Genome-wide DNA methylation profiling in anorexia nervosa discordant identical twins.

Up until now, no study has looked specifically at epigenomic landscapes throughout twin samples, discordant for Anorexia nervosa (AN). Our goal was to find evidence to confirm the hypothesis that epigenetic variations play a key role in the aetiology of AN. In this study, we quantified genome-wide patterns of DNA methylation using the Infinium Human DNA Methylation EPIC BeadChip array ("850 K") in DNA samples isolated from whole blood collected from a group of 7 monozygotic twin pairs discordant for AN. Results were then validated performing a genome-wide DNA methylation profiling using DNA extracted from whole blood of a group of non-family-related AN patients and a group of healthy controls. Our first analysis using the twin sample revealed 9 CpGs associated to a gene. The validation analysis showed two statistically significant CpGs with the rank regression method related to two genes associated to metabolic traits, PPP2R2C and CHST1. When doing beta regression, 6 of them showed statistically significant differences, including 3 CpGs associated to genes JAM3, UBAP2L and SYNJ2. Finally, the overall pattern of results shows genetic links to phenotypes which the literature has constantly related to AN, including metabolic and psychological traits. The genes PPP2R2C and CHST1 have both been linked to the metabolic traits type 2 diabetes through GWAS studies. The genes UBAP2L and SYNJ2 have been related to other psychiatric comorbidity.

Use of Paliperidone Palmitate Throughout a Schizoaffective Disorder Patient's Gestation Period.

Introduction: Paliperidone palmitate treatment of schizophrenia or schizoaffective disorder is effective and well tolerated, but there is almost no data on its safety during pregnancy. Case report: An analysis is made of the safety and tolerability of paliperidone palmitate treatment throughout the gestation period in a 34-year-old patient diagnosed with schizoaffective disorder. Discussion: Paliperidone palmitate treatment throughout the gestation period was safe and well tolerated by both mother and foetus, there being no malformations or other perinatal complications in the newborn to date.

Hostility and helper T-cells in patients with bulimia nervosa.

OBJECTIVE: The study aimed to analyze the correlation between lymphocyte counts and several psychopathological variables associated with psychological instability (depression, hostility, impulsivity, self-defeating personality traits, and borderline personality symptoms) in patients with bulimia nervosa (BN). METHOD: Sixty BN patients were assessed, using specific scales for eating pathology, general psychopathology, impulsivity, depression, and borderline personality features. Lymphocyte and lymphocyte subset counts were performed. Plasma cortisol at 8:00, before and after administration of 1 mg of dexamethasone at 23:00, was determined. The influence of body weight, and the use of tobacco, alcohol, and caffeine was controlled. The relationship between each isolated variable and the number of immune cells was analyzed. In a second step, supplementary post-hoc analysis of the variables was introduced to confirm the accuracy of the psychopathological assessment. RESULTS: Hostility was negatively correlated with the number of helper T-cells (CD4+). Patients with high hostility had lower CD4+ cell counts and lower CD4+/CD8+ ratios. In the post-hoc control study, hostility was significantly related with other "interpersonal" items. CONCLUSIONS: These results support the idea that hostility, as an expression of disturbed interpersonal relationships, could play a role as a modulator of immune activity in patients with BN.

Efficacy of bupropion in the treatment of pemoline dependence.

We present the case of a woman who requested psychiatric evaluation because she had been taking pemoline for six months at a dose between 100-150 mg/day, and was finding it difficult to discontinue taking this substance. Initiation of 300 mg/day of bupropion solved the patient's dependence problem. We propose using antidepressants such as bupropion for the treatment of addictive behaviors due to central nervous system stimulants.

[Psychological features and Doppler-Duplex in erectile disfunction]. / Aspectos psicológicos y Doppler-Duplex dinámico en disfunción eréctil.

OBJECTIVES: To establish a relationship between Doppler-Duplex colour ultrasound after prostaglandin intracorporeal injec tion and psychological features in patients suffering from erectile dysfunction. METHODS: Forty two patients with erectile dysfunction were prospectively evaluated with Doppler-Duplex colour ultra sonography after intracavernosal injection of 20 micrograms of E1 prostaglandin. Dynamic vascular pattern were analyzed an penile tumescence were graded in poor, moderate or good (I, II, III). All of them completed the International Index of Erectile Dysfunction, International Exam of Personality Traits (IPDE) and the Symptom Checklist (SCL-90). RESULTS: 29 patients (69.05%) showed a normal ultrasonography response (Peak Systolic Velocity >30 cm/s; Telediastolic velocity negative or less than 5 cm/s and penile tumescence grade III) and were classified as good responders with probably psy chogenic erectile dysfunction. Patients who did not show these values were classified in the group of erectile dysfunction of vas cular origin. We found significative differences between the two groups in sex desire, tumescence and paranoid personality. Th more frequent personality features were paranoid and squizoid (excentric) and ananchastic and anxious (fearful ones). Somatization and obsessive-compulsive symptoms have been outlined over the rest. We have found that paranoid personality is sixteen times more frequent in patients with normal ultrasonography. CONCLUSIONS: Psychological features and dysfunctional personality traits accompany psychogenic and organic erectile dys function, thus it is thought that mixed aetiology coexist in this patients. Doppler-Dupplex Colour ultrasound is an usefu method to exclude organic vascular factors. On de basis of our article, is more common to find psychological discomfort an dysfunctional personality traits in patients with normal ultrasound, which may help in their diagnosis and treatment.

