[Study of eating habits in a female population comparing groups with and without food-related diseases]. / Estudio de hábitos alimentarios en población femenina comparando grupos con patología y sin patología alimentaria.

GOAL: To analyze female subjects in the rural setting to detect food-related disorders and factors associated with these. To isolate these factors and prevent the development of food-related disorders in Primary Health Care. Also to assess continuity in the alterations in the general, sub-clinical and bulimic populations. SCOPE AND SUBJECTS: 127 women with absence of dysfunctions: 57 sub-clinical and 63 bulimics, all from south-western Spain. INTERVENTIONS: Those adolescents at risk of dysfunctions would present positive results in pathological personality traits; therefore, their identification in Primary Health Care would avoid the transition to complete forms and would be favour the theory of the continuum. RESULTS: Significant differences were found between sub-clinical and bulimic women for mean age and age of onset of eating-related difficulties. Subjects without eating-related dysfunctions have a lower body mass index (BMI) than sub-clinical ones and the latter have less than bulimic subjects, both now and in the past. The objective and subjective history of excess weight was recorded for all three populations, together with eating-related behaviour and the various symptoms suggesting personality disorders, and data on their consumption of toxic substances. CONCLUSIONS: In our sample, 30% of the population obtained scores above the cut-off value in the two scales used, so they could be considered at risk for having food-related dysfunctions and it is necessary to take action at the level of Primary Health Care, as it is in the transition from childhood to adolescence that diets are begun to be followed because of an excessive assessment of weight and it is in this sphere that early action can be taken.

[Purging behaviors and nutritional status in anorexia nervosa and bulimia nervosa]. / Conductas purgativas y estado nutricional en anorexia nerviosa y bulimia nerviosa.

AIMS: The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. SETTING AND PATIENTS: The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSM-IV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). METHODS: The assessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. RESULTS: The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. CONCLUSIONS: The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods].

Conductas purgativas y estado nutricional en anorexia nerviosa y bulimia nerviosa / Purging behaviours and nutritional status in anorexia nervosa and bulimia nervosa

Objetivos: La intención del estudio fue comprobar si el empleo de métodos purgativos en pacientes con trastornos alimentarios (anorexia nerviosa [AN], y bulimia nerviosa [BN]) podía reflejarse en la existencia de un estado nutricional específico. Ámbito y pacientes: El grupo en estudio estuvo formado por 184 pacientes ambulatorios con diagnóstico confirmado de trastorno de la alimentación DSM-IV. Ciento dieciséis pacientes (63 por ciento) padecían BN: 90 del subtipo purgativo y 26 del subtipo no-purgativo. Sesenta y ocho pacientes (37,0 por ciento) cumplían los criterios diagnósticos del DSM-IV para la AN: 48 del subtipo restrictivo y 20 del subtipo compulsivo-purgativo. Intervenciones: El proceso de evaluación incluyó antropometría (perímetros corporales y pliegues cutáneos) y análisis de la impedancia corporal. Resultados: Los dos subgrupos de pacientes AN presentaron diferencias significativas frente a cada uno de los subgrupos de pacientes BN. Desde el punto de vista nutricional, fueron encontradas diferencias entre pacientes con patrones purgativos y no purgativos dentro de la población anoréxica pero no entre los pacientes bulímicos. Conclusiones: La significación clínica de estos hallazgos es discutida y se propone la identificación alternativa de tres subgrupos de pacientes AN: 1) tipo restrictivo [pacientes que controlan la ingesta y no utilizan métodos de purga]; 2) tipo purgativo [pacientes con verdaderos atracones que utilizan métodos de purga], y 3) tipo pseudo-purgativo [pacientes con episodios subjetivos de descontrol alimentario que utilizan métodos de purga] (AU)

Aims: The aim of the study was to investigate whether the use of purgative methods in patients with eating disorders (anorexia nervosa [AN] and bulimia nervosa [BN]) could be capable of producing changes in the nutritional status of the patients. Setting and Patients: The group under study was composed of 184 female eating disordered outpatients. One hundred and sixteen patients (63.0%) fulfilled the DSMIV diagnostic criteria for BN (90 purging type, 26 nonpurging type). Sixty eight patients (37.0%) fulfilled the DSM-IV criteria for the diagnosis of AN (48 restricting type, 20 binging-purging type). Methods: The asessment process included anthropometry (body circumferences and skinfold thickness) and body impedance analysis. Results: The two subgroups of AN patients significantly differed from each of the BN subgroups. From a nutritional point of view, some significant differences between the two DSM-IV subtypes of AN existed, but not between the purging type and the nonpurging type of BN. Conclusions: The paper discusses the clinical significance of these findings. An alternative subtypification of AN patients is proposed: 1) restricting type [patients who control their food intake and do not purge]; 2) purging type [patient with true episodes of binging which are followed by purgative behaviors]; and 3) pseudopurging type [patients with subjective binging episodes who use purging methods] (AU)

Body mass index and some psychopathological symptoms in open community nuns.

This article examines the connections between body weight and psychopathological symptoms in a religious community. The Symptom Checklist 90-Revised was administered to 34 nuns, whose body mass index (BMI) values significantly correlated with hostility (r=0.46, p<0.01). These findings support the idea that people living in open religious communities share social values regarding weight and body size, and reveal high levels of psychological discomfort when body weight increases.

Visual hallucinations induced by the combination of prolintane and diphenhydramine.

The case of a young man is presented who developed visual hallucinations following two months of concomitant use of prolintane and diphenhydramine at therapeutic dosages. An increase in dopaminergic brain activity is proposed as the causal mechanism for hallucinations--whereas prolintane can induce the release of dopamine at the synaptic cleft, diphenhydramine can act inhibiting the reuptake of dopamine and inducing a potentiation of its effects. The psychiatric complications appearing two months after starting the use of both drugs could be attributed to a phenomenon of pharmacological kindling.

