ABSTRACT
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Bullous skin lesions with eccrine gland necrosis have been repeatedly described in drug-induced coma, while similar cutaneosus changes in patients with non-drugin-duced coma have only rarely been reported. We present one comatose patients with bullous skin lesión and eccrine gland necrosis on the dependent part of the body. These findings suggest that the hyperthermia, coupled with hy-poxia and local pressure could cause sweat gland fatigue and degeneration
Subject(s)
Humans , Male , Aged , Suicidal Ideation , Drug Overdose/complications , Skin Diseases, Vesiculobullous/chemically induced , Personality Disorders/psychology , Skin Diseases, Vesiculobullous/pathology , Ivabradine/poisoning , Ramipril/poisoning , Trazodone/poisoning , Alprazolam/poisoningABSTRACT
BACKGROUND: The authors attempted to determine if mental status could predict personality profiles, 18 months after surgery in morbidly obese patients. METHODS: Personality characteristics of 100 morbidly obese patients (85 female, 15 male) were analyzed after bariatric surgery (vertical banded gastroplasty). Patients were given the Millon Clinical Multiaxial Inventory-II (MCMI-II). Data were compared with a Spanish clinical population to validate the test in our country. RESULTS: Significant differences were found in Schizoid scale (P<0.0001), Paranoid scale (P<0.001), Histrionic scale (P<0.0001), Compulsive scale (P<0.0001), and Delusional disorder scale (P<0.0001) between the two groups. When psychiatric comorbidity appeared, there were higher values on these scales. CONCLUSIONS: Morbidly obese patients undergoing bariatric surgery show traits and personality disturbances, and the mental state impairs the personality structure.
Subject(s)
Gastroplasty/methods , Obesity, Morbid/psychology , Obesity, Morbid/surgery , Personality Disorders/diagnosis , Adolescent , Adult , Age Distribution , Body Mass Index , Case-Control Studies , Cohort Studies , Female , Follow-Up Studies , Humans , Incidence , MMPI , Male , Middle Aged , Personality Disorders/epidemiology , Postoperative Period , Probability , Reference Values , Risk Assessment , Sex Distribution , Spain/epidemiology , Treatment Outcome , Weight LossABSTRACT
OBJECTIVE: To analyze the body composition of a group of patients fulfilling DSM-IV criteria for bulimia nervosa (BN), comparing the patients who had a history of DSM-IV anorexia nervosa (AN) with those without such a history to determine (1) whether both groups differed in terms of body composition and (2) whether the differences between groups could be the consequence of the past condition. METHODS: The sample consisted of 104 patients, 43 with prior AN (BN-AN group) and 61 without a history of AN (BN-nonAN). The patients were assessed using anthropometric and bioelectrical methods: height and weight, body circumferences, abdominal diameter, skinfold thickness, and body impedance analysis. In a later phase and to test the influence of current low weight on the results, two experimental groups were created: the first group was composed of the patients from the BN-AN group who had a normal body mass index (BMI range in this group, 20.1-23.4 kg/m2; n = 23); the second group consisted of 23 patients from the BN-nonAN group in the same BMI range. In both phases unpaired sample t tests were performed for statistical analysis. RESULTS: More than 40% of the bulimic patients with a history of AN had a BMI less than 20. They had a lower percentage of body fat, lower muscle mass, and higher percentage of extracellular water. Nevertheless, most of these differences disappeared in the second phase of the analysis, when only the patients within a normal weight range were compared. DISCUSSION: According to these results, a significant number of bulimic patients with a history of AN tend to retain some clinical traits of the past condition and could be viewed as remaining in a "subclinical anorexic status": they are thinner and seem to have less difficulties in maintaining low weight than patients without a history of AN. Nevertheless, in patients who have reached a normal weight after AN, all these differences disappear. This fact raises some important questions related to the boundaries between AN and BN, the shifting from one to another, or when AN patients really recover.
Subject(s)
Anorexia Nervosa/epidemiology , Bulimia/epidemiology , Adolescent , Adult , Anorexia Nervosa/diagnosis , Anorexia Nervosa/psychology , Anthropometry , Bulimia/diagnosis , Bulimia/psychology , Diagnostic and Statistical Manual of Mental Disorders , Female , Humans , Incidence , PrevalenceABSTRACT
OBJECTIVE: At a general level, impulsivity is related to both bulimic and general psychopathology. However, it is a complex construct, and the specific role of different forms of impulsivity in psychopathology remains to be determined. The present study of bulimic outpatients examined the association of internally and externally directed impulsive behaviors with general and bulimic psychopathology. METHODS: Thirty female bulimic outpatients completed standardized measures of bulimic attitudes/behaviors, general psychopathology and impulsive behaviors. RESULTS: While general psychopathology was associated with internally directed impulsive behaviors (e.g., self-harm), bulimic pathology was more specifically linked with externally directed impulsivity (e.g., theft; reckless driving). DISCUSSION: The results indicate that the bulimia-impulsivity link in eating disordered patients is not simply a by-product of the broader association of impulsivity with psychopathology. Therefore, bulimic pathology does not seem to be just a manifestation of general psychological disturbance. Further research is suggested to test these results and potential clinical implications are outlined.