Assessment of expressed emotion in families of patients with eating disorders: using the Camberwell Family Interview on a Spanish sample.

INTRODUCTION: The level of expressed emotion (EE) in the family members has been related to several clinical and outcome related factors in patients with eating disorders. This study aimed to study the levels of EE in families of patients with eating disorders using the Camberwell Family Interview (CFI) in order to determine whether they were similar to those reported in other studies developed outside Spain. METHODS: Seventy-one parents of 43 eating disorders patients were evaluated using a Spanish version of the CFI. RESULTS: In our sample, 46.5 % of the families had EE high levels. There were no significant differences between mothers and fathers in global scores, but mothers tended to have higher emotional overinvolvement with the patient. CONCLUSIONS: The percentage of families that had high EE in our sample was lower than that reported for families with a member with schizophrenia and slightly higher than that detected in other studies on eating disorders. Mothers tended to have higher EE levels than fathers.

[History of sexual abuse in patients with bulimia nervosa: its influence on clinical status]. / Antecedentes de abusos sexuales en pacientes con bulimia nerviosa: su influencia en el estado clínico.

INTRODUCTION: Studies analyzing the relationship between sexual abuse and bulimia nervosa (BN) have reported discrepant results. This study aimed to assess the role of a history of sexual abuse in the clinical status of a group of patients diagnosed of BN using DSM-IV diagnostic criteria. METHODS: Seventy patients with BN were assessed using specific clinical tools: Eating Attitudes Test-40 items (EAT-40), Bulimia Investigation Test Edinburgh (BITE), Symptom Checklist (SCL-90), Structured Clinical Interview for DSM-IV Axis II Personality Disorders (SCID-II), Sixteen Personality Factors Test (16-PF) and a clinical interview for the assessment of past and current substance abuse. The data from the 15 patients with a history of sexual abuse (21.4 % of the sample) were compared with those from the 55 patients without such a history. RESULTS: Both groups were very similar regarding symptom severity. Only the tendency to somatization and higher scores in the factor E of the 16-PF (dominance) were associated with antecedents of sexual abuse in the sample. CONCLUSIONS: The results support the idea that sexual abuse may be related to higher non-specific vulnerability to psychopathology, but do not increase symptom severity in BN patients.

[Factors associated with poor response after surgery in morbid obesity]. / Factores asociados a mala respuesta tras cirugía en obesidad mórbida.

The eating behavior, the psychopathological status, and the personality were analyzed in a group of patients with morbid obesity, 18 months after surgery, isolating psychopathological factors associated with a poor response.

Psychopathological differences between morbidly obese binge eaters and non-binge eaters after bariatric surgery.

AIMS: To determine the psychological characteristics of a group of morbidly obese patients with binge eating disorders and to investigate whether the psychopathological status of binge eaters is different from that of other morbidly obese patients. METHODS: We used the Binge Eating Scale, the Three-Factor Eating Questionnaire and the Millon Clinical Multiaxial Inventory-II (MCMI-II) to interview 140 morbidly obese patients 18 months after bariatric surgery (vertical banded gastroplasty), and compared the results obtained in binge eaters (n = 25) and non-binge eaters (n = 115). RESULTS: The binge eaters had more eating disturbances (more binge eating, less restriction, more disinhibition, more hunger) and psychopathological characteristics (passive-aggressive traits, aggressive-sadistic traits, manic disorders, alcohol dependence and major depression) than the non-binge eaters. They were also younger and achieved a lower percentage of weight loss. CONCLUSIONS: After bariatric surgery, our obese binge eaters reported significantly more psychiatric symptoms, especially those relating to eating disorders, depression, alcohol dependence and personality disturbances. Their weight loss was less satisfactory, and they sought bariatric surgery at a younger age.

