[Assessment of cortical brain blood flood by brain perfusion spect in patients with a diagnosis of eating behavior disorders]. / Valoración del flujo cortical cerebral mediante SPECT de perfusión cerebral en pacientes con diagnóstico de trastornos de la conducta alimentaria.

OBJECTIVE: To evaluate cortical brain blood flow by 99mTc-HMPAO SPECT in patients with Eating Disorders (ED): restrictive anorexia (RA) and purgative bulimia (PB). MATERIAL AND METHOD: The study included 7 women with diagnostic criteria of RA and 12 with PB. The control group was made up of 12 healthy women. All subjects underwent brain 99mTc-HMPAO SPECT. The SPECT studies were quantified, yielding semiquantitative indexes relating to cerebellar activity in different regions. Body dissatisfaction was assessed by means of the BSQ (Body Shape Questionnaire). The results were analyzed with the ANOVA variance and had a statistical significance of p < 0.05. RESULTS: Mean BSQ scores were 98.28 (range 71-159) in the RA group, 145.05 (range 73-191) in the PB group, and 57.4 (range 37-88) in the control group. All patients in the sample (i.e., both RA and PB) showed global cerebral hypoperfusion versus the controls, although the difference only reached statistical significance in the RA group in the left parietal lobe (p = 0.02) and in the right (p = 0.004) and left temporal lobes (p = 0.015). In the PB group, the significantly hypoperfused regions were the right (p < 0.001) and left (p = 0.008) superior frontal lobe, the right inferior frontal lobe (p = 0.042), the right (p = 0.042) and left (p = 0.002) parietal lobes, and the right temporal lobe (p = 0.002). CONCLUSION: The results obtained showed that patients with ED had cerebral hypoperfusion compared with healthy subjects. This pattern is common in parietotemporal regions for both PB and AR although with temporal and parietal predominance in RA and PB, respectively. In addition, patients with PB had frontal region involvement.

Influencia de la motivación en la evolución clínica de los trastornos del comportamiento alimentario / Influence of motivation and clinica outcome in eating disorders

Introducción. Nuestro objetivo era valorar si en los pacientes con un trastorno del comportamiento alimentario (TCA) la motivación al inicio del tratamiento puede influir sobre la evolución clínica al año de seguimiento.Métodos. En el estudio fueron incluidos 102 pacientes que acudieron para recibir tratamiento en una unidad hospitalaria de trastornos alimentarios y que reunían criterios de TCA del DSM-IV. Todos los pacientes fueron diagnosticados según la entrevista estructurada SCID-I y se registraron las variables sociodemográficas y clínicas. Asimismo, previamente a ser incorporados a nuestro programa de tratamiento completaron el Cuestionario de actitudes ante el cambio en los TCA (ACTA) y otros cuestionarios de psicopatología alimentaria y general.Resultados. Bajas puntuaciones iniciales en la subescala de «recaída» predecían en las pacientes con anorexia una mayor recuperación ponderal y en las pacientes con bulimia se asociaban a un menor número de atracones semanales tras 1 año de seguimiento.Conclusiones. La actitud del paciente al inicio de un programa terapéutico, especialmente la sensación de recaída, es un factor pronóstico importante en la respuesta terapéutica

Introduction. Our aim was to assess if the degree of motivation at the beginning of the treatment for eating disorders (ED) might have an influence on the clinical outcome at one year of follow-up. ;;Methods. 102 patients diagnosed of ED, following ED DSM-IV criteria, who initiated treatment at the hospital eating disorders unit, were included in the study.All the patients were examined with the structured interview SCID-I and numerous clinical and demographic variables were recorded. Before beginning eating disorders treatment, patients completed one questionnaire that assessed attitudes towards change in eating disorders (ACTA) and other questionnaires measuring eating and general psychopathology. Results. At one year of follow-up, initial low scores on the «relapse» subscale predicted a greater weight recovery in patients with anorexia nervosa and a lower number of weekly binges in bulimic patients. Conclusions. Attitude towards treatment at the beginning of a therapeutic program, mainly feeling of relapse, is a significant prognostic factor for the therapeutic response

[Influence of motivation and clinical outcome in eating disorders]. / Influencia de la motivación en la evolución clínica de los trastornos del comportamiento alimentario.

