Repeated traumatic experiences in eating disorders and their association with eating symptoms.

OBJECTIVE: This study aimed to analyze the association between traumatic experiences (TEs) and eating symptoms and their severity in a healthy group (HG) of students and an eating disorder group (EDG). METHOD: The HG (N=150) comprised first- and secondyear undergraduate psychology students, the EDG (N=150) day hospital patients. EDG patients were evaluated consecutively when they entered the Day Hospital Eating Disorder Unit. Information on TEs was collected via an ad hoc questionnaire, a semi-structured interview and the first part of The Dissociation Questionnaire (Part I). The Bulimic Investigatory Test Edinburgh was used to evaluate eating symptoms and their severity. RESULTS: Emotional abuse was the most frequent TE in both groups. In the EDG, TEs occurred more in patients with purging behavior (anorexia nervosa of the binge-eating/purging type, AN-P; and bulimia nervosa of the purging type, BN-P) than in those with AN-R (anorexia nervosa of the restricting type). In patients with purging behavior, TEs often begin in childhood and are repeated. When the severity of eating symptoms in patients with EDs who had suffered repeated TEs was compared with those who had suffered an isolated TE, a tendency towards greater severity of eating symptoms associated with TE repetition was observed. CONCLUSIONS: The results obtained with respect to the presence and type of TEs in EDs concurred with those of other studies. However, unlike other studies, we found high percentages of childhood TEs in ED subtypes with purging behavior. In these ED subtypes, TEs tended to be more repeated than in ED subtypes with restrictive behavior. Further studies are required to draw conclusions on the effect of the different TEs and their repetition on eating symptoms and their severity.

[Barcelona Bipolar Eating Disorder Scale (BEDS): a self-administered scale for eating disturbances in bipolar patients]. / Una escala autoaplicada para las alteraciones de la conducta alimentaria en el trastorno bipolar: Bipolar Eating Disorder Scale (BEDS) de Barcelona.

INTRODUCTION: The presence of eating disorders in bipolar population is not rare, with rates over 10 %, according to the few available epidemiologic studies, however the literature on this issue is still scarce. An even higher percentage of bipolar individuals suffer from serious problems related to eating behavior without fulfilling criteria for DSM-IV eating disorder. METHODS: The Bipolar Eating Disorders Scale (BEDS) was designed on the basis of the existing eating scales, adjusted to the characteristics of bipolar disorders from the complaints of our sample of patients (n=350). Subsequently, a group of experts made the selection of the most representative and independent items in order to obtain a short, 10-item scale, aimed at assessing the intensity and frequency of eating dysfunctions in the bipolar population and not at diagnosis. We administered the scale to a healthy control group (n=55) to evaluate feasibility and to determine the cut-off score. RESULTS: The BEDS is a 10-item simple, self-administered scale. Average time of completing this scale is about 1.13 min (1 min, 21 seconds) +/-26 seconds. Median score was 6 and the mean score was 6.6 with a standard deviation of 3.7, this being the reason why the cut-off point was found to be around 13 points. Patients receiving scores over 13 may require an individualized intervention to evaluate which were the main difficulties and to propose treatment. CONCLUSIONS: The BEDS allows for a rapid and effective evaluation of both the intensity and the frequency of eating dysfunctions in bipolar patients in order to perform an adequate intervention for the specific needs of each one of the patients.

Una escala autoaplicada para las alteraciones de la conducta alimentaria en el trastorno bipolar: Bipolar Eating Disorder Scale (BEDS) de Barcelona / Barcelona Bipolar Eating Disorder Scale (BEDS): a self-administered scale for eating disturbances in bipolar patients

