La paradoja del iboga: intoxicación por un remedio natural de desintoxicación / The paradox of iboga: intoxication by a natural detoxification remedy

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Changes in genetic and environmental influences on disordered eating between pre-menarche and postmenarche girls. A twin study.

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.

Cambios en la influencia genética y ambiental en los trastornos de la alimentación entre niñas en estadio pre y post menarquia. Un estudio gemelar / Changes in genetic and environmental influences on disordered eating between pre-menarche and post-menarche girls. A twin study

Introducción. La incidencia y heredabilidad de los trastornos de la conducta alimentaria (TCA) se incrementa durante la pubertad. El objetivo de la presente investigación fue evaluar los cambios en las influencias genéticas ambientales sobre un amplio espectro de actitudes y conductas alimentarias anómalas durante la pubertad. Metodología. participaron 160 parejas de gemelas adolescentes, que se categorizaron en dos grupos en función del estado de menarquia (pre y pos). Medidas de TCA: Las actitudes y conductas alimentarias anómalas fueron evaluadas mediante el ChEAT (Children's Eating Attitudes Test) y cuatro subescalas del EDI (Eating Disorders Inventory); Impulso a la delgadez, Insatisfacción corporal, Ineficacia y Perfeccionismo. Las correlaciones intrapareja en gemelas MZ (monozigotas) y DZ (dizigotas) se calcularon por separado en los grupos de premenarquia y posmenarquia para cada medida de TCA. Resultados. Cuarenta y ocho gemelas premenarquia (30 MZ y 18 DZ) y 110 gemelas posmenarquia (66 MZ y 44 DZ). Las correlaciones sugirieron que no hay una influencia genética en la puntuación total del ChEAT en las niñas en estado premenarquia, mientras que en las niñas posmenarquia el porcentaje de la varianza para las influencias genéticas es elevado. En relación a las subescalas del EDI, únicamente la variable "Ineficacia" mostró una moderada heredabilidad en las niñas en estadio premenarquia, mientras que las cuatro actitudes alimentarias mostraron una moderada heredabilidad en el grupo de niñas posmenarquia. Conclusiones. Nuestro abordaje revela cambios significativos relacionados con la menarquia en las contribuciones de las influencias genéticas y ambientales sobre las conductas y actitudes alimentarias anómalas. Los clínicos deberían centrar su atención en las niñas adolescentes con alto riesgo de desarrollar TCA especialmente durante el periodo crítico de la menarquia

Background. Eating disorders' incidence and heritability 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

Influencias genéticas y ambientales en rasgos psicológicos y actitudes alimentarias en una población escolar española / Genetic and environmental influences on psychological traits and eating attitudes in a sample of Spanish schoolchildren

Introducción. La heredabilidad de los trastornos de la conducta alimentaria, como la anorexia nerviosa y la bulimia nerviosa, se ha estimado alrededor del 22% al 62%. El objetivo del presente trabajo es determinar la influencia de los factores genéticos y ambientales que contribuyen en la expresión de los factores psicológicos medidos a través del Eating Disorders Inventory, en función del sexo, en adolescentes de la Comunidad Valenciana (España). Material y métodos. Quinientas ochenta y cuatro parejas de gemelos de 13 a 18 años de edad. Para determinar la cigosidad los profesores rellenaron un cuestionario de similitud física. Se aplicaron las subescalas del Eating Disorders Inventory, impulso a la delgadez, insatisfacción corporal, perfeccionismo e ineficacia. Se ha realizado una modelización de las mismas para establecer los componentes genéticos y ambientales (comunes y específicos) de su varianza. Resultados. En las niñas las 4 variables mostraron un componente de heredabilidad, del 37,7% para la ineficacia, del 42,8% para el perfeccionismo, del 56,9% para el impulso a la delgadez y del 65,5% para la insatisfacción corporal. En los niños se descarta una influencia genética para la insatisfacción corporal, que aparece influenciada exclusivamente por factores ambientales. El resto de variables mostraron un componente heredable, pero en menor medida que en las niñas. Conclusiones. A excepción de la IC en niños, las actitudes y comportamientos alimentarios muestran un patrón parcialmente heredable, que varía en función del sexo (AU)

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 (AU)

Genetic and environmental influences on psychological traits and eating attitudes in a sample of Spanish schoolchildren. / Influencias genéticas y ambientales en rasgos psicológicos y actitudes alimentarias en una población escolar española.

