Laura Rodríguez-Santos

Psychopathology and lymphocyte subsets in patients with bulimia nervosa

Abstract The association between lymphocyte subsets and several psychopathological variables which had proved to be able to affect immune cell count in other conditions was investigated in bulimia nervosa patients. Sixty-seven female bulimia nervosa patients and 29 female healthy controls were assessed for nutritional status (weight, blood cells, lymphocyte subsets, biochemical parameters and hormones) and psychopathology (anxiety, depression, hostility, impulsivity and borderline personality traits). A negative correlation between impulsivity and helper T-cells (CD4+) was found in controls. In the bulimia nervosa group, the patients with higher anxiety had the lower lymphocyte count, and anxiety and hostility were negatively related to CD4+ count. In addition, helper/cytotoxic T-cell ratio negatively correlated in this group with impulsivity, hostility and depression. In the light of these results, the potential influence of psychopathology on lymphocyte subset counts seems to be specific in bulimia nervosa patients, and more relevant than in healthy controls.

Neurobiological and Clinical Variables Associated with Alcohol Abuse in Bulimia Nervosa

The study was aimed at analysing the reciprocal relationships of several clinical and neurobiological items in order to predict alcohol misuse in patients with bulimia nervosa (BN). Seventy BN patients and 70 healthy controls were assessed for depression, impulsivity, borderline personality traits and self-defeating behaviours using specific scales; serum cortisol and 24-hour urinary excretion of serotonin and 5-hydroxiindolacetic acid were also assessed. The study confirmed the implications of these clinical factors for alcohol misuse in BN patients, but the results suggested that depressive symptoms and hypercortisolism could lie behind these relationships.

Neurobiological and psychopathological variables related to emotional instability: a study of their capability to discriminate patients with bulimia nervosa from healthy controls.

Objective: To analyze the capability of a set of neurobiological and psychopathological variables to discriminate bulimia nervosa (BN) patients from healthy controls. Method: Seventy-five female patients with purging BN and 30 healthy controls were compared for psychopathology (impulsivity, borderline personality traits, depressive symptoms and self-defeating personality traits) and neurobiological parameters reflecting hypothalamic-pituitary-adrenal axis activity (morning serum cortisol before and after dexamethasone) and monoamine activity (24-hour urinary excretion of norepinephrine, serotonin, dopamine, and their main metabolites: 3-methoxy-4-hydroxyphenylglycol, 5-hydroxyindoleacetic acid, and homovanillic acid). Furthermore, the relationships between the 2 sets of variables were compared in the 2 samples. Results: BN patients displayed higher impulsivity, more severe depressive features, and more borderline and self-defeating personality traits than controls. The 4 psychopathological variables were strongly interrelated in patients, whereas only depressive features correlated with self-defeating personality traits in controls. Patients had lower 24-hour excretion of serotonin and dopamine than controls, as well as lower ability to suppress cortisol. The relations between the biochemical and the psychopathological variables were only significant in the BN patients, but not in the control group. When discriminant analysis methods were applied, patients and controls differed for psychopathology (impulsive behaviors and borderline personality traits) and biological parameters (baseline cortisol and dopamine excretion), but when the variables were analyzed together, the differences in neurobiological parameters appeared as mediated by the psychopathological status. Discussion: Our results suggest that hypothalamic-pituitary-adrenal axis activity, dopamine activity and other biological parameters are worthy of further study as potential dimensional markers of BN, although they seem to depend on the psychopathological status of the patients, in such a way that the psychopathological items associated with emotional instability (impulsivity and borderline personality traits) seem to be more reliable as clinical markers at the time being.

Missense Gamma-Aminobutyric Acid Receptor Polymorphisms Are Associated with Reaction Time, Motor Time, and Ethanol Effects in Vivo

Background: The Gamma-aminobutyric acid type A receptor (GABA-A receptor) is affected by ethanol concentrations equivalent to those reached during social drinking. At these concentrations, ethanol usually causes impairment in reaction and motor times in most, but not all, individuals. Objectives: To study the effect of GABA-A receptor variability in motor and reaction times, and the effect of low ethanol doses. Methods: Two hundred and fifty healthy subjects received one single dose of 0.5 g/Kg ethanol per os. Reaction and motor times were determined before ethanol challenge (basal), and when participants reached peak ethanol concentrations. We analyzed all common missense polymorphisms described in the 19 genes coding for the GABA-A receptor subunits by using TaqMan probes. Results: The GABRA6 rs4454083 T/C polymorphisms were related to motor times, with individuals carrying the C/C genotype having faster motor times, both, at basal and at peak ethanol concentrations. The GABRA4 rs2229940 T/T genotype was associated to faster reaction times and with lower ethanol effects, determined as the difference between basal reaction time and reaction time at peak concentrations. All these associations remained significant after correction for multiple comparisons. No significant associations were observed for the common missense SNPs GABRB3 rs12910925, GABRG2 rs211035, GABRE rs1139916, GABRP rs1063310, GABRQ rs3810651, GABRR1 rs12200969 or rs1186902, GABRR2 rs282129, and GABRR3 rs832032. Conclusions: This study provides novel information supporting a role of missense GABA-A receptor polymorphisms in reaction time, motor time and effects of low ethanol doses in vivo.