Introducción. Los estudios realizados sobre patología alimentaria y trastorno bipolar son más bien escasos, a pesar de la frecuente comorbilidad entre trastorno alimentario y trastorno bipolar que los pocos estudios epidemiológicos realizados han confirmado, con cifras por encima del 10 por ciento. Sin embargo, un porcentaje todavía mayor de pacientes bipolares padece problemas en el área de la alimentación que por sus características y gravedad no alcanzan a cumplir criterios para un trastorno específico de la conducta alimentaria. Métodos. Se presenta la escala autoaplicada para las alteraciones de la conducta alimentaria en el trastorno bipolar (Bipolar Eating Disorder Scale, BEDS). El diseño de esta escala se ha realizado en base a ítems de otras escalas ya existentes que valoran la conducta alimentaria y a una lista exhaustiva de quejas referidas por una muestra amplia de pacientes bipolares (n =350) respecto a sus problemas con la alimentación. Posteriormente, un grupo de expertos seleccionó los ítems más representativos e independientes hasta construir una escala cuantitativa breve, destinada a la cuantificación, que no al diagnóstico, de las disfunciones alimentarias en pacientes bipolares. Se ha pasado la escala a un grupo de controles sanos (n =55) para evaluar su factibilidad y determinar un punto de corte. Resultados. La BEDS es un cuestionario sencillo, autoaplicado y factible, ya que consta de tan sólo 10 ítems. El tiempo de ejecución fue de 1,13 min (1 min, 21 s) ñ26 s. La puntuación mediana en controles fue de 6 y la puntuación media de 6,6 con una desviación típica de 3, 7, por lo que el punto de corte se presituó sobre los 13 puntos. Pacientes con puntuaciones superiores a los 13 puntos requerirán una intervención individualizada para valorar cuáles son sus mayores dificultades y proponer un tratamiento. Conclusiones. La BEDS permite evaluar de una manera rápida y sencilla tanto la intensidad como la frecuencia de las diferentes alteraciones alimentarias en los pacientes bipolares con el fin de poder realizar una intervención adecuada a las necesidades específicas de cada uno de los pacientes (AU)

Situación actual de la hipocondría / Current situation of hypochondria

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Bone marrow changes in anorexia nervosa are correlated with the amount of weight loss and not with other clinical findings.

The clinical history and biochemical and hematologic variables for 44 consecutive patients diagnosed with anorexia nervosa were recorded. Bone marrow aspirates and biopsy specimens were analyzed by standard morphologic procedures, and bone marrow adipocytes were studied morphometrically. The bone marrow of the 44 patients was classified as normal (5 cases [11%]), hypoplastic or aplastic (17 [39%]), with partial or focal gelatinous degeneration (13 [30%]), or with complete gelatinous degeneration of the bone marrow (GDBM; 9 [20%]). These patterns correlated with amount of weight loss (P = .005) but not other clinical findings. WBC counts were lower in patients with GDBM (P = .0189), but this and other peripheral blood variables did not always reflect the severity of bone marrow damage. Hypoplastic or aplastic bone marrow showed an increase in bone marrow fat fraction due to an increase in adipocyte diameters, while in GDBM, fat fraction and adipocyte diameters decreased. Morphologic changes in bone marrow and stereologic alterations in bone marrow adipocytes may be observed in anorexia nervosa. The extent of damage is related to the amount of weight loss, not to other factors. Peripheral blood cell counts may not reflect the extent of damage. In some patients, this process may be reversible with reestablishment of adequate nutritional intake.

Validation and utility of the patient health questionnaire in diagnosing mental disorders in 1003 general hospital Spanish inpatients.

OBJECTIVE: To determine whether the Spanish version of the patient health questionnaire (PHQ) has validity and utility for diagnosing mental disorders in general hospital inpatients. METHODS: Participants in the study were 1003 general hospital inpatients, randomly selected from all admissions over an 18-month period. All of them completed the PHQ, the Beck Depression Inventory (BDI), and measures of functional status, disability days, and health care use, including length of hospital stay. They also had a structured interview with a mental health professional. RESULTS: A total of 416 (42%) of the 1003 general hospital inpatients had a PHQ diagnosis. There was good agreement between PHQ diagnoses and those of an independent mental health professional (for the diagnosis of any PHQ disorder, kappa = 0.74; overall accuracy, 88%; sensitivity, 87%; specificity, 88%), similar to the original English version of the PHQ in primary care patients. Patients with PHQ diagnoses had more functional impairment, disability days, and health care use than did patients without PHQ diagnoses (group main effects for functional status measures and disability days, p < .001; group main effects for health care use, p < .01). The group main effect for hospital length of stay was not significant. An index of depression symptom severity calculated from the PHQ correlated significantly both with the number of depressive symptoms detected at interview and the total BDI score. PHQ administration was well accepted by patients. CONCLUSIONS: The Spanish version of the PHQ has diagnostic validity in general hospital inpatients comparable to the original English version in primary care.

Growth hormone-binding protein directly depends on serum leptin levels in adults with different nutritional status.

