Diferencias clínicas entre pacientes obesos mórbidos con y sin atracones / Clinical differences between morbid obese patients with and without binge eating

Introducción. Nuestro objetivo fue evaluar las diferencias clínicas de pacientes obesos con y sin alteraciones de la conducta alimentaria. Material y métodos. Se estudiaron a 210 pacientes con obesidad mórbida derivados de forma consecutiva a una consulta de psiquiatría en un hospital general por diferentes motivos. Se realizó una entrevista clínica, se valoró la presencia de comorbilidad psiquiátrica y se aplicaron una serie de escalas de psicopatología y de conducta alimentaria: Escala de Depresión de Beck (BDI), Escala de Ansiedad de Beck (BAI), Inventario de Obsesiones-Compulsiones de Maudsley (MOCI), Escala de Impulsividad de Barrat (BIS), Inventario de Trastornos de la Alimentación (EDI), Test de Actitudes hacia la Comida (EAT), Test de Bulimia de Edimburgo (BITE) y Cuestionario sobre la Figura Corporal (BSQ). La muestra se dividió en dos grupos: pacientes con conductas de atracones según las definiciones de la CIE-10 y el DSM-IV y aquellos sin estas conductas. En el primer grupo se incluyeron 14 pacientes con bulimia nerviosa, 32 con criterios de trastorno por atracón y 15 pacientes con atracones sin criterios para uno de los dos trastornos citados (total, 61 pacientes con atracones frente a 145 sin atracones). Resultados. Los pacientes con atracones tenían más psicopatología, fundamentalmente mayor prevalencia de distimia, eran más impulsivos según la BIS y obtenían puntuaciones más elevadas en algunas escalas que valoraban la alteración de la conducta alimentaria. Estos pacientes tenían más antecedentes familiares de trastornos de la conducta alimentaria (TCA) y presentaban mayor insatisfacción corporal a pesar de un menor índice de masa corporal (IMC). Este grupo refería mayores limitaciones funcionales debidas a su obesidad y presentaba mayor obsesividad sobre el peso y la comida. Conclusiones. Por tanto, los obesos mórbidos con atracones forman un grupo posiblemente homogéneo (independientemente del diagnóstico de trastorno de la conducta alimentaria presente) y diferenciado del resto de los obesos mórbidos por la existencia de mayor psicopatología fundamentalmente de tipo afectivo, mayor impulsividad y mayor severidad en las escalas que evalúan síntomas nucleares de los trastornos de la conducta alimentaria e insatisfacción corporal

Introduction. Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. Methods. We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). Results. Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. Conclusions. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction

[Clinical differences between morbid obese patients with and without binge eating]. / Deferencias clinicas entre pacientes obesos mórbidos con y sin atracones.

INTRODUCTION: Our objective was to evaluate clinical differences between morbid obese patients with and without binge eating. METHODS: We evaluated 210 morbid obese patients who were referred consecutively to a psychiatric evaluation in a general hospital for different reasons. We used a clinical interview, evaluated psychiatric comorbidity and applied a series of psychopathology and eating behavior scales: Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Maudsley Obsessive-Compulsive Interview (MOCI), Barrat Impulsiveness Scale (BIS), Eating Disorder Inventory (EDI), Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE) and Body Shape Questionnaire (BSQ). The sample was divided in two subgroups: patients with binge eating according to ICD-10 and DSM-IV criteria, and patients without binge eating. The first subgroup was composed of 14 patients with bulimia nervosa, 32 with binge eating disorder, and 15 patients with binge eating who did not fulfill criteria for bulimia or binge eating disorder (subgroup was composed by 61 patients vs 145 patients without binge eating). RESULTS: Binge eating patients showed more psychopathology, more prevalence of dysthymia, higher score in impulsiveness, and scales that evaluated eating disorder. Binge eating patients showed more familial background of eating disorders; more body dissatisfaction in spite of a lower Body Mass Index (BMI). This group showed more functional disability induced by obesity and more weight and shape overconcern. CONCLUSIONS. The findings suggest that the morbid obese with binge eating constitute a distinct subgroup (independently of eating disorder diagnosis) among the obese population, with more psychopathology severity, especially affective disorder, more impulsivity, and more severity in core items of eating disorder scales and body dissatisfaction.

