P. L. Cabras

Screening for binge eating disorder in obese outpatients

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielbergs State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.

Psychometric properties of EDE 12.0D in obese adult patients without binge eating disorder

The aim of the present study is to assess the psychometric properties of the Eating Disorder Examination (EDE) 12.0D in obese adult patients without Binge Eating Disorder (BED). A consecutive series of 115 obese patients without BED (23 M; 92 F), seeking treatment for obesity at the Outpatient Clinic of the Section of Metabolic Diseases and Diabetology of the University of Florence was studied using the EDE 12.0D. Patients had a mean (±SD) age of 40.8±15.1 years, and a Body Mass Index (BMI) of 36.3±5.9 Kg/m2. Interna consistency of EDE and its scales was evaluated through Cronbach’s α; factor structure o EDE 12.0D was studied with factor analysis. EDE total and Shape Concern (SC) scores were found to be higher in females than in males. EDE total, SC and Eating Concern (EC) scores were inversely correlated to age, but not BMI. Factor analysis suggested the grouping o items in two subscales. The first scale includes all the items from EC, Weight Concern (WC and SC except reaction to prescribed weighing; the second scale consists of all the items from Restraint. Data obtained show that items from EC, WC and SC all converge into the same factor analysis derived scale in obese patients without BED. EDE 12.0D provides relevant information about psychopathological features of obese patients, but a grouping o items into subscales different from those originally described could be indicated.

Venlafaxine versus fluoxetine in the treatment of atypical anorectic outpatients: a preliminary study.

The efficacy of venlafaxine and fluoxetine in the treatment of atypical anorexia nervosa (AN) was compared in a controlled trial. A consecutive series of 24 atypical anorectic females was assigned to either venlafaxine (75 mg/day) or fluoxetine (40 mg/day) plus cognitive-behavioural therapy (CBT). Eating Disorder Examination (EDE12.0D), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores were compared before and after 6 months of treatment. Venlafaxine and fluoxetine determined an increase of body mass index (BMI) and a significant reduction of EDE12.0D and BDI scores venlafaxine alone reduced STAI scores. It would seem that venlafaxine is as effective as fluoxetine when combined with CBT in the treatment of atypical AN.

Basic symptoms and negative symptoms in the light of language impairment

The Frankfurter Beschwerde-Fragebogen (FBF), assessing basic symptoms (B-S), and the Scale for the Assessment of Negative Symptoms (SANS) were administered to 30 patients satisfying DSM-III-R criteria for the diagnosis of schizophrenia. Considering the relationship between BS and negative symptoms (N-S), we identified the key role of the impairment of receptive and expressive language for the correlation of these two orders of phenomena.

Cognitive-behavioral therapy versus combined treatment with group psychoeducation and fluoxetine in bulimic outpatients.

A series of 51 female bulimic outpatients, aged 23.4±3.9, were assigned either to Cognitive-Behavioral Therapy (CBT) or combined Group Psychoeducation and Fluoxetine (GPF) treatment. The Eating Disorder Examination (EDE) was performed at the beginning o treatment and after 6 months, together with the administration of self reported question naires for depression (BDI) and Anxiety (STAI). A significant (p<0.001) reduction of the number of monthly binge episodes (from 25.0±12.9 to 6.2±3.8 and from 24.8±9.1 to 8.0±4.3) for CBT and GPF respectively were observed. Similar reductions were obtained in the number o episodes of compensatory behaviors. Both treatments reduced depression and anxiety (p<0.001) while CBT only determined a significative improvement of EDE scores. The data obtained suggest that GPF is as effective as CBT in reducing bulimic symptomatology but its long-term efficacy should be evaluated in a follow-up study.

Eating attitudes and behavior throughout the menstrual cycle in obese women: A case-control study

Premenstrual variations of eating behavior are reported in several studies, but their relationship with mood is unclear. Eating behavior and physical and psychological complaints during the menstrual cycle were studied in 107 obese patients and 93 matched controls using retrospective (Weekly Bulimic Test Edinburgh, W-BITE and Premenstrual Assessment Form, PAF) and prospective (Daily Rating Form, DR) questionnaires. Eating disorder symptoms increased in the premenstrual phase, as shown by the W-BITE scores both in patients (6.2±5.3 premenstrual week vs 4.9±4.4 postmenstrual week, p< 0.05) and in control subjects (4.9±4.1 premenstrual week vs 4.2±3.0 postmenstrual week, p<0.05) and were correlated to premenstrual complaints in control subjects (r=0.5; p<0.05) but not in obese women (r=0.2; p=NS). A close relationship between physical and psychological premenstrual disturbances was observed in obese patients only. Premenstrual variation of eating behavior could be the target of specific treatment.

A bidimensional model for diagnosis and classification of functional psychoses

Considering the major nosographies since Kraepelin, we underline the stability of the two classical functional psychoses and the difficulties in defining a satisfying classification of the intermediate forms. In an attempt to overcome the dichotomic view of the two traditional psychoses we propose a bidimensional model that is based on prototype descriptions of typical schizophrenic and affective disorders and allows the systematization of the intermediate forms. The advantages of this model are discussed with reference to therapy and prognosis and with regard to its relationship with clinical reality.