Papel de la depresión y la impulsividad en la psicopatología de la bulimia nerviosa

INTRODUCTION The study aimed to analyze the role of depression and impulsivity in the psychopathology of bulimia nervosa (BN). MATERIALS AND METHODS Seventy female patients with DSM-IV BN, purging subtype, were assessed for eating-related symptoms, body dissatisfaction, affective symptoms, impulsivity, and personality traits. Factor analysis and structural equation modeling methods were used for statistical analysis. RESULTS BN appeared as a condition which incorporated 5 general dimensions: a) binge eating and compensatory behaviours; b) restrictive eating; c) body dissatisfaction; d) dissocial personality traits; and e) a cluster of features which was called «emotional instability» The 5 obtained dimensions can be grouped into 2 basic factors: body dissatisfaction/eating behaviour and personality traits/psychopathology. The first one contains the clinical items used for the definition of BN as a clinical condition in the DSM-V and the International Classification of Diseases 10, and reflects the morphology and the severity of the eating-related symptoms. The second dimension includes a cluster of symptoms (depressive symptoms, impulsivity, and borderline, self-defeating and dissocial personality traits) which could be regarded as the «psychopathological core» of BN and may be able to condition the course and the prognosis of BN.

Blunted cortisol response to stress in patients with eating disorders: Its association to bulimic features

OBJECTIVE Clinical research on cortisol response to stress in patients with eating disorders has provided controversial and even contradictory results. As this might be the consequence of the inclusion in the studies of heterogeneous clinical populations, 3 highly selected samples were studied. METHODS Dexamethasone suppression test was performed on 15 restricting anorexia nervosa patients without history of bulimia nervosa (BN), 17 BN patients with normal weight and no history of anorexia nervosa, and 22 healthy controls. Three days later, the Trier Social Stress Test was applied, and 8 saliva samples were collected along the trial for cortisol assessment. RESULTS When the patients were considered as a single group, a slightly blunted cortisol response to stress was observed, but when the 3 groups were considered separately, the blunted response was observed only in the BN patients. DISCUSSION The results support the association between blunted cortisol response and bulimic features.

Eating Disorders as New Forms of Addiction

Eating disorders (ED) seem to share many characteristics with substance-related disorders (SRD). As very often the two conditions run together, it has been proposed that eating dysfunctions could be understood as behavioral forms of addiction. This has lead to the concept of “food addiction,” a proposed new form of addiction. This chapter reviews recent research focusing on the relationship between ED and SRD. Three specific areas are addressed: (a) animal models that suggest the association between substance dependence and compulsive overeating; (b) epidemiological studies that confirm the comorbidity between ED and SRD; and (c) neuroimaging studies that reveal the existence of modifications in the reward circuits following binge eating and other eating dysfunctions. The data from the different studies can be integrated into a model based on the consideration of “food addiction” as a specific form of behavioral addiction that could be applied at least to a group of patients suffering from eating disorders.

Contents Vol. 63, 2011

A. Drago, Naples G. Erdmann, Berlin A. Fischer, Göttingen J.M. Ford, San Francisco, Calif. S. Galderisi, Naples M. Hatzinger, Solothurn U. Hegerl, Leipzig K. Hirata, Mibu M. Kato, Osaka J. Kornhuber, Erlangen D. Lehmann, Zürich P. Monteleone, Naples G. Okugawa, Osaka G.N. Papadimitriou, Athens M. Popoli, Milano M. Reuter, Bonn F. Rösler, Marburg G. Ruigt, Oss J.K. Rybakowski, Poznan F. Schneider, Aachen R. Schwarting, Marburg M. Shigeta, Tokyo D. Souery, Brussels A. Steiger, Munich P. Willner, Swansea Associate Editors

P03-72 Utility of personality measurement in the recovery from surgery

Objectives The aim of this study was to asses the impact of different psychological and/or biological effects in the recovery from surgery. Methods The sample was composed of 42 patients waiting for a surgical intervention. Patients with cognitive impairment were removed from the sample. Prior to surgical intervention (48 to 72 hours), patients were administered the Millon Clinical Multiaxial Inventory-II (Millon, 1986) and salivary cortisol were measured 24 hours before surgery. Following surgical intervention, recovery was coded as good or poor accordingly to Moix et als criteria (1995). Dietary intake, resting and sleeping hours, as well as the existence of fever, perceived pain and related surgery complications were daily registered and controlled for. Results The cortisol values were increased in patients with high score in Histrionic Scale (t = 2.10, p = 0.043). There was a significant relation between personality, cortisol and recovery. The patients with low score in Dependent Scale (t = 2.33, p = 0.029), Histrionic Scale ( t = 2.51, p = 0.020), Alcohol Dependence Scale (t = 2.01, p = 0.049), Drug Dependence Scale (t = 2.08, p = 0.050) and cortisol show better recovery from surgery. Conclusion The results of this study indicate that psychological factors and levels of cortisol may have a critical rol in post-operatory recovery. Taking these data into account, it seems necessary to assess psychopathology on a regular basis in all the patients waiting for surgically interventions.

P01-135 Psychophatology differences between pregnant women who conceived naturally and through assisted reproduction

Objective In the past few decades, new and more efficient techniques to help solve fertility problems have become widely available throughout the developed world. The aim of this study was to determine whether there were differences on psychopathology factors between women who had conceived after in vitro fertilization (IVF) and women who had conceived naturally. Methods The sample was composed of 41 pregnant women of whom 28 women had conceived through assisted reproductive technology (IVF) and 13 had conceived naturally. Women were evaluated by week 20 of pregnancy at the Infanta Cristina University Hospital Obstetrics and Gynecology Service, in Badajoz. Women consented to complete the Symptom Checklist-90-Revised (SCL-90-R). Results IVF women were characterized by higher scores on Anxiety Scale (t = 3.90; p = 0.045) and lower scores on Hostility Scale (t = 4.35; p = 0.041) than women who had conceived naturally. There were no differences in the others scales. Conclusions IVF women appear to present a temperamental profile characterized by a tendency to anxiety. Further research is needed to firstly, confirm these preliminary findings, and secondly, to longitudinally explore its impact on pregnancy outcome and mother-infant attachment.