INTRODUCTION: Our aim was to assess if the degree of motivation at the beginning of the treatment for eating disorders (ED) might have an influence on the clinical outcome at one year of follow-up. METHODS: 102 patients diagnosed of ED, following ED DSM-IV criteria, who initiated treatment at the hospital eating disorders unit, were included in the study. All the patients were examined with the structured interview SCID-I and numerous clinical and demographic variables were recorded. Before beginning eating disorders treatment, patients completed one questionnaire that assessed attitudes towards change in eating disorders (ACTA) and other questionnaires measuring eating and general psychopathology. RESULTS: At one year of follow-up, initial low scores on the "relapse" subscale predicted a greater weight recovery in patients with anorexia nervosa and a lower number of weekly binges in bulimic patients. CONCLUSIONS: Attitude towards treatment at the beginning of a therapeutic program, mainly feeling of relapse, is a significant prognostic factor for the therapeutic response.

Factores de riesgo y de protección para el uso de tóxicos en adolescentes. Un estudio longitudinal / Risk and protective factors for drug abuse in adolescents. A longitudinal research

Introducción. El objetivo del presente estudio era identificar posibles factores, tanto de riesgo como protectores, para el hecho de sufrir problemas con el consumo de tóxicos en adolescentes. Métodos. Realizamos un seguimiento durante 2 años (en segundo y en cuarto de Educación Secundaria) sobre variables sociodemográficas, psicopatología general y alimentaria, funcionamiento familiar y consumo de tóxicos de 1.076 alumnos. Resultados. Controlando el efecto del consumo de tóxicos inicial, consumir tabaco a los 13 años predice el consumo de alcohol 2 años después y viceversa. Independientemente del efecto de esta asociación, la psicopatología general, la insatisfacción con la imagen corporal y las autolesiones al inicio son factores de riesgo para el consumo de alcohol 2 años después. Junto al sexo femenino y las altas calificaciones académicas, el buen funcionamiento familiar constituye un factor de protección contra el hecho de sufrir posteriormente problemas con los tóxicos. Conclusiones. Estos hallazgos podrían tener relevancia en el desarrollo de estrategias preventivas para el consumo de tóxicos en población adolescente

Introduction. The aim of the present study was to identify possible risk and protective factors for the development of problems with the use of drugs in adolescents. Methods. A two years follow-up was carried out (from the 2nd to the 4th year of the Compulsory Secondary Education). Sociodemographic variables, general and eating psychopathology, family functioning and patterns of drugs use were assessed in 1,076 students. Results. After controlling the effect of having problems with the use of drugs at the beginning, cigarettes smoking at the age of 13 years predicted the consumption of alcohol 2 years later and vice versa. Independently of the effect of this association, general psychopathology, body image dissatisfaction and self-harm at the beginning were risk factors for alcohol consumption 2 years later. Moreover, besides female gender and high academic achievements, normal family functioning was a protective factor against the fact of suffering problems with drugs later on. Conclusions. These present findings might have relevance in the development of preventive strategies for the use of drugs in adolescent population

Risk and protective factors for drug abuse in adolescents. A longitudinal research.

INTRODUCTION: The aim of the present study was to identify possible risk and protective factors for the development of problems with the use of drugs in adolescents. METHODS: A two years follow-up was carried out (from the 2nd to the 4th year of the Compulsory Secondary Education). Sociodemographic variables, general and eating psychopathology, family functioning and patterns of drugs use were assessed in 1,076 students. RESULTS: After controlling the effect of having problems with the use of drugs at the beginning, cigarettes smoking at the age of 13 years predicted the consumption of alcohol 2 years later and vice versa. Independently of the effect of this association, general psychopathology, body image dissatisfaction and self-harm at the beginning were risk factors for alcohol consumption 2 years later. Moreover, besides female gender and high academic achievements, normal family functioning was a protective factor against the fact of suffering problems with drugs later on. CONCLUSIONS: These present findings might have relevance in the development of preventive strategies for the use of drugs in adolescent population.

