Francisco José Vaz Leal

Influence of Attitudes towards Change and Self‐directness on Dropout in Eating Disorders: A 2‐Year Follow‐up Study

OBJECTIVE This study examined dropout-related factors at the Outpatient Eating Disorders Treatment Programme. METHOD One hundred ninety-six eating disorders patients following DSM-IV diagnostic criteria that consecutively commenced treatment were recruited and followed up for a 2-year period. A total of 151 patients completed the whole assessment with a set of questionnaires evaluating eating and general psychopathology. The Attitudes towards Change in Eating Disorders questionnaire was used, and personality was evaluated using the Temperament and Character Inventory. During the follow-up period, patients were re-assessed. Two years later, 102 patients continued on treatment. RESULTS Scores on Precontemplation at the beginning were predictors for dropout at 2-year follow-up. Character variables, as Responsibility, Integrity and Self-acceptance were protective factors to be at Precontemplation stage. DISCUSSION The clinicians challenge is to help eating disorders patients to develop an unyielding sense of responsibility and self-acceptance, aimed to integrate the therapeutic choice into their own intrapersonal frame of goals.

Pattern of birth in restrictive and bulimic eating disorders.

OBJECTIVE To determine whether different eating disorders are associated with being born at different points in the year. Based on previous research, it was hypothesised that being born during warm months (June-August) is likely to be associated with restrictive anorexia, rather than bulimic disorders (bulimia nervosa, binge-purge anorexia). METHOD Case notes from 105 eating-disordered women were used to yield dates of birth and diagnosis. Associations were calculated between diagnostic group and birth period (month, quarter of year, high-risk quarter). RESULTS Restrictive anorexics were significantly more likely than the bulimics (42.6% vs. 24.1%) to be born during the warmest quarter (June-August) than during the remainder of the year. CONCLUSIONS This preliminary study suggests that being born during warmer periods may form a small risk factor for the development of a restrictive eating disorder. Further research is suggested to test and extend the hypothesis.

Los trastornos de la conducta alimentaria, consideraciones sobre nosología. etiopatogenia y tratamiento en el siglo XXI

Amazing advances have been made in medical sciences since the first international conference on eating disorders (ED) was held in the 1970s, and there have been remarkable changes in the field of ED itself. Back then, virtually all that was talked about was anorexia nervosa; clinicians and researchers were mainly concerned about the possible hypothalamic and endocrine factors that seemed to be involved and there had been no epidemiological studies or controlled trials with psychiatric drugs or psychotherapy. Although the picture today is quite different, there are still significant gaps which even affect the classification of these disorders, as well as their neurobiological bases and both the pharmacological and psychological treatments which should be used. This paper gives a brief summary of these gaps and discusses the need to find endophenotypes which may help in categorising and directing research into these disorders. Mention is made of possible contributions from other fields for the benefit of greater progress in understanding eating disorders. Specific reference is made to the addictive model, out of which neuropsychology and animal models may provide data transferable to our area of expertise. Lastly, the current state of ED treatment is discussed with pointers as to from what perspective it would be most useful to seek improvements.

Factors predicting pain severity and psychopathology following a rehabilitation programme in patients with neck-and-shoulder pain

Abstract Background: Neck pain is assumed to be a multifactorial entity, and several investigators have suggested that some psychological areas emerge in neck pain. Aims: The aim of the current study is to isolate psychopathological and personality factors to achieve progress in patients with cervical pain undertaking a rehabilitation programme. Methods: 120 outpatients attending consecutively a rehabilitation clinic were initially selected. They had neck pain, shoulder pain and neck-and-shoulder pain. We evaluated, at baseline and endpoint, pain symptoms (West Haven-Yale Multifactorial Pain Inventory), personality traits (Eysenck Personality Questionnaire-A), and psychological status (Symptom Checklist-90-Revised). Two dimensions related to rehabilitation treatment were considered: severity of pain and severity of psychopathology. Results: The rehabilitation programme relieves pain and psychological discomfort. Interference and pain severity are risk factors for pain after treatment. Gender, psychoticism...

Calidad de vida en pacientes con obesidad mórbida sometidos a gastroplastia vertical bandeada

Resumen Introduccion.Los pacientes con obesidad morbida que son sometidos a tecnicas quirurgicas para perder peso constituyen una poblacion referencial para analizar la calidad de vida ya que, generalmente, el tratamiento quirurgico provoca una importante y duradera perdida de peso. Metodos. La muestra esta formada por 100 pacientes con obesidad morbida (85 mujeres, 15 varones) que han sido sometidos a tratamiento quirurgico (gastroplastia vertical anillada) para perder peso. Cuarenta pacientes (40%) cumplieron criterios CIE-10 para el diagnostico de trastornos psiquiatricos y fueron incluidos en el grupo de “obesos morbidos psiquiatricos”. Los 60 pacientes restantes (60%) no cumplieron criterios diagnosticos CIE-10 y fueron incluidos en el grupo de “obesos morbidos sanos”. Cada paciente completo le escala de calidad de vida del Lancashire Quality of Life Profile-European Version (LQOLP-EU). Resultados. La calidad de vida del grupo con trastornos psiquiatricos esta mas deteriorada que en el grupo carente de ellos. Hemos encontrado diferencias estadisticamente significativas para los dos grupos en las subescalas de relaciones familiares (p < 0,001), salud (p < 0,002), bienestar general (p < 0,001), afectividad positiva (p < 0,0001), afectividad negativa (p < 0,0001), autoestima negativa (p < 0,0001), opinion del paciente (p < 0,002) y opinion del clinico (p < 0,001). La perdida de peso no se relaciona con el diagnostico psiquiatrico. Conclusiones. La calidad de vida de los pacientes con obesidad morbida sometidos a cirugia bariatrica esta mas deteriorada si presentan trastornos psiquiatricos. La perdida de peso es independiente del diagnostico psiquiatrico. Hacemos hincapie en la necesidad de realizar una evaluacion psiquiatrica en los pacientes con obesidad morbida sometidos a cirugia bariatrica, antes y despues de la intervencion, ya que nos hemos encontrado con una peor calidad de vida que podria ensombrecer el pronostico a largo plazo. Palabras clave: Obesidad morbida. Cirugia bariatrica. Calidad de vida. Trastornos psiquiatricos.