A comparison of psychopathology in eating disorder patients from France and the United States.

OBJECTIVE: This study compares Minnesota Multiphasic Personality Inventory (MMPI) profiles of subtypes of eating disorder patients in France and the United States. METHOD: The patients were hospitalized in psychiatric hospitals in France and the United States. Diagnoses were made by independent clinicians who reviewed the clinical material. The 550-item version of the MMPI was administered to the US subjects; and a 357-item version to the French. RESULTS AND DISCUSSION: In both the US and French subjects, more psychopathology was found in the groups diagnosed with both anorexia nervosa and bulimia nervosa than in those with either anorexia nervosa or bulimia alone, consistent with previous research. The US subjects had generally more psychopathology than the French, except in the anorexia-restrictor subgroup.

Selective processing of eating and body words in restricting-type anorexics, binge-eating-type anorexics, bulimics, and control subjects.

A French adaptation of the Stroop colour-naming task was used to investigate selective processing of information related to eating and the body in 92 female subjects: 18 with restricting-type anorexia nervosa (RAs), 25 with binge-eating-type anorexia (BAs), 20 with bulimia nervosa (BNs), and 29 controls (Cs). All participants were significantly slower in colour-naming words related to eating and the body. This suggests that eating and body Stroop effects were not diagnostic category effects. Eating Stroop effect was significantly stronger in eating disordered patients than in Cs, but very similar in RAs, BAs, and BNs. It did not correlate with the body mass index nor with Eating Disorder Inventory (EDI) scores. Body Stroop effect did not differ significantly between groups. However some of our results suggested a tendency for this effect to be higher in BNs, corroborating previous literature data. Body Stroop effect correlated with EDI score in RAs, and with the "body dissatisfaction" subscale score in BNs and BAs. It did not correlate with the body mass index. Further studies are currently being carried out to determine whether inpatient treatment for anorexia nervosa induces significant changes in eating and/or body Stroop effect, and whether such changes might be predictive of clinical outcome.

A short-term cognitive behavioural therapy for bulimia nervosa including brief hospitalisation.

This was a metabolic study of bulimia nervosa required to design short-term cognitive-behavioural therapy (CBT) beginning with a brief admission to a psychiatric ward. The treatment produced significant improvements in eating behaviour and results are compared with those of previously published studies. The comparisons do not suggest that brief admission at the onset of therapy might enhance its effectiveness. In other respects, increase in normal meal intake was found to correlate significantly with decrease in hinging. This supports the notion that appropriate food intake at meal times should be an important issue in CBT for bulimia nervosa.

High resting energy expenditure in normal-weight bulimics and its normalization with control of eating behaviour.

Resting energy expenditure (REE) has been found to be lower in normal weight-bulimics (NWBs) than in controls and it was speculated that metabolic abnormalities might underlie bulimia. This study consisted of a longitudinal assessment of REE, body composition and energy intake before, during and after the control of eating behaviour, with comparisons between REEs in NWBs, those in controls, and estimated basal energy expenditure (EBEE). NWBs in acute phase of bulimia were assessed the 1st, 2nd, and last day of a one-week hospitalization that warranted compliance with normal diet. Assessments were then repeated after a six-week outpatient psychotherapy. Mean REE in NWBs was higher than that in controls and EBEE on admission. It decreased down to normal rate at discharge and at therapy termination. Fat-free mass (FFM) decreases slightly during hospitalization despite a weight-maintenance diet, but REE-FFM ratio also decreased significantly. Metabolic factors which might account for these results are discussed. Data suggest that: (1) caloric requirements in NWBs were higher than estimated weight-maintenance rations; (2) binge-eating increased REE; (3) control of eating behaviour decreased REE.

Haloperidol blood levels and clinical outcome: a meta-analysis of studies relevant to testing the therapeutic window hypothesis.

Haloperidol, the most studied antipsychotic drug, is the only one about which reliable statements on the relationship between blood levels and clinical outcome can be made. A systematic overview was undertaken to determine whether there was an optimum blood concentration range for clinical efficacy. Eighteen published studies which provided individual patient data in tables or graphs were reviewed. Clinical benefits tended to decline when the haloperidol blood concentration was increased above 26 ng/ml. Our data support the existence of a therapeutic window between 4 and 26 ng/ml for haloperidol in the treatment of schizophrenic, schizoaffective and schizophreniform disorders.

[Measuring the development of eating disorders in a group of patients with the Eating Disorders Inventory (EDI)]. / La mesure d'évolution dans un groupe de patients ayant des troubles de conduites alimantaires par le Eating Disorders Inventory (EDI).

The Eating Disorders Inventory (EDI I) has been applied to four groups of patients with Eating Disorders (ED): Anorexic Bulimic Subtype (AB N = 22), Anorexic Restrictive Subtype (AR N = 36); Bulimic (B N = 51) and Other Eating Disorders (OED N = 15), according to the DSM III-R criteria. We have also applied the Eating Attitude Test (EAT-40), the Beck Depression Inventory (13 items), the Hamilton Anxiety Rating Scale and the Hamilton Depression Rating Scale. During their hospital care, the patients have been treated by cognitive-behavioural therapy. The order or decreasing total scores in EDI at the admission is the B subtype, then the AR subtype, then the OED group. In total score, the B and AB improved more than the order groups, between their admission and a second assessment three months later. Body dissatisfaction, Drive for thinness and Interpersonnal distrust are the only subscales for which no group showed a statistical improvement after three months. The B group decreased more in the subscale, than the other groups, particularly in Interoceptive awareness, Ineffectiveness and bulimia.