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.

Demencia Whippleiana / Whippleian dementia

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Nutrient Intake and Depression Symptoms in Spanish Children: The ANIVA Study.

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.

Genetic and environmental contributions to perfectionism and its common factors.

UNLABELLED: The aims of this study: (1) To evaluate the relative contributions of genetics and environment to perfectionism and it's two constructs: self-oriented, and socially prescribed perfectionism. (2) To clarify genetic and environmental common origins of both personal and social components. METHODS: Participants were 258 pairs of adolescent Spanish twins. Socially prescribed and self-oriented perfectionism were assessed using the perfectionism subscale of the Eating Disorder Inventory. STATISTICS: univariate and bivariate twin models, according to sex. Results; Heritability of self-oriented perfectionism was 23% in boys and 30% in girls, and of socially prescribed perfectionism 39% in boys and 42% in girls. Bivariate analysis suggested a common genetic and environmental pathway model. The genetic correlation between both perfectionisms was 0.981 in boys and 0.704 in girls. The non-shared environmental correlation was 0.254 in boys and 0.259 in girls. Conclusions; genetic influences on perfectionism are moderate during adolescence. Our results point toward a shared genetic component underlying both kind of perfectionism. These findings generate doubts about the hypothesis of a leading role of genetics in the pathogenesis of Self-oriented perfectionism and of environment in socially prescribed. The high genetic correlation seems to indicate that self-oriented and socially prescribed are the same dimension of perfectionism.

Influencias genéticas y ambientales sobre el índice de masa corporal en una población española adolescente gemelar / Genetic and environmental contributions to body mass index in a Spanish adolescent twin sample

Fundamento y objetivo: Los estudios familiares y gemelares han demostrado que los factores genéticos son responsables del 47-90% de la variancia interindividual del índice de masa corporal (IMC). El objetivo de la presente investigación fue evaluar los factores genéticos y ambientales que contribuyen a las diferencias en el IMC, y en función del sexo, en una muestra gemelar de escolares de la Comunidad Valenciana. Material y método: Quinientas ochenta y cuatro parejas de gemelos de 13 a 18 años de edad completaron el estudio: 82 parejas monocigóticas (MC) y 87 dicigóticas (DC) varones, 118 (MC) y 102 (DC) mujeres, y 195 parejas (DC) de sexo opuesto. Para determinar la cigosidad, los profesores rellenaron un cuestionario de similitud física y pesaron y tallaron a los participantes. Se calculó el IMC y se estableció el estado nutricional según la edad. Se llevó a cabo una modelización del IMC que permitió establecer los componentes genéticos y ambientales (comunes y específicos) de su variancia. Resultados: Se observó un 7,1% de sobrepeso y un 2,8% de obesidad. La heredabilidad del IMC se estimó en un 88% en niños y en un 72,1% en niñas. Los factores ambientales específicos explicaron el resto de la variancia del IMC (en niños el 12% y en niñas el 8,8%). Solo en las niñas apareció una contribución de los factores ambientales comunes. Conclusiones: La influencia genética sobre el IMC es intensa durante la adolescencia, con ligeras variaciones en función del sexo, siendo solo las niñas vulnerables a las influencias ambientales comunes (AU)

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 (AU)

[Genetic and environmental contributions to body mass index in a Spanish adolescent twin sample]. / Influencias genéticas y ambientales sobre el índice de masa corporal en una población española adolescente gemelar.

