Alexandra Pham-Scottez

Factors predictive of ten‐year mortality in severe anorexia nervosa patients

Huas C, Caille A, Godart N, Foulon C, Pham‐Scottez A, Divac S, Dechartres A, Lavoisy G, Guelfi JD, Rouillon F, Falissard B. Factors predictive of ten‐year mortality in severe anorexia nervosa patients.

Predictors of dropout from inpatient treatment for anorexia nervosa: data from a large French sample.

Dropout from anorexia nervosa inpatient treatment programs is frequent and is linked to a poorer outcome. This study aimed to identify predictive factors for dropout among anorexia nervosa inpatients. Between 1988 and 2004, 601 consecutive female inpatients with anorexia, restrictive (AN-R) or binge/purging (AN-B/P) subtype (Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV)), were assessed at admission (clinical, socio-demographic, and psychological data). A stepwise logistic model was developed. Dropout rates were respectively 50.0% and 56.2% for AN-R and AN-B/P. Seven predictive factors were identified in multivariate analysis: having one or more children, low desired body mass index (BMI), a low minimum BMI, high scores on the SCL-90 paranoid ideation and the Morgan and Russell eating behavior subscales, and low educational status. Early dropouts had a particular profile: lower desired BMI, higher score on SCL90 paranoid subscale, and more impulsive behaviors (alcohol use, suicide attempts). Dropout appeared as a multifactorial event. In clinical practice, certain factors could serve as warning messages reflecting the severity of the illness (high EDI score and low minimum BMI); while others could be targeted before hospitalization (having at least one child and low desired BMI).

Decreased sensitivity to facial emotions in adolescents with Borderline Personality Disorder.

Whereas severe relationship dysfunction in BPD is well described in adolescence, little is known about the way these patients process facial expressions of emotion. Because few data are available regarding this issue, the present study compared the sensitivity to morphed facial emotional expressions of 22 BPD female adolescents versus 22 matched controls. Participants had to identify as rapidly as possible the various emotions displayed progressively and continuously on faces. Results indicate that adolescents with BPD are less sensitive to facial expressions of anger and happiness, i.e. they require more intense facial expressions than control participants to correctly identify these two emotions. However, they did not exhibit any deficit in recognizing fully expressed emotions. These results suggest that sensitivity to facial emotions is impaired in adolescents with BPD. Theoretical and clinical implications are discussed.

Mortality and Its Predictors in Severe Bulimia Nervosa Patients

BACKGROUND The risk of mortality remains unclear for bulimia nervosa (BN) patients, especially the most severe. The aims of this study were to improve knowledge on BN and mortality. METHODS With initial evaluation at admission, 258 BN (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) consecutive inpatients were included (1988-2004). Vital status was established from the French national register. Standardized Mortality Ratio (SMR) calculation and bivariate Cox analysis were performed for the hypothesised predictors of mortality. RESULTS Mean follow-up duration was 10.5 years. Ten deaths were recorded, and the crude mortality ratio was 3.9%; SMR = 5.52 [CI95 (2.64-10.15)]. The majority of deaths were from suicide [6/10, SMR = 30.9 (5.7-68.7)]. The mean age at time of death was 29.6 years. Predictive factors were previous suicide attempt and low minimum BMI. CONCLUSIONS Severe BN patients are at higher risk of death (mainly suicide) especially if previous suicide attempt or previous low BMI. More studies are needed to confirm these results.

Personality Pathology Comorbidity in Adult Females with Eating Disorders

Personality pathology is examined in 100 female in-patients diagnosed with eating disorders. The Eating Disorder Inventory-II and the NEO-PI-R were self-administered and personality pathology was assessed using a structured interview. Clinicians additionally evaluated patients’ global functioning. The results indicated sizeable personality disorder comorbidity, and two dimensions of personality pathology, for example, an internalizing and an externalizing factor, could be identified. Patients’ global functioning was primarily associated with dimensions of personality pathology, but not with eating disorder symptoms. Assessment and therapeutic interventions should focus on this co-occurring pathology in order to improve patients’ functioning.

Traitement des troubles psychiatriques par la stimulation magnétique transcrântenne

RésuméLa stimulation magnétique transcranienne est une technique non invasive de stimulation électrique du cortex cérébral. Cette stimulation électrique focale est responsable de nombreux effects biologiques corticaux et à distance du siège de la stimulation, dont certains sont proches des effets observés sous antidépresseurs ou avec les chocs électroconvulsivants. Cette technique reste une technique de recherche car de nombreuses difficultés demeurent pour réaliser une stimulation focale anatomiquement précise et les protocoles de stimulation sont toujours en évolution. Les études sur la dépression montrent des effects certains mais modestes sur des sujets résistants aux traitements. En dehors de cette indication, l’effet le plus important démontré est une action durable sur les hallucinations auditives résistant au traitement neuroleptique.AbstractTranscranial magnetic stimulation is a noninvasive way to produce an electric stimulation of the cerebral cortex. This stimulation results in many biological effects in the stimulated cortical zone and also at distant subcortical centers. Some of these effects are shared with antidepressants and electroconvulsive shocks. But some technical difficulties remain (e.g. to stimulate precisely the anatomic targets, in spite of interindividual variability) and stimulation protocols are in progression, which prevent a large use of TMS outside research labs. Clinical trials in depression show modest effects with resistant depressive episodes. The most important and lasting clinical effects of TMS seem to be the treatment of medication resistant auditive hallucinations in schizophrenia.