[In search of psychological marks for prediction about sensibility to cognitive therapy]. / Recherches d'indices psychologiques prédictifs de la réponse à la thérapie cognitive.

The use of Beck's cognitive therapy showed that some patients obtained no improvement. A few studies have enlightened some prospective factors in response to cognitive therapy. Therefore the purpose of this study is to elicit some M.M.P.I. profiles which could predict the outcome of the therapy. 51 patients were assessed before and after cognitive psychotherapy. Three groups of reactivity were obtained: the responders, partially responders and non responders.

Anhedonia and blunted affect in major depressive disorder.

The relation between anhedonia and affective flattening was studied in 61 normal subjects and 61 major depressives. Affective flattening and anhedonia were defined by the following self-rating scales: Fawcett-Clark Pleasure Capacity Scale (FCPCS), Hardy Displeasure Capacity Scale (HDCS), FCPCS-PP (subscale of physical pleasure), and HDCS-PD (subscale of physical displeasure). The depressives are more sensitive to displeasure and more anhedonic than controls. Concerning physical stimulations (FCPCS-PP and HDCS-PD) in the depressed group, anhedonia and affective flattening are not linked, suggesting that physical anhedonia is not secondary to low emotional reactivity (affective flattening) and constitutes an independent dimension.

Taste responsiveness in anorexia nervosa.

Preferences for sugar/fat mixtures were examined in 12 anorectic females and in 14 normal-weight volunteer controls. The subjects, recruited at an eating-disorders clinic in Paris, were tested after an overnight fast and 2 hours after lunch. Anorectic patients disliked the taste of foods rich in fat more than did controls. Perceptions and preferences for sweet taste did not differ between anorectic females and controls. After lunch, taste preference ratings were equally reduced in both groups, suggesting that satiety aversion to sucrose is present even in anorexia nervosa.

[Assessment of difficulties in mental representation of visual stimuli in anorexic patients]. / Essai d'approche des troubles de la représentation mentale à partir de stimulus visuels chez des patients anorexiques.

The aim of this research is to assess the mental representation associated to visual stimuli for anorexic patients. Two studies are described. The first one is a systematic observation of food representation for five patients within a 3-month period. The disruptive factors, mainly related to food visual aspect decrease with time. Consequently, a second experiment was carried out. Two groups were compared as far as the food mental representation related to visual food stimuli is concerned: a group of anorexic patients and a group of control subjects selected according to sex, age, and educational standard. The results show the existence of habituation process as there is a decrease of disruptions concerning the mental representation of food color, texture and shape. This result must be confirmed on a larger sample.

Physical anhedonia in major depressive disorder.

Physical anhedonia, evaluated by the score on the physical anhedonia scale (PAS) of Chapman et al. [J. Abnorm. Psychol. 4 374-382 (1976)] was studied in 61 patients, who met RDC criteria for major depressive disorder and in 61 normal subjects. The depressed patients scored significantly higher than the normal group and presented a continuous distribution. Physical anhedonia of depressed patients seems related to the severity of the depression and does not appear to identify a qualitatively distinct subgroup.

[Topographical analysis of endogenous evoked potentials in depressed old people and in patients with Alzheimer's type dementia]. / Analyse topographique des potentiels évoqués endogènes chez des sujets âgés déprimés et chez des sujets atteints de démence de type Alzheimer.

Latencies, amplitudes and localization of the maximum of the peaks of late onset evoked responses have been studied in 3 groups of elderly people: normal, depressed and demented (probable dementia of Alzheimer type DAT) at the early stage of the disease. Evoked responses with an auditory oddball paradigm have been recorded with 16 electrodes in 2 situations: counting the target sounds, and motor response with measurement of the reaction time. No difference in amplitude was observed between the 3 groups. Only a significant difference for P3 latency was observed between the DAT and the depressed groups and only in the counting situation. The maximum P3 response was most often found on the anterior areas in the DAT group and in the posterior areas in the normal and depressed groups. The topographic localization of the P3 peak could therefore be of some help in the characterize of subjects with probable DAT at the early stage of the disease.

[Acute neuropsychiatric manifestations in HIV infection: apropos of 5 clinical cases]. / Manifestations neuropsychiatriques aiguës dans le cadre de l'infection par le virus H.I.V.: à propos de cinq cas cliniques.

There is an increasing incidence of neuro psychological impairment in Acquired Immune Deficiency Syndrome patients. It is now recognized by certain authors as a 50 per cent (Nollet D. 88). This leads to increasing number of studies. As the AIDS epidemic continue psychiatrists have to become more familiar with this type of manifestations. Five cases of acute onset of neuropsychiatric syndrome are described and compared to an overview of literature. The connection with direct HIV brain involvement is discussed.