Uso de recursos hospitalarios tras un programa de tratamiento de alcoholismo en un hospital general / Hospital resource use after an alcoholism treatment program in a general hospital

Objetivo: El objetivo de nuestro estudio fue evaluar el uso de recursos sanitarios en un hospital general tras un programa ambulatorio de tratamiento del alcoholismo en el mismo hospital. Material y métodos: Se incluyó a 145 pacientes que iniciaron el tratamiento de forma consecutiva. Se estableció una comparación del uso de consultas externas de otras especialidades del hospital, días de ingresos hospitalarios y visitas a urgencias, entre los pacientes que permanecían en tratamiento a los 6 meses de iniciarlo y aquellos que no permanecían ese tiempo. Se calculó un índice de uso de cada recurso considerando el tiempo de seguimiento de cada paciente. Resultados: Los pacientes que permanecieron en tratamiento de deshabituación 6 meses presentaron un descenso en el uso de urgencias y en los días de ingreso hospitalario tanto respecto a antes del tratamiento como al compararlos con los pacientes que no permanecieron los 6 meses. No hubo diferencias en el uso de consultas externas entre grupos. Conclusiones: Los programas de deshabituación producen beneficio al reducir la utilización de algunos recursos sanitarios

Aim: The aim of this study was to evaluate resource use in a general hospital after an outpatient alcoholism treatment program. Material and methods: One hundred forty-five consecutive patients who started the treatment program were included. The use of outpatient care in other hospital departments, days of hospitalization, and the use of the emergency room were compared among patients who remained in the treatment program 6 months after starting and those who did not. A medical care index for outpatient, inpatient and emergency use was calculated, taking into consideration each patient's period of follow-up. Results: Days of hospitalization and emergency room use were reduced in patients who remained in the alcoholism treatment program for 6 months in comparison with the subgroup without 6 months of retention. No differences were found in the use of outpatient care between the two groups. Conclusions: In view of these results, alcohol treatment programs reduce some resource use

Consumo de sustancias psicoactivas en pacientes con trastorno de pánico / Psychoactive drugs use in patients with panic disorder

Introducción. Los objetivos de este estudio fueron evaluar la prevalencia del consumo de drogas en pacientes ambulatorios con trastorno de pánico, su repercusión sobre la evolución y la respuesta al tratamiento de dicho trastorno. Material y métodos. La muestra está constituida por 79 casos con diagnóstico de trastorno de pánico o agorafobia con trastorno de pánico según la CIE-10 y 83 controles con otros trastornos psiquiátricos en tratamiento en el mismo centro. Se realizó un seguimiento durante 6 meses. Resultados. Se obtuvo una prevalencia para el consumo habitual de drogas a lo largo de la vida del 13 % para el alcohol, el 52 % para el tabaco y el 47 % para el café; no hubo consumos de otras sustancias. El consumo actual de cafeína era inferior en los casos que en los controles, no existiendo diferencias respecto a los otros consumos, y el consumo de café se relacionó con requerimientos de mayores dosis de antidepresivos. Conclusiones. Por tanto, la prevalencia de consumo habitual de sustancias a lo largo de la vida en pacientes con trastorno de pánico en tratamiento ambulatorio se sitúa alrededor de un 13 % para el alcohol, un 47 % para el café y un 52 % para el tabaco; hay un menor consumo de cafeína, aunque no existen diferencias en otros consumos respecto a un grupo de controles psiquiátricos. La presencia de agorafobia no repercute en el consumo. El consumo tiene escasas repercusiones sobre la clínica y la respuesta al tratamiento, aunque puede modificar las dosis requeridas de antidepresivos