The aim of this work was to assess the relationship between GH-binding protein (GHBP) and leptin. Both peptides are nutritionally regulated, but the recent implication of a role for leptin in the GH axis requires further study. To avoid the sexual dimorphism in leptin values, we performed leptin standardization according to gender (SD score-leptin). The relationship between SD score-leptin and GHBP was studied in 128 adults with different nutritional status [8 groups according to body mass index (BMI)], ranging from severely underweight anorexia nervosa to highly morbid obesity. Both GHBP and SD score-leptin significantly increased according to BMI within the range from 18-27 kg/m2, whereas no significant differences were found among underweight groups (BMI, < 18 kg/m2) or among obesity grades (BMI, > 27 kg/m2). We found a strong correlation between GHBP and SD score-leptin (r = 0.8; P < 0.0001). Multiple regression analysis revealed SD score-leptin to be a significant determinant of GHBP, accounting for 64% of the variation, whereas BMI did not contribute further to explaining changes in GHBP. This suggests a physiological pathway involving both GHBP (the soluble fraction of GH receptor) and leptin. Thus, we might speculate that leptin could be the signal that induces the related nutritional changes observed in GHBP/GH receptor expression.

Analytical performance and clinical usefulness of two binding assays for growth hormone binding protein (GHBP) measurement: high performance liquid chromatography (HPLC)-gel filtration and dextran-coated charcoal adsorption.

We compared two binding assays for growth hormone binding protein (GHBP) measurements, which differ in the method of bound and free GH separation: HPLC-gel filtration or dextran coated-charcoal adsorption (DCC). Two pools of sera (high and medium GHBP activity) were used for quality-control assessment. Moreover, 62 samples from 34 children and 28 adults with different nutritional status were studied. Total, between- and intra-iodination coefficients of variation (CVs) from the two methods were not different. Although percentage binding measured in the pool sera significantly differed, the concentrations assessed by Scatchard plot were comparable. Results obtained by the two methods in the 62 sera were significantly correlated (r = 0.77, P < 0.001). With both methods GHBP activity correlated with chronological age and body mass index (BMI) and differed among groups with different nutritional status. Although HPLC and DCC separation methods for GHBP measurement differ in their practicability, our study demonstrates that performance and the clinical usefulness of the two methods are comparable.

[Morbid obesity. Reflections on a surgical protocol (II). The experience accumulated over 5 years]. / Obesidad mórbida. Reflexiones sobre un protocolo quirúrgico (II). Experiencia acumulada durante cinco años.

Bariatric surgery is done on a selected, ill patient (morbid obesity), with a surgical risk which is intrinsic to his condition and morbidity. The results on any program are more a function of the adequate selection, information and control, than of the surgical model itself. The first 125 patients of the present surgical series have been reviewed, with a minimum of 18 months of follow up, and the complications are detailed, with emphasis on the compulsory and necessary radiological evaluation in the immediate post-operative period, during the follow up, and in the face of any complication. The effectiveness criteria of the technique and the real value of the weight loss are reevaluated, as well as defining the criteria of failure of surgical treatment. Finally, we end with an up dating of the psychological results observed, as well justifying the need for a bariatric surgery protocol, with its ethical-legal implications. The final conclusion is that bariatric surgery shall only be clinically and ethically accepted if it complies with the principles for which it was designed.

[Severe obesity: its surgical treatment in 120 patients. The results and a prospective focus]. / Obesidad severa: tratamiento quirúrgico en 120 pacientes. Resultados y enfoque prospectivo.

Severe or morbid obesity (M.O.) is a pathological state which is very difficult to treat by non-surgical means. It is defined internationally on the basis of anthropometric measurements when a body mass index (BMI) of 40 kg/m2 is exceeded. In such cases, the pathological increase in body fat influences patient mortality and morbidity. The present state of bariatric surgery is reviewed in the series presented. The guidelines are submitted which are currently used as an approach to surgery, and the reasons are set out used by the authors, on the base of 5 years' experience and more than 110 patients operated on (ringed vertical gastroplasty-RVG, inflatable silicone gastric band, Salmon's technique) in a prospective approach to new surgical projects. The series presented is divided into two groups. It is shown that not all the severely obese (SMO) (BMI > 50 kg/m2) respond adequately to a simple restrictive technique (RVG) notwithstanding very considerable weight loss. Other techniques are currently under consideration for this group. It is concluded that bariatric surgery demonstrates effective and permanent results if the right technique is used on the patient selected.