Validation of the Greek ORTO-15 questionnaire for the assessment of orthorexia nervosa and its relation to eating disorders symptomatology.

PURPOSE: The aim of the study was the validation of the Greek version of the ORTO-15 questionnaire. An additional aim was to explore the relation between orthorexic and eating disorder behaviors in a sample of Greek students. METHODS: ORTO-15 was translated and adapted in the Greek language. After its final version was drafted, its test-retest reliability was checked. Then, the questionnaire was administered to 120 students of psychology along with EAT-26. Additionally, demographics, BMI and information related to eating disorders were collected. RESULTS: The Greek version of the ORTO-15 questionnaire showed acceptable internal consistency (Cronbach's a 0.7). Factor analysis produced a three-factor model similar to the original English version of the questionnaire. The correlation of ORTO-15 and EAT-26 revealed that higher measurements in the diet and bulimia EAT-26 scale were related to increased orthorexic symptomatology. Finally, there was no significant correlation between the 3 factors of the ORTO-15 (emotional, rational and behavioral) and age, education or Body Mass Index. CONCLUSIONS: This study is the first attempt to assess orthorexia nervosa in a Greek student population. ORTO-15 was found to be a reliable tool for the measurement of orthorexia in Greece. Finally, in accordance with other studies, orthorexic symptoms were partially related to eating disorder symptomatology, thus raising the question of possible similarities and overlap between the two clinical constructs. LEVEL OF EVIDENCE: Level V, Cross-sectional descriptive study.

[The psychiatric comorbidity of anorexia nervosa: A comparative study in a population of French and Greek anorexic patients]. / La comorbidité psychiatrique de l'anorexie mentale : une étude comparative chez une population de patients anorexiques français et grecs.

OBJECTIVE: The current study had two objectives: (1) to access the psychiatric comorbidity in axis I and axis II (according to DSM-IV) of anorexia nervosa in a sample of 60 anorexic patients; (2) to compare the features of the psychiatric comorbidity between the two groups of French and Greek anorexic patients who participated in the study, as well as to compare some psychological and behavioral aspects of their anorectic psychopathology. METHOD: Sixty anorexic patients, thirty French and thirty Greek, aged between 18 and 60 years, referred for evaluation and therapy at the unit of eating disorders at the "Institut national Marcel-Rivière of the MGEN" (hôpital de La Verrière, France) and at the unit of eating disorders of the First Department of Psychiatry of EGINITIO University Psychiatric Hospital in Athens (Greece), were accessed with the Eating Attitudes Test-26 (EAT26), Eating Disorder Inventory (EDI), Symptom Checklist-90-Revised (SCL90R), Mini International Neuropsychiatric Interview, Version 5.0.0 and the International Personality Disorder Examination. RESULTS: The comparison between the Greek and French patient populations did not show significant differences in age, socio-educational status, family status and BMI. French patients were hospitalized more regularly than Greek patients (χ2 (1)=6.65, P=0.01) and psychotropic drug therapy was more common in French anorexic patients (χ2 (1)=4.59, P=0.06). The results of the EAT 26 questionnaire in Greek and French patients show an average of 34.93 (±18.54) in total, with no statistically significant difference between the two groups. The results of EDI show a statistically significant difference between the two groups in the subscale 3 (body dissatisfaction) in which the Greeks scored on average at 9.40 and the French at 14.90 (t (58)=3.09, P<0.01). According to the results of the MINI scale, 47% of the patients in our total sample had a restrictive anorexia nervosa and 47% had anorexia nervosa of binge-eating/purging type. The most frequent comorbid disorder was the major depressive episode (40%) and the obsessive compulsive disorder (18.3%). The only statistically significant difference between the two groups was the frequency of the major depressive episode, which appeared statistically higher among the French (χ2 (1)=6.94, P=0.01). According to the results of IPDE, 73.3% of patients in total (76.6% of the French and 70% of the Greeks) showed a personality disorder. The most common personality disorder was borderline personality disorder (40%), followed by obsessive-compulsive personality disorder (26.6%) and avoidant personality disorder (21.7%), with no statistically significant differences between the two groups. DISCUSSION: The profile of anorexic patients who are addressed to the specialized units of eating disorders in both cities (Paris, Athens) had many points in common (demographic parameters, BMI, subtype of anorexia). The results of the EAT-26 and EDI questionnaires did not differ between the two groups, except for the EDI questionnaire subscale 3, which showed body dissatisfaction, where the French had higher scores; this fact underlines the influence of cultural factors on some psychological and behavioral aspects of the psychopathology of the anorexia nervosa. The rates of comorbidity of anorexia nervosa in axis I and axis II found in our study are in agreement with data from various literature reviews and studies in the recent years. The most interesting point of the comorbidity comparison on axis I between the two groups of patients concerns the difference in the frequency of the major depressive episode, for which the results show higher rates in French patients. We can consider that this finding follows the general trend of mood disorder rates in Western countries and we can assume an explanation based on cultural influences. Finally, we can consider that the differences concerning the hospitalization of French patients in a more regular way than Greek patients and the higher rates of psychotropic treatment in French patients reflect the differences in the health systems between the two countries. CONCLUSION: Our study has shown high rates of major depressive episode, as well as personality disorders. There were statistically significant differences in four parameters between our two patient groups, explained by the influence of cultural factors.