Introduction. The objectives of this study were to evaluate the prevalence of drug use in out-patients with panic disorder and their influence in evolution and therapeutic response of panic disorder. Material and methods. The sample was made up of 79 out-patients diagnosed of panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria and 83 controls from the same center with other psychiatric disorders. Subjects were followed-up for six months. Results. Prevalence of regular lifetime drug use was: 13 % for alcohol, 52 % for nicotine and 47 % for caffeine. No other drug use was observed. Patients with panic disorder used less caffeine than controls, there being no differences in other drug use. Caffeine use was associated with higher antidepressant dosages. Conclusions. Thus, prevalence of regular drug use in panic disorder during the lifetime of out-patients with panic disorder was: 13 % for alcohol, 47 % for caffeine use and 52 % for nicotine use. Those with panic disorder use less caffeine than other psychiatric patients, but there were no differences in other drug use. Presence of agoraphobia has no repercussion on consumption. There were no differences in clinical manifestations and treatment responses between users and non-users, but drug use may modify antidepressant dosages

[Psychoactive drugs use in patients with panic disorder]. / Consumo de sustancias psicoactivas en pacientes con trastorno de pánico.

INTRODUCTION: The objectives of this study were to evaluate the prevalence of drug use in out-patients with panic disorder and their influence in evolution and therapeutic response of panic disorder. MATERIAL AND METHODS: The sample was made up of 79 out-patients diagnosed of panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria and 83 controls from the same center with other psychiatric disorders. Subjects were followed-up for six months. RESULTS: Prevalence of regular lifetime drug use was: 13 % for alcohol, 52 % for nicotine and 47 % for caffeine. No other drug use was observed. Patients with panic disorder used less caffeine than controls, there being no differences in other drug use. Caffeine use was associated with higher antidepressant dosages. CONCLUSIONS: Thus, prevalence of regular drug use in panic disorder during the lifetime of out-patients with panic disorder was: 13 % for alcohol, 47 % for caffeine use and 52 % for nicotine use. Those with panic disorder use less caffeine than other psychiatric patients, but there were no differences in other drug use. Presence of agoraphobia has no repercussion on consumption. There were no differences in clinical manifestations and treatment responses between users and non-users, but drug use may modify antidepressant dosages.

Efectividad del uso del citalopram en pacientes con trastornos de pánico / Effectiveness of citalopram in out-patients with panic disorder

Nuestro objetivo fue estudiar la efectividad y tolerancia del citalopram en el trastorno de pánico. Cincuenta y cinco pacientes con trastorno de pánico o agorafobia con trastorno de pánico según criterios de la CIE-10 que iniciaron tratamiento ambulatorio, fueron seguidos durante seis meses. La dosis de citalopram se ajustó según criterios clínicos y se pautaron benzodiacepinas si se consideraba que estaban indicadas. Se valoró la efectividad del tratamiento usando como variables dependientes el cambio en la frecuencia de las crisis y en la impresión clínica global del médico (ICG), como variables de efectividad secundarias se usaron los cambios en diversas escalas de depresión y ansiedad. Once pacientes abandonaron el seguimiento. El 83,4% de los pacientes presentó una mejoría marcada o notable según la ICG de eficacia. Los efectos secundarios más frecuentes, fueron las disfunciones sexuales y las molestias abdominales. Por lo tanto, el citalopram puede resultar efectivo en disminuir el número de crisis de angustia y mejora sustancialmente otras manifestaciones clínicas en más del 80% de los pacientes, con un favorable perfil de tolerancia, en las condiciones clínicas habituales

The objective of this study was to study the effectiveness and tolerability of citalopram in panic disorder. Fifty five out-patients with panic disorder or agoraphobia with panic disorder according to the ICD-10 criteria who initiated treatment, were followed up for six months. Dosages of citalopram were ajusted according clinical criteria, and use of benzodiacepines was permitted. Effectiveness variables were the changes in number of panic attacks, and the clinical global impression (CGI) of efficacy, and secondary variables, were the changes of scores in a variety of depressión and anxiety scales. Eleven patients were drop-outs. A 83.4% of patients had a notably or excellent improvement according to the CGI. More prominent adverse effects were sexual dysfunction and gastrointestinal discomfort. Citalopram appears effective to improve the number of panic attacks and another clinical manifestations of panic disorder in 80% of the patients, with a favourable tolerability profile