[Clinical features and weight loss in patients with morbid obesity after bariatric surgery]. / Características clínicas y pérdida de peso en pacientes con obesidad mórbida tras cirugía bariátrica.

OBJECTIVE: To analyze the psychological status of morbidly obese patients suffering changes after surgical procedure for weight reduction. METHODS: We analyze the weight loss in 100 morbidly obese patients (85 female, 15 male) after bariatric surgery (vertical banded gastroplasty). We correlated the percentage of weight loss with the age of these patients, initial weight (body mass index at surgery), quality of life, eating behaviour, psychopathology, personality, and marital status. RESULTS: We have found relation between initial weight and weight loss (heavier patients lose more weight). The percentage of weight loss is associated with the Eating Behaviour (Body Dissatisfaction, Disinhibition), the Quality of Life (Positive Affect), the Psychopathology (Hostility), the Personality Traits (Narcissist), and the Marital Status (Idealistic Distortion). CONCLUSIONS: The weight loss in morbidly obese patients after surgery is major in the more obese one. The satisfactory weight loss after surgery improve the eating behaviour, quality of life, psychological and marital status.

Eating behavior in morbidly obese patients undergoing gastric surgery: differences between obese people with and without psychiatric disorders.

BACKGROUND: This study analyzes eating behavior in a group of morbidly obese patients who have undergone gastric reduction surgery for weight loss, and evaluates whether the existence of psychiatric comorbidity marks significant differences in their eating behavior. METHODS: The study group was composed of 100 morbidly obese patients (85 females, 15 males) who had received surgical treatment for weight reduction (vertical banded gastroplasty). 40 of these patients (40%) met ICD-10 criteria for the diagnosis of psychiatric disorders and were included in the "Psychiatric Obese group" (PO). The other 60 patients (60%) did not show ICD-10 diagnostic criteria and were included in the "Non-Psychiatric Obese group" (NO). Each patients completed the Binge Eating Scale (BES), the Three Factor Eating Questionnaire, the Bulimia Investigatory Test-Edinburgh (BITE), and the Eating Disorder Inventory (EDI). RESULTS: Significant differences were found between the two groups (PO and NO) in the Binge Eating Scale (p < 0.001), Three Factor Eating Questionnaire subscale Disinhibition (p < 0.001), BITE (p < 0.001), Eating Disorder Inventory subscale Perfectionism (p < 0.002), and Global EDI (p < 0.001). Logistic regression analysis showed correlation between PO group and Global EDI (Odds Ratio OR = 1.43) and BITE (OR = 1.16). No significant gender differences were found for eating behavior, clinical diagnosis, age, percentage of weight loss, time after operation, and BMI before surgery. CONCLUSION: Surgically treated morbidly obese patients with a psychiatric disorder (PO) have a more destructured eating pattern (with a predominance of binge eating and disinhibition) than NO.

Subtype criteria for bulimia nervosa: short- versus long-term compensatory behaviors.

Weight control methods used by a group of bulimic patients were studied, analyzing the relationship among compensatory strategies and other clinical variables. Sixty-nine female consecutive patients who sought help for DSM-IV bulimia nervosa were recruited for the study. The prevalence and frequency of use of binge eating and six compensatory methods (vomiting, laxatives, diuretics, diet pills, fasting, and compulsive exercise) were assessed in each patient. Factor analysis was used to group the variables, and a cluster analysis was performed on a second step. The clinical variables were finally analyzed in each of the groups isolated through cluster analysis. According to the results of the factor analysis, the compensatory strategies were identified as short-term compensatory methods (vomiting), long-term methods (diet pills, diuretics, and laxatives), and nonpurging methods (dieting and exercise). Three groups of patients were isolated through cluster analysis: short-term purgers (vomiting), long-term purgers (laxatives + diet pills + diuretics), and a mixed group (vomiting + laxatives). Long-term purgers were older and heavier, had a greater prevalence of past overweight, and used more compensatory methods. These results confirm the necessity to continue investigating alternative ways of classifying bulimia nervosa patients based on compensatory behaviors, considering the existence of clinical dimensions rather than rigid clinical subtypes.

Intoxicación hídrica con hiponatremia: a propósito de dos casos clínicos / Water intoxication and hyponatremia: report of two cases

Presentamos los casos clínicos de dos pacientes con antecedentes psiquiátricos que desarrollaron un cuadro clínico de polidipsia primaria con intoxicación acuosa e hiponatremia. Ambos fueron valorados en el servicio de urgencias de psiquiatría por presentar dos cuadros psiquiátricos de etiología orgánica, que se resolvieron con el tratamiento médico. Ilustramos el cuadro clínico de la polidipsia primaria, las complicaciones clínicas de la intoxicación hídrica e hiponatremia, así como unas breves consideraciones en cuanto al diagnóstico y tratamiento. (AU)

Food aversions in eating disorders.

The food aversions of a group of anorexia nervosa patients, bulimia nervosa patients, and no eating disordered individuals (controls) were compared. An open questionnaire was used to obtain data on the eating aversions of each of the three populations. The foodstuffs were placed in categories according to their nutritional value. They were also converted into nutrients, and the average value for each population was calculated. With the exception of the 'legumes' and 'dry fruits' categories, the degree of aversion towards the other food groups detected in the individuals with eating disorders was significantly greater than that detected in controls. Aversion towards food with a high protein content (meat, fish, milk and eggs) was characteristic of patients with eating disorders and is a source of clinical problems, which are discussed in this article.