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.

Prevalencia y comorbilidad del Trastorno de Ansiedad Generalizada en una muestra española de escolares adolescentes / Prevalence and comorbidity of generalized anxiety disorder in a sample of spanish adolescent schoolchildren

Los datos epidemiológicos del Trastorno Ansiedad Generalizada (TAG) son relativamente escasos en niños y adolescentes. Este estudio pretende determinar la prevalencia y comorbilidad del TAG en una muestra de adolescentes escolares de la provincia de Valencia. La población evaluada, con edades comprendidas entre 12 y 16 años (14.04 ± 1.22), procedía de centros con Enseñanza Secundaria Obligatoria. Diseño transversal, empleando una entrevista diagnóstica (K-SADS) llevada a cabo por profesionales de salud mental, en una única intervención. La muestra definitiva, 962 participantes, presentaba una prevalencia global del TAG del 3% (2,4% varones; 3,7% mujeres). La prevalencia era máxima, para ambos grupos, a los 14 años de edad. El 58% de los participantes con TAG presentaban, al menos, otro diagnóstico psiquiátrico siendo el más frecuente el de otro trastorno de ansiedad (48,3%). Los niveles de prevalencia y comorbilidad obtenidos, en ausencia de datos previos en nuestro entorno, son similares a los descritos en otros medios; por ello, su detección precoz permitiría una intervención temprana

The epidemiological data on Generalized Anxiety Disorder (GAD) are relatively scant in children and adolescents. This study attempts to determine the prevalence and comorbidity of GAD in a sample of adolescent schoolchildren from the province of Valencia. The study population, aged from 12 to16 years(14.04 ± 1.22), came from a series of secondary schools. The study has a crossover design, using a diagnostic interview (K-SADS) conducted by mental health professionals with a single intervention. The prevalence rate for GAD in the final sample of 962 individuals was 3% (2.4% males; 3.7% females). Prevalence was highest for both groups at 14 years of age. Of the participants with GAD, 58% had at least one other psychiatric diagnosis, the most common being another anxiety disorder (48.3%). The prevalence and comorbidity rates found, in the absence of any prior data in our environment, are similar to those described in other settings; therefore, early detection would allow early intervention

Los trastornos de la conducta alimentaria: consideraciones sobre nosología, etiopatogenia y tratamiento en el siglo xxi / Eating disorders: considerations on nosology, etiology and treatment in the XXI century

Desde la primera conferencia internacional sobre los trastornos alimentarios, celebrada en los años 70, hasta la actualidad, el desarrollo de las ciencias médicas ha sido sorprendente. En el campo de los trastornos de la conducta alimentaria (TCA) también se han producido cambios notables. En las fechas iniciales prácticamente solo se hacía mención de la anorexia nerviosa y sus posibles factores hipotalámicos y endocrinos; no había estudios epidemiológicos ni ensayos controlados con psicofármacos o psicoterapia. El panorama actual es bien diferente aunque hay carencias importantes que afectan a la propia nosografía de estas patologías, al conocimiento de sus bases neurobiológicas y a sus tratamientos, tanto farmacológicos como psicológicos. Teniendo en cuenta estas circunstancias, hacemos un breve sumario de las carencias existentes y planteamos la necesidad de encontrar endofenotipos que ayuden en la categorización e investigación de los TCA. Se hace mención a las aportaciones que desde otros campos hacen posible un avance más profundo en el conocimiento de los TCA. Específicamente se recurre al modelo adictivo, desde el cual la neuropsicología y los modelos animales pueden ofrecer datos trasladables a nuestro ámbito de conocimiento. Por último, se hace mención al estado actual de los tratamientos de los TCA y se señala desde qué perspectiva sería útil plantear mejoras(AU)

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(AU)

[Eating disorders: Considerations on nosology, etiology and treatment in the XXI century]. / Los trastornos de la conducta alimentaria: consideraciones sobre nosología, etiopatogenia y tratamiento en el siglo XXI.

