample of individuals with first-episode schizophrenia (FES) spectrum disorders. In this study, we aimed to extend our study of OFC functions by using the OAT paradigm, to determine whether there are abnormalities in the early phases of schizophrenia. We examined the performance of 70 patients with FES and 21 healthy controls on a computerized version of OAT. There were no significant differences between patients and control subjects with respect to the OAT. This finding suggests that the OFC function, as measured by decision-making tasks, is preserved in the early phases of schizophrenia.

Intervención con familias: razones del desuso / Family intervention: reasons for its disuse

Dentro de las intervenciones psicosociales para el tratamiento de la psicosis, la intervención con familias en diversos formatos ha demostrado ciertos beneficios (e.g. la reducción de recaídas) sin que suponga un aumento en la carga familiar. Pese a ello sigue siendo escasamente utilizada en los dispositivos asistenciales. En este trabajo repasamos algunas de las razones de este desuso y las distintas dificultades que podemos encontrar para enganchar a las familias en el tratamiento, para de ahí sacar algunas conclusiones sobre los modos de ayuda a familiares o cuidadores de personas con psicosis y las necesidades profesionales e institucionales para garantizar su aplicación en la práctica habitual. Se describe un modo de evaluar la disponibilidad inicial de las familias y los datos preliminares obtenidos con él. Finalmente, se comentan las particularidades de la función del psicólogo clínico con relación a otras especialidades sanitarias. (AU)