Thought-Shape Fusion in bulimia nervosa: an experimental investigation.

The aim of the present study was to experimentally investigate a cognitive distortion, 'Thought Shape Fusion' (TSF), in patients with bulimia nervosa (BN). TSF has been postulated as a specific distortion in patients with eating disorders and occurs when the thought about eating a forbidden food increases a person's estimate of her weight / shape, elicits a perception of moral wrongdoing and makes her feel fat. Previous psychometric measures of TSF in clinical and control groups, experiments eliciting TSF in a student sample and in patients with anorexia nervosa, all confirm a strong association between TSF and eating disorder psychopathology. Twenty patients diagnosed with BN participated in a within-participants experimental design with the aim of eliciting TSF and investigating further the possible effects of corrective behaviours (checking and mental neutralizing). Verbal analogue scales constituted the main outcome measures. TSF triggered a perception of moral wrongdoing, heightened levels of body dissatisfaction, elevated feelings of anxiety and guilt and prompted urges to engage in checking and mental neutralizing. Corrective behaviours significantly reduced the effects of the experimental procedure. Components of TSF are present in BN and are likely to play a mediating role in the maintenance of the disorder. The precise connection between TSF and BN remains to be explored in future clinical trials.

A study of eating attitudes and related factors in a sample of first-year female Nutrition and Dietetics students of Harokopion University in Athens, Greece.

OBJECTIVE: To investigate eating attitudes and related factors in a sample of first-year female students of Harokopion University, Nutrition and Dietetics (ND) School. METHOD: The Eating Attitudes Test (EAT-26), a set of 12 male and female figures, and two questionnaires for demographic, clinical and nutritional data were administered to 53 ND students and 54 first-year female students of Athens Technological Institution Health Visitors (HV) School. RESULTS: The ND group scored higher in EAT-26 total score (p=0.05) and Diet subscale (p=0.02) than the HV group. EAT-26 score in the ND group correlated significantly with dinner avoidance (correlation coefficient: 0.3, p=0.02). Logistic regression analysis showed that avoidance of dinner (p=0.03), choosing leaner ideal women figures (p=0.005) and larger self images (p=0.01) were the three factors that could predict high EAT-26 scores in the ND group (EAT-26>or=20). CONCLUSIONS: First-year ND students might have more often disordered eating attitudes as opposed to students from other university programs.

[A study of eating attitudes in Nutrition and Dietetics senior students].