Subject(s)
Bulimia/epidemiology , Bulimia/psychology , Disruptive, Impulse Control, and Conduct Disorders/epidemiology , Disruptive, Impulse Control, and Conduct Disorders/psychology , Adult , Anorexia Nervosa/diagnosis , Anorexia Nervosa/epidemiology , Anorexia Nervosa/psychology , Body Mass Index , Bulimia/diagnosis , Disruptive, Impulse Control, and Conduct Disorders/diagnosis , Female , Humans , Severity of Illness Index , Surveys and QuestionnairesABSTRACT
Se sabe que la obesidad mórbida es una enfermedad compleja que puede deberse a factores biológicos, psicológicos o sociales, además de estar influida por determinados factores metabólicos y de comportamiento. Se analizó la psicopatología de un grupo compuesto por 100 pacientes (85 mujeres, 15 hombres) con obesidad mórbida, que habían recibido tratamiento quirúrgico de restricción gástrica (gastroplastia vertical bandeada) para perder peso. Cada paciente completó la Symptom Check List- 90-R (SCL-90-R) 18 meses después de la cirugía; 40 (40(por ciento) cumplieron criterios CIE-10 de patología psiquiátrica. Se determinaron los diagnósticos psiquiátricos más frecuentes: trastornos afectivos, de ansiedad, alimentarios (trastorno por atracón, anorexia nerviosa, bulimia nerviosa) y dependencia de alcohol. Se precisó la conflictiva de pareja en el 50(por ciento) de las pacientes con patología psiquiátrica. El estudio de regresión logística ha mostrado relación entre la existencia de patología psiquiátrica y las escalas de depresión, ansiedad, hostilidad e índice de severidad general de la SCL-90-R. No se halló relación entre la edad de inicio y la psicopatología detectada. Se comprobó que los pacientes con enfermedad mórbida presentan una importante tasa de patología psiquiátrica y elevados niveles de malestar psicológico y dicho estado se relaciona con el índice de severidad general de la SCL-90R(AU)
Subject(s)
Humans , Male , Female , Obesity, Morbid/psychology , Gastroplasty , Obesity, Morbid/pathologyABSTRACT
Se sabe que la obesidad mórbida es una enfermedad compleja que puede deberse a factores biológicos, psicológicos o sociales, además de estar influida por determinados factores metabólicos y de comportamiento. Se analizó la psicopatología de un grupo compuesto por 100 pacientes (85 mujeres, 15 hombres) con obesidad mórbida, que habían recibido tratamiento quirúrgico de restricción gástrica (gastroplastia vertical bandeada) para perder peso. Cada paciente completó la Symptom Check List- 90-R (SCL-90-R) 18 meses después de la cirugía; 40 (40(por ciento) cumplieron criterios CIE-10 de patología psiquiátrica. Se determinaron los diagnósticos psiquiátricos más frecuentes: trastornos afectivos, de ansiedad, alimentarios (trastorno por atracón, anorexia nerviosa, bulimia nerviosa) y dependencia de alcohol. Se precisó la conflictiva de pareja en el 50(por ciento) de las pacientes con patología psiquiátrica. El estudio de regresión logística ha mostrado relación entre la existencia de patología psiquiátrica y las escalas de depresión, ansiedad, hostilidad e índice de severidad general de la SCL-90-R. No se halló relación entre la edad de inicio y la psicopatología detectada. Se comprobó que los pacientes con enfermedad mórbida presentan una importante tasa de patología psiquiátrica y elevados niveles de malestar psicológico y dicho estado se relaciona con el índice de severidad general de la SCL-90R(AU)
It is known that morbid obesity is a complex disease that may be caused by biological, psychological or social factors and that certain metabolic and compartmental factors influence on it. The psychopathology of a group made up of 100 patients (85 women, 15 men) with morbid obesity that had undergone surgical treatment of gastric restriction (vertical banding gastroplasty) to lose weight was analyzed. Each patient completed the Symptom Check List-90-R (SCL-90-R). 18 months after surgery, 40 of them (40 percent) fulfilled the ICD-10 criteria of psychiatric pathology. The most frequent psychiatric diagnoses were determined: affective disturbance, anxiety disorder and food disorder (disturbance due to gluttony, nervous anorexia and nervous bulimia) and alcohol dependence. The conflict of the couple was observed in 50 percent of the patients with psychiatric pathology. The logistic regression study has shown a relationship between the existance of psychiatric pathology and the scales of depression, anxiety, hostility and index of general severity of the SCL-90-R. No relation was found between the age at onset and the detected psychopathology. It was proved that the patients with morbid disease present an important rate of psychiatric pathology and high levels of psychological malaise and such state is related to the index of general severity of the SCL-90-R(AU)
Subject(s)
Humans , Male , Female , Obesity, Morbid/psychology , Gastroplasty/methods , Bariatric Surgery/methods , PsychopathologyABSTRACT
UNLABELLED: Obese patients may share some clinical features with anorexia nervosa patients because they risk developing an eating disorder when they diet. Methods and Results Some common etiological, psychological, and social factors have been proposed for both disorders. We present two cases of patients suffering from morbid obesity who, after weight loss, presented an intense fear of regaining weight and developed anorexic-like symptoms. In the first case, the symptoms appeared after gastric reduction surgery. In the second case, a strict diet was the triggering factor. DISCUSSION: This paper stresses the need for psychiatric evaluation of all patients with morbid obesity who seek treatment in clinical settings, in order to identify the factors that may lead to psychiatric complications.