Attitudes towards change and treatment outcome in eating disorders.

OBJECTIVE: To investigate the influence of the stage of change on treatment outcome among patients suffering from eating disorders. METHOD: Sixty-seven women receiving free outpatient treatment for eating disorders initially participated in this study. Their demographic, lifetime and clinical characteristics, eating disorder symptoms and general distress were assesssed at baseline and after one year, together with the results of self-report questionnaire on Attitudes towards Change in Eating Disorders (ACTA). RESULTS: High scores on the Maintenance subscale were protective for eating psychopathology as measured by the Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI-2) and the frequency of purging. Action was predictive of weight changes. Precontemplation and Relapse respectively predicted little change in EAT and the Bulimic Inventory Test Edinburgh (BITE). High Preparation scores were predictive of the level of EDI-2 Interoceptive Awareness, Maturity Fears, and Ascetism. DISCUSSION: Our results suggest considering the stage of change as a useful outcome predictor.

[Antipsychotics in treatment of eating disorders patient: a study with risperidone]. / Uso de antipsicóticos en el tratamiento de pacientes con trastorno de la conducta alimentaria: estudio con risperidona.

INTRODUCTION: The use of antipsychotic drugs in the treatment of eating disorders (ED) patients is a controversial issue. Although a few studies support the systematic use of antipsychotics, they are frequently used, mainly in severe disorders with other associated psychopathological symptoms. METHODS: 27 ED patients were included in the study, 7 dropped-out prematurely or did not complete the pharmacological treatment. All the patients were interviewed and diagnosed according to the Structured Clinical Interview for the DSM-IV (SCID-I) and the personality diagnosis was carried out with the Spanish version of the International Personality Disorders Examination (IPDE). The clinical assessment was performed with the Clinical Global Impression (CGI) scale and the Change Severity Assessment (CSA) at baseline and three months after the beginning of the treatment with risperidone. RESULTS: A significant proportion of patients showed clear clinical and general state improvement in areas like physical state, eating behavior, family and social relationships and work ability. CONCLUSIONS: Risperidone associated to the previous therapeutic treatment in patient with a severe ED, with comorbid disorders and where other pharmacological treatments have not been effective, could be a useful option.

Uso de antipsicóticos en el tratamiento de pacientes con trastorno de la conducta alimentaria: estudio con risperidona / Antipsychotics in treatment of eating disorders patient: a study with risperidone

Introducción. El uso de antipsicóticos en el tratamiento de los trastornos de la conducta alimentaria (TCA) es un aspecto controvertido. Pocos estudios avalan su empleo sistemático, pero es frecuente su utilización, sobre todo en pacientes graves con otras alteraciones psicopatológicas asociadas. Métodos. Veintisiete pacientes diagnosticadas de TCA según criterios DSM-IV fueron incluidas en el estudio, siete abandonaron prematuramente o no cumplieron la pauta farmacológica. Todas las pacientes fueron entrevistadas según la Entrevista Clínica Estructurada para el DSM-IV (SCID-I) y el diagnóstico de personalidad se realizó con la versión española del International Personality Disorders Examination (IPDE). La evaluación clínica se realizó con la escala de Impresión Clínica Global (ICG) y con la valoración del cambio de la gravedad (EC) al inicio y 3 meses después de haber iniciado el tratamiento con risperidona. Resultados. Una proporción significativa de pacientes presentaron mejoría clínica evidente, así como de su estado general, en áreas como situación física, conducta alimentaria, relaciones sociofamiliares y capacidad laboral. Conclusiones. El uso de risperidona en pacientes con un TCA grave, con comorbilidad asociada y donde otros tratamientos farmacológicos no han sido eficaces, podría ser una opción útil asociada a otros regímenes terapéuticos