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.

El trastorno bipolar : una guía para familiares y pacientes

Contiene: qué es el Trastorno Bipolar, cómo se manifiesta, si son frecuentes los Trastornos Bipolares, cuáles son las causas, cómo se reconoce, cómo evolucionan, cómo se tratan, preguntas más frecuentes, dónde lograr ayuda y dónde lograr más información.

Pluviometría y asistencia a urgencias / Rain figures and attendance at emergency departments

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Variables demográficas, clínicas y psicológicas que influyen en la falta de asistencia a la primera consulta en salud mental / Demographic, clinical, and psychological variables influencing non-attendance at first mental-health appointment

Objetivos. Identificar las variables demográficas, clínicas y psicológicas de tres grupos de pacientes tras haber sido remitidos a psiquiatría desde Atención Primaria: los que no llegan a solicitar fecha de visita, los que la solicitan y no acuden, y aquellos que la solicitan y acuden. Elaborar estrategias para evitar fallos de asistencia a las primeras consultas. Método. Estudio observacional secuencial de recogida durante 18 meses de datos de todos los pacientes derivados al Centro de Salud Mental. Instrumentos utilizados: petición de interconsulta, cuestionario clínico (SCL-90r de Derogatis), cuestionario de personalidad (EPI de Eysenck), hoja de registro de datos demográficos, y entrevista semiestructurada telefónica.Resultados. Las variables demográficas significativas fueron el estado civil, los pacientes casados acudían más a las primeras visitas y la presencia o no de hijos en casa, aquellos con hijos en casa acudieron más. Los de menor nivel de estudios solicitaron cita con menor frecuencia y los que disponían de teléfono, más. El resto de variables no resultaron significativas. No se obtuvieron variables psicológicas, ni clínicas que diferenciaran los tres grupos. El tiempo prolongado de espera y la mejoría clínica fueron las caúsas más frecuentes para no acudir tras haber solicitado cita, y la mejoría clínica y considerar que la derivación se había debido a un motivo insuficiente, en caso de no llegar a hacerlo. Conclusiones. Un 7% de los pacienes derivados a Salud Mental no llegan a solicitar cita. Los datos demográficos ofrecen resultados dispares. Los cuestionarios SCL-90 y EPI no permitieron determinar características clínicas y psicológicas de los pacientes “incumplidores”. Estrategias como disminuir las listas de espera, y revisar los criterios de derivación podrían resultar útiles para reducir el incumplimiento

Objectives. To identify the demographic, clinical, and psychological variables in three groups of patients who were referred to psychiatric services by primary-care services: those who do not request an appointment, those who request one but do not attend, and those who request one and attend. To design strategies to prevent non-attendance at first appointments. Method. An 18-month sequential observational study that recorded the data of all patients referred to the Mental Health Centre. Instruments used: inter-service referral form; a clinical questionnaire (the Derogatis SCL-90-R), a personality questionnaire (the Eysenck EPI), a demographic information form; and a semi-structured telephone interview. Results. The significant demographic variables were marital status and the presence of children in the home. Patients with lower educational levels requested appointments less frequently, and those with telephones requested them more frequently. The remaining variables were not statistically significant. No psychological or clinical variables were found to distinguish between the three groups of patients. The most frequent causes of non-attendance after requesting an appointment were long waiting times and clinical improvement, while the most frequent reasons for not requesting an appointment were clinical improvement and the belief that there were insufficient grounds for psychiatric referral. Conclusions. 7 percent of patients referred to Mental Health Services do not even request an appointment. Demographic data still offer disparate results. The SCL-90 and EPI questionnaires did not make it possible to identifv the clinical and psvchological characteristics of non-attending patients. Strategies such as shortening waiting lists and reviewing the criteria for referral could prove useful in reducing non-attendance