[Are the neuropsychological alterations in eating disorders endophenotypes of the disease? Review and state of the art]. / Son las alteraciones neuropsicologicas de los trastornos de la conducta alimentaria endofenotipos de la enfermedad? Revision y estado actual del tema.

INTRODUCTION. Recent studies have shown that alterations to the executive cognitive functions may be endophenotypes of eating disorders. AIM. To perform a critical review of the literature on neuropsychological alterations in patients with eating disorders and their first-degree relatives. DEVELOPMENT. We review the papers written in English and in Spanish indexed in Medline and PsycINFO over the last 10 years. We included abstracts of papers that have still not been published and search terms were crossed. Excluding some isolated clinical cases, we obtained 41 studies on patients with anorexia nervosa (n = 17), bulimia nervosa (n = 5), both (n = 13) or a non-specific eating disorder (n = 6). CONCLUSIONS. The studies reviewed display important limitations due to their heterogeneous methodology and small samples, which give rise to contradictory results. Most of them were conducted on anorexia nervosa. Cognitive rigidity seems to be more frequent in patients with anorexia and their relatives, and alterations in decision-making or central coherence is more often found in bulimia nervosa. There is evidence suggesting that the neuropsychological alterations found in eating disorders are endophenotypes of the disease.

Motivación como predictor de respuesta al tratamiento en los trastornos de la conducta alimentaria / No disponible

Introducción: Motivación es el impulso que nosmueve para alcanzar una meta. Nuestro trabajo pretendeaveriguar si la motivación del paciente con trastorno dela conducta alimentaria (TCA) está relacionada conparámetros de la historia clínica y los resultados obtenidosen distintos cuestionarios psiquiátricos.Resultados: Muestra de 24 pacientes (91,7% mujeresy edad media 25,75 años). Los diagnósticos de anorexianerviosa, bulimia nerviosa y trastorno de la conductaalimentaria no especificado estaban igualmente representados.La mayoría de pacientes no presentabacomorbilidad psiquiátrica. El 45,8% presentaba unamotivación alta para el tratamiento en la evaluación inicial.No hubo asociación significativa entre la motivacióndel paciente y las variables analizadas.Conclusiones: La motivación al tratamiento del TCAen un paciente es un constructo independiente de la patología(AU)

Introduction: Motivation is the boost that movespeople to achieve an objective. The aim of the study isto evaluate the correlation of the motivation of a patientwith eating disorder (ED) with clinical parameters andresults obtained from psychiatric tests.Results: Sample with 24 patients (percentage offemale 91,7% and mean of 25,75 years). Anorexia nervosa(AN), Bulimia Nervosa (BN) and eating disordersno otherwise specified (EDNOS) were equally represented.Majority did not present axis I co morbidity. Inthe first assessment the 45,8% had a high motivation forthe treatment. Patient motivation was not related withany of the clinical parameters.Conclusions: Motivation for change, in ED patients,is an independent factor of the pathology(AU)

Repercusiones de la retirada de la tioridazina / Repercussions of the withdrawal of thioridazine

Introducción. Como consecuencia de la retirada del mercado de la tioridazina, pacientes que habían sido tratados con este fármaco requieren un nuevo abordaje terapéutico. Observamos casos de ingreso en la unidad de agudos por descompensación tras la retirada de tioridazina y que presentan difícil manejo terapéutico. Se realiza una descripción de las características clínicas y de la pauta farmacológica que lleva a la estabilización del paciente. Resultados. La muestra obtenida en nuestra unidad es de 15 pacientes con una media de 20 años de estabilidad previa a la retirada de tioridazina. Representan un 6% de todos los pacientes en tratamiento con tioridazina durante2005 en nuestra región sanitaria. Presentaron un perfil psicopatológico común: patrón afectivo sobreañadido a la clínica psicótica, predominando labilidad emocional y tendencia a hipertimia de difícil manejo farmacológico. En un 27%se consiguió estabilidad con fenotiazinas piperazinas en monoterapia; en un 60 % requirieron la asociación con eutimizante y/o a antipsicótico atípico. Un 20% se estabilizaron con antipsicóticos atípicos en monoterapia. En un 40% pauta moseutimizante para manejar la inestabilidad afectiva y un 27 % presentaron respuesta a tratamiento con terapia electroconvulsiva (TEC), que se prescribe de segunda elección debido a la resistencia al tratamiento farmacológico asociado a gravedad. Conclusiones. Proponemos iniciar un tratamiento con el grupo de fenotiazinas piperazinas valorando la introducción de un eutimizante y/o TEC. Se ha producido un 33% de reingresos; un 40 % de los casos han requerido centros demedia/larga estancia y registramos un suicidio consumado. Observamos un elevado coste tanto de recursos asistenciales, económicos como de calidad de vida (autonomía, habilidades sociales y nivel cognitivo) en nuestra muestra tras la retirada de tioridazina (AU)

Introduction. As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. Results. The sample obtained in our unit included15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our healthcare area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27% of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60% of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. Conclusions. We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril® (thioridazine) withdrawal of the market (AU)

[Repercussions of the withdrawal of thioridazine]. / Repercusiones de la retirada de la tioridazina.

INTRODUCTION: As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. RESULTS: The sample obtained in our unit included 15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our health care area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27 % of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60 % of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. CONCLUSIONS: We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/ long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril (thioridazine) withdrawal of the market.