Introduction. The use of antipsychotic drugs in the treatment of eating disorders (ED) patients is a controversial issue. Although a few studies support the systematic use of antipsychotics, they are frequently used, mainly in severe disorders with other associated psychopathological symptoms. Methods. 27 ED patients were included in the study, 7 dropped-out prematurely or did not complete the pharmacological treatment. All the patients were interviewed and diagnosed according to the Structured Clinical Interview for the DSM-IV (SCID-I) and the personality diagnosis was carried out with the Spanish version of the International Personality Disorders Examination (IPDE). The clinical assessment was performed with the Clinical Global Impression (CGI) scale and the Change Severity Assessment (CSA) at baseline and three months after the beginning of the treatment with risperidone. Results. A significant proportion of patients showed clear clinical and general state improvement in areas like physical state, eating behavior, family and social relationships and work ability. Conclusions. Risperidone associated to the previous therapeutic treatment in patient with a severe ED, with comorbid disorders and where other pharmacological treatments have not been effective, could be a useful option

[Attitudes towards change in eating disorders (ACTA). Development and psychometric properties]. / El cuestionario de actitudes frente al cambio en los trastornos de la conducta alimentaria (ACTA). Desarrollo y propiedades psicométricas.

INTRODUCTION: The aim of the present study was the development of a self-reported instrument in Spanish to assess attitudes towa rds change in eating disord e rs (AC TA ) and to analyze its reliability and validity. METHODS: The questionnaire was elaborated following the transtheoretical approach of stages of changes, proposed by Prochaska and DiClemente and using the clinical records systematically registered regarding patients cognitions, behaviors and emotions related to the disorder. It was administered to 186 patients who where diagnosed an eating disorder according DSM-IV criteria. Subsequently, the process of refinement and validation of the scale was initiated. Moreover, a set of self-reported instruments was used to assess the eating disorder psychopathology: the Eating Attitudes Test (EAT), the Bulimic Investigatory Test Edinburgh (BITE), the Eating Disorders Inventory (EDI-2) and the Body Shape Questionnaire (BSQ). RESULTS: The final version consisted of 59 items divided into six subscales: precontemplation, contemplation, determination, action, maintenance and relapse. All of them s h owed an internal consistency over 0.70 which corresponded to the six factor obtained after the factorial analysis. Furthermore, the subscales were logically correlated to each other and to the questionnaires measuring eating psychopathology. CONCLUSIONS: The present results suggest that the ACTA be an easily administered, reliable and valid questionnaire, which could be used withinthe motivational approach. This could provide interesting information regarding the knowledge of the therapeutical process.

El cuestionario de actitudes frente al cambio en los trastornos de la conducta alimentaria (ACTA). Desarrollo y propiedades psicométricas / Attitudes towards change in eating disorders (ACTA). Development and psychometric properties

Introducción. El objetivo del estudio era desarrollar un cuestionario en español para evaluar la actitud frente al cambio en los trastornos de la conducta alimentaria (ACTA) y analizar su fiabilidad y validez en una muestra de pacientes que sufren este trastorno. Métodos. El cuestionario se elaboró siguiendo el modelo transteórico de los estados del cambio de Prochaska y DiClemente y a partir de información clínica registrada sistemáticamente acerca de las cogniciones, emociones y conductas del paciente relacionadas con el trastorno. Se administró a 186 pacientes diagnosticadas de algún trastorno alimentario según criterios del DSM-IV, iniciándose posteriormente el proceso de depuración y validación. Además se usaron otros cuestionarios autoaplicados para evaluar la psicopatología alimentaria, el Eating Attitudes Test (EAT), Bulimic Investigatory Test Edinburgh (BITE), Eating Disorders Inventory (EDI-2) y el Body Shape Questionnaire (BSQ). Resultados. La ve rsión final constaba de 59 ítems distribuidos en seis subescalas: precontemplación, contemplación, decisión, acción, mantenimiento y recaída, todas ellas con una consistencia interna mayor de 0,70 y q u e se correspondían de fo rma bastante aproximada con los seis factores extraídos en el análisis factorial. Además las subescalas se correlacionaban de fo rma lógica entre sí y con los cuestionarios que miden la psicopatología alimentaria .Conclusiones. Los presentes resultados sugieren que el ACTA es un instrumento de fácil administración con adecuada fiabilidad y validez, cuyo empleo dentro del enfoque motivacional podría aportar información de utilidad en cuanto al conocimiento del proceso terapéutico (AU)

[Spanish version of the Gardner body image validation scale in patients with eating behavior disorders]. / Adaptación española de la escala de evaluación de la imagen corporal de Gardner en pacientes con trastornos de la conducta alimentaria.