[Psychopathology of bulimia nervosa: a multidimensional model]. / Psicopatología de la bulimia nerviosa: un modelo multidimensional1

INTRODUCTION: In recent years, a number of studies have been carried out with the intention of isolating clinical dimensions in the psychopathology of bulimia nervosa. Although borderline personality has been considered a core element of the bulimic psychopathology by most of the authors, it has not been incorporated into any of these models. In this context, the present study was aimed at testing the consistence of the more complex model proposed until now, including in the analysis borderline personality as a clinical variable. SAMPLE AND METHODS: A group of 66 female patients fulfilling DSM-IV criteria for bulimia nervosa were assessed using a set of clinical instruments. The isolated items were processed using factor analysis techniques. RESULTS: Five basic dimensions of bulimia nervosa were obtained: 1. body disatisfaction; 2. restrictive eating behaviors; 3. purging behaviors; 4. emotional instability; and 5. disocial behavior. CONCLUSIONS: Our results support the idea that bulimia nervosa is a multidimensional condition. In our model, the dimension emotional instability incorporated borderline features, which tended to be strongly associated to self-defeating behaviors and depressive symptoms.

[Differential study of the complete and subclinical presentations of bulimia nervosa]. / Estudio diferencial de las formas completas y subclínicas de bulimia nerviosa.

INTRODUCTION: We examined the subtyping criteria for bulimia nervosa by comparing atypical and full-blown syndrome patients. METHODS: Sixty-one bulimic patients were compared on a number of demographic, clinical, and psychopathological variables. Thirty-nine patients met definite DSM-IV diagnostic criteria for bulimia nervosa and twenty-two had a subclinical form of this disorder. RESULTS: Although patients with less severe eating disorder experienced substantial distress and impairment, the study revealed some interesting clinical differences between the two groups. DISCUSSION: Subclinical bulimia nervosa may be more common in young women than now believed, and seems to be associated with persistent body image dissatisfaction, higher weight, non-purgative methods for controlling weight gain, and lower associated psychopathology.

[Personality disorders in patients with eating disorders: a controlled study]. / Trastornos de personalidad en pacientes con trastornos alimentarios: un estudio controlado.

A group of 24 eating-disordered female subjects (10 anorexia nervosa--AN--and 14 bulimia nervosa--BN--patients) were interviewed, using a semistructured interview for DSM-III-R Axis-II Personality Disorders (SCID-II). A group of 54 subjects without eating disorder acted as a control group. A high rate of personality disorder (PD) diagnoses occurred in eating disordered subjects (AN and BN patients), with a high prevalence of borderline, dependent, and self-defeating PD. Avoidant and obsessive-compulsive PD were more common in AN patients, whereas BN was associated with histrionic PD. Findings have implications for the assessment and diagnosis of eating-disordered patients and for treatment planning.

[Psychosocial factors and the compliance with drug prescriptions in depressed patients: a clinical contribution]. / Factores psicosociales y observancia de las prescripciones farmacológicas en pacientes deprimidos: una contribución clínica.

The present paper summarizes the results of a clinical investigation developed on 35 depressed outpatients. Several clinical and psychosocial variables were isolated with the aim of establishing which of them could be related with a premature treatment withdrawal. The results are discussed and the responsibility of psychosocial factors in treatment compliance is stressed. Personality traits, family support, and negative life events seem to be the most significant factors associated to non-adherence. In the author's opinion, these factors could be related to the treatment compliance not only in depressive disorders but also in many other medical and psychiatric diseases.

[Expectations of the patient and attitudes toward treatment as predictive factors in the clinical course of affective disorders]. / Expectativas del paciente y actitudes hacia el tratamiento como elementos de predicción de la evolución clinica en los trastornos afectivos.

The effect of antidepressant treatment was evaluated in a group of outpatients with symptoms of depressive illness ("dysthymic disorder" and "major depression", according to DSM-III criteria) with regard to the expectations they had for the results of the therapy. Therefore, patient ideas about the efficacy of the treatment, psychiatrist capability, duration of illness and other factors were analyzed. The clinical status of the patients was studied at the 1st visit, 2nd visit (a week later), and 3rd visit (3 weeks later). The patients were included in one of the followings three groups: "good responders", "moderate responders", and "bad responders". Data were analyzed statistically to show the correlation between patients expectations and attitudes toward the treatment, and clinical outcome.

Psychotherapeutic management of suicide attempts in children and early adolescents: working with parents.

Metatherapy (a psychotherapeutic procedure based upon parental couple collaboration) is a technique useful for working with severely disorganized family contexts, in which psychopathological diseases (such as psychotic or psychosomatic disorders, suicide attempts of the children etc.) can appear. The management of the family has two definite phases: (a) case evaluation, with the participation of the whole family group and (b) case treatment, with exclusive participation and active collaboration of the parental couple. The usefulness of this therapeutic tool proceeds from the restructuration and boundary delimitation that it provides, stressing the recuperation of parental executive capacity. Thus, metatherapy can be used in the treatment of suicide attempts and severe depression of children and early adolescents, because the patients can see themselves free of the mark of illness, and the parents (usually suffering from a very strong anxiety and powerful feelings of guilt) can be confirmed in their role and be pleased to give their collaboration for the treatment of their family. These interactional changes improve the clinical outcome of these cases.