Subject(s)
Anorexia Nervosa/diagnosis , Bulimia/diagnosis , Diet, Reducing/psychology , Gastroplasty/psychology , Obesity, Morbid/psychology , Postoperative Complications/diagnosis , Adult , Anaphylaxis/diagnosis , Anaphylaxis/psychology , Anorexia Nervosa/psychology , Body Image , Body Mass Index , Bulimia/psychology , Compulsive Personality Disorder/diagnosis , Compulsive Personality Disorder/psychology , Female , Humans , Postoperative Complications/psychology , Risk Factors , Somatoform Disorders/diagnosis , Somatoform Disorders/psychology , Weight LossABSTRACT
Insight of patients with schizophrenia seems to be a complex phenomenon that includes elements of a psychological, psychopathological, neurocognitive, and interactional nature. The purpose of this research was to study two of these areas (psychopathology and interpersonal relationships) in order to determine their influence on insight and their interrelation. Eighty-two outpatients fulfilling DSM-IV criteria for schizophrenia were studied using the Schedule for the Assessment of Insight (SAI), the Positive and Negative Syndrome Scale (PANSS), and the Social Cognitions and Object Relations Scale (SCORS). Bivariate correlations and multiple regression tests were performed. The positive component of the PANSS and the understanding of social causality (SCORS) appeared as the most significant variables related to level of insight. Positive symptoms were inversely related to insight, whereas understanding of social causality was directly associated with an appropriate awareness of illness. These results support the idea that insight is a complex and multidimensional phenomenon. In this respect, the study of the psychopathological dimension of insight should be accompanied by the consideration of interactional and social factors, because awareness of illness can be considered ultimately as an index of concordance between patients' views of the illness and cultural standards regarding mental disorders.
Subject(s)
Interpersonal Relations , Schizophrenia , Schizophrenic Psychology , Social Perception , Adolescent , Adult , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Female , Humans , Male , Middle Aged , Psychology , Schizophrenia/complicationsABSTRACT
BACKGROUND: We questioned whether differences in psychopathological status and interpersonal relations exist in a group of morbidly obese patients 18 months after bariatric surgery, as related to extent of weight loss. METHODS: The study group consisted of 100 morbidly obese patients (85 female, 15 male) who had undergone surgical treatment (vertical banded gastroplasty) for weight reduction. Each patient completed the Lancashire Quality of Life Profile European version, the Eating Disorder Inventory, the Symptom Check List-90-Revised, and the Millon Clinical Multiaxial Inventory-II. The sample was divided into 2 groups according to the percentage of excess weight loss 18 months after surgery: a greater weight loss group (weight loss > 30%) and a lesser weight loss group (weight loss < 30%). RESULTS: Significant differences were found between the 2 groups in percentage of weight loss (P < 0.0001), negative self-esteem (P < 0.001), drive for thinness (P < 0.001), body dissatisfaction (P < 0.001), global EDI (P < 0.002), anxiety (P < 0.003), GSI (P < 0.002), avoidant (P < 0.001), borderline (P < 0.0001), and passive-aggressive (P < 0.002). CONCLUSION: Greater weight loss strongly correlates with improved quality of life, less disturbed eating behavior, and lower psychopathology. These results justify the clinical use of surgical procedures and demonstrate that weight loss has powerful psychological and psychosocial implications.