The aim of the study was to investigate eating attitudes and related factors in a sample of senior female students of Harokopeion University, Nutrition and Dietetics Department (ND). The group of ND students was compared to a relative sample of female senior students of Technological Institute of Athens, Health Visitor's School (HV). Sixty five ND and 60 HV female senior students were approached af ter lectures. From the 55 ND and the 46 HV students that were eligible to be included in the study, 44 ND and 37 HV students agreed to participate. Ten ND and 14 HV students were excluded because they were either older than 25 years or suffering from a chronic physical or mental disorder. Eleven ND and 9 HV students refused to participate mainly because the did not wanted to be weighted by the researchers. Eating Attitudes Test (EAT-26), and two questionnaires for demographic, clinical and nutritional data were administered to all participants. Also each student was asked to pinpoint on a set of 12 male and female figures the figure that was more likely to represent their own body as well as their ideal female and male body. The ND group scored lower in the mean EAT-26 total score (p=0.03) and oral control subscale (p=0.01) than the HV group. EAT-26 score in the ND group correlated positively with self figure (Kendall's tau-b=0.2, p=0.04) and body dissatisfaction (Kendall's tau-b=0.3, p=0.01). The difference between the ideal female figure and the self figure was used as an indication of body dissatisfaction. Logistic regression analysis showed that avoidance of dinner (OR= 0.7, sig=0.03), choosing leaner ideal women figure (OR= 2.1, sig=0.03) and larger self image (OR=0.5, sig=0.001) were the three factors that could predict high EAT-26 total scores (EAT-26 ≥20) in the group of senior female students from both university departments. In conclusion, Nutrition and Dietetics senior female students showed less disordered eating attitudes than senior female Health Visitor's students. Furthermore, the estimation of the ideal female body figure as compared to the perception of the participant's own body figure was significantly related to disordered eating attitudes in the total sample of female university students.

Maternity blues in Athens, Greece: a study during the first 3 days after delivery.

BACKGROUND: Although maternity blues have been studied in many countries worldwide the factors that influence the occurrence of this clinical entity are not well understood. The purpose of this study was to investigate the prevalence, time course and symptomatology of maternity blues in a Greek urban environment as well as the relation of maternity blues with certain clinical and sociodemographic factors. METHOD: A study of a sample of 402 women that were recruited during the first day after delivery. Each woman completed the Kennerley's Blues Questionnaire on a daily basis for the first 3 days of puerpartum. Clinical and sociodemographic data were obtained through questionnaires and personal interview. RESULTS: 179 (44.5%) women experienced severe maternity blues during the first 3 days after delivery. Delivery by caesarian section (P=0.006), stressful events during pregnancy (P=0.02), depressive feelings the last month prior to delivery (P=0.002), anxiety on the day of delivery (P=0.001) and hypochondriasis (P=0.001) were the factors that were found to relate significantly to maternity blues. CONCLUSION: The women's emotional condition prior and after delivery, delivery via caesarotomy, as well as fears concerning somatic health had strong impact on the occurrence of maternity blues.

Protracted acute stress reaction following an earthquake.

OBJECTIVE: To verify the official criteria of ICD-10 diagnosis of acute stress reaction (ASR) among earthquake victims. METHOD: Data on psychosocial variables and the diagnosis of ASR were collected from 91 subjects. RESULTS: The diagnosis of ASR was made in 70% of the sample. However, the restrictive duration criterion (i.e. symptoms not exceeding the first 48 h) was fulfilled only in 10%; in the remaining 60% the symptoms lasted for about another week. Thus, 60% of the sample constituted a group with protracted ASR (PASR) and 40% a group without it (n-PASR). Medical history was more frequent among PASR than n-PASR; PASR showed higher anxiety levels (both pre- and post-disaster) than n-PASR; finally, the persistence of ASR related positively to the fear of death at the time of the earthquake and pre-disaster anxiety levels. CONCLUSION: As in the vast majority of earthquake victims the ASR is protracted beyond 48 h, a revision of ICD-10 guidelines should be considered.

Melatonin response to clonidine administration in depression: indication of presynaptic alpha2-adrenoceptor dysfunction.