This study reports the Spanish version of a new scale for the assessment of body image, developed by Gardner, Stark, Jackson and Friedman (1999). A silhouette method was used as a self-evaluation measure of schematic ideal body size within three groups of women: anorexia nervosa (n= 57), bulimia nervosa (n=57) and normal control (n=168). The results showed that, considering the body mass index as covariant of the results, the clinical groups formed by anorexic and bulimic patients judged their current body size as significantly greater than the control group. In the same way, the clinical groups judged their ideal body size significantly thinner than that considered by the control group. We can conclude that this scale for assessment is a sensitive psychometrical measure of the body image.

Adaptación española de la escala de evaluación de la imagen corporal de Gardner en pacientescon trastornos de la conducta alimentaria / Spanish version of the Gardner body image validation scale in patients with eating behavior disorders

Este estudio recoge la adaptación española de la escala de valoración de la imagen corporal de Gardner, Stark, Jackson y Friedman (1999). La escala, basada en el empleo de siluetas corporales esquemáticas, fue aplicada a tres grupos de mujeres: 57 pacientes con anorexia nerviosa, 57 bulímicas y 168 controles. Los resultados mostraron que, considerando el índice de masa corporal en calidad de covariante de los resultados, los grupos clínicos formados por anoréxicas y bulímicas juzgaron su tamaño corporal como significativamente mayor que el grupo de control; del mismo modo, los grupos clínicos juzgaron su tamaño corporal ideal significativamente más delgado que el considerado por el grupo de control. Se concluye afirmando que esta escala es un instrumento psicométricamente sensible para evaluar la imagen corporal (AU)

Entrevista motivacional y actitudes ante el cambio en pacientes con un trastorno del comportamiento alimentario / No disponible

Presentamos aquí los resultados preliminares de un estudio en el que, basándonos en los principios de la técnica de entrevista motivacional y siguiendo el modelo transteórico del cambio propuesto por Prochaska y DiClemente, hemos diseñado un cuestionario específico para valorar las Actitudes ante el Cambio en pacientes con Trastornos Alimentarios (ACTA). Posteriormente hemos correlacionado las distintas subescalas de este, con las puntuaciones a los seis meses en diversos cuestionarios que valoran psicopatología alimentaria. Encontramos que altas puntuaciones en la escala de mantenimiento eran un factor protector de la psicopatología alimentaria, medida con el EAT-40 a los seis meses. Las altas puntuaciones en la fase de decisión eran predictoras del grado de insatisfacción con la imagen corporal, así como las puntuaciones en la escala de contemplación también predecían la sintomatología bulímica, medida con la subescala de síntomas del BITE a los seis meses (AU)

We present here the preliminary results of a research work in which, based on the principles of motivational interviewing and following the transtheoretical model of change, proposed by Prochaska and DiClemente, we designed a questionnaire to assess the attitudes towards change in eating disordered patients (ACTA.).The correlation between the ACTA subscales scores and several questionnaires, that evaluate eating disorder psychopathology, were analysed. We found that high scores on maintenance subscale was a protective factor of eating psychopathology, measured by the EAT-40 six months later. High scores on decision step was predictive for the level of dissatisfaction with own body image In addition, scores on the contemplation scale predicted bulimic symptoms measured with the BITE symptoms subscale six months later (AU)

Aspectos patogénicos de los pacientes con trastornos del comportamiento alimentario / Patogenic factors in the eating disorders patients

El objetivo de nuestro trabajo es articular un modelo explicativo de cómo aspectos culturales y fundamentalmente la autoestima pueden condicionar la aparición de un trastorno de la conducta alimentaria, su expresión clínica y la respuesta al tratamiento. (AU)