BACKGROUND: The aim of this study was to investigate alpha2-adrenoceptor sensitivity in depression, by using melatonin response to clonidine administration as an index of alpha2-adrenoceptor functioning. METHOD: 35 depressed subjects and 41 healthy controls were assessed for overnight urinary melatonin pre- and post-administration of oral clonidine. RESULTS: Administration of clonidine significantly reduced melatonin concentrations in depressed patients but not in control subjects. LIMITATION: A single oral dose (0.15 mg) of clonidine was administered. CONCLUSIONS: Further indication is provided for presynaptic alpha2-adrenoceptor dysfunction in depression with the application of an alternative pharmacological challenge method.

Neurotransmitter parameters in plasma and urine of affective patients in depression and in normothymia after drug treatment.

Several neurochemical parameters were estimated in plasma and urine of patients with affective disorders in the depressive phase and later in normothymia, after successful drug treatment. Significant increases were found for the activity of the enzyme dopamine-beta-hydroxylase in plasma and the concentrations of cyclic AMP in plasma and urine. No consistent changes were found for prolactin or cyclic GMP in plasma, and for methoxyhydroxyphenylgkyglycol, homovanillic acid, 5-hydroxyindoleacetic acid and cyclic GMP in urine. The major change we observed in the clinical state of the patients is thus not reflected in change in the urinary biogenic amine metabolites. Their changes were found to correlate inversely to their pretreatment values. In normothymia, high values decrease and low values increase for all three amine metabolites, indicating that antidepressives act towards a normalization of the amine turnover mechanisms.

Subtypes of schizophrenia and ABO blood types.

Determination of ABO blood types was carried out in 430 (171 female and 259 male) patients with hebephrenic schizophrenia and in 340 (155 female and 185 male) patients with paranoid schizophrenia. Results were compared with a random sample of 600 individuals (268 female and 332 male) drawn from the general population. No significant association was detected between any of the ABO blood phenotypes and affliction either with hebephrenic or paranoid schizophrenia

Affective disorders and ABO blood types.

Results of the present study provide evidence of: 1) a positive association between bipolar affective disorder and blood type O and a corresponding negative association between the former and blood type A, 2) a positive association between unipolar affective disorder and blood type O, and 3) a positive association between involutional depression and blood type A and a corresponding negative association between the former and blood types B and O. Sex does not appear to modify the ABO blood types' distribution in patients with bipolar, unipolar affective disorder, or involutional depression, and the same holds for early- or late-onset of the illness in patients with bipolar or unipolar affective disorders. Findings in the present study do not support the validity of the bipolar-unipolar distinction of affective disorders, and provide evidence in favour of the view that involutional depression is a genetically distinct nosological entity.

Physical activity and plasma cyclic adenosine monophosphate levels in manic-depressive patients and healthy adults.

Intense exercise for one hour induced a significant increase in plasma cyclic adenosine monophosphate (cAMP) in 5 healthy volunteers. In 44 manic-depressive patients, cAMP levels correlated more strongly with mood ratings than with activity scores. The authors conclude that physical activity is one of the factors which contribute to changes of cAMP levels in affective illness.

Plasma cyclic AMP in manic-depressive illness.

The postulated disturbance of cyclic AMP (cAMP) in manic-depressive illness was investigated by using plasma as the biological material. Cyclic AMP was measured by a protein-binding assay, which was found very satisfactory for the purpose of this study. In the drug-free state, depressed patients (n = 28) had significantly lower and manic patients (n = 9) significantly higher plasma concentrations of cAMP than controls. Unmedicated manic-depressive subjects had normal cAMP levels during normothymic phases (n = 7). Cyclic AMP was reduced by neuroleptics in mania and elevated by tricyclics in depression. Lithium exerted a normalizing effect on cAMP in both phases of the illness. It is concluded that manic-depressive illness is associated with a disturbance in the cAMP system. The use of plasma rather than urine for the investigation of the state of cAMP in psychiatric disorders is advocated.