Teresa Rodríguez-Cano

Risk factors for eating disorders in adolescents. A Spanish community-based longitudinal study.

The aim of this study was to identify psychopathological, social and family variables that, measured at the age of 13, might predict the development of eating disorders 2 years later, using a standardized interview and controlling the effect of initially abnormal eating behavior. At age 13 and 15, 1076 adolescents completed questionnaires for the screening of psychiatric morbidity, abnormal eating attitudes and family dysfunction. Probable cases of eating disorders [159] and 150 controls were assessed with standardized interviews (SCAN). Controlling the effect of previous eating psychopathology, pathological body dissatisfaction, measured with the Body Shape Questionnaire (BSQ), and a negative perception of parental attitudes were predictors of eating disorders 2 years later. Self-esteem was a protective factor for body dissatisfaction. Preventive actions should focus on self-esteem as a protective factor for body dissatisfaction, a strong predictor for eating disorders. The significance of family perception should be explored more in detail in future research.

Attitudes towards change and treatment outcome in eating disorders

Objective: To investigate the influence of the stage of change on treatment outcome among patients suffering from eating disorders. Method: Sixty-seven women receiving free outpatient treatment for eating disorders initially participated in this study. Their demographic, lifetime and clinical characteristics, eating disorder symptoms and general distress were assesssed at baseline and after one year, together with the results of self-report questionnaire on Attitudes towards Change in Eating Disorders (ACTA). Results: High scores on the Maintenance subscale were protective for eating psychopathology as measured by the Eating Attitudes Test (EAT-40), Eating Disorders Inventory (EDI-2) and the frequency of purging. Action was predictive of weight changes. Precontemplation and Relapse respectively predicted little change in EAT and the Bulimic Inventory Test Edinburgh (BITE). High Preparation scores were predictive of the level of EDI-2 Interoceptive Awareness, Maturity Fears, and Ascetism. Discussion: Our results suggest considering the stage of change as a useful outcome predictor.

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.

The role of temperament and character in the outcome of depressive mood in eating disorders

OBJECTIVES The aims were to see which temperament and character dimensions were associated with depression, mainly with its outcome at two-year follow up in eating disorders (EDs). METHODS Participants (N=151) were 44 Anorexia nervosa (AN), 55 Bulimia nervosa (BN) and 52 Eating disorders not otherwise specified (EDNOS) patients. The Beck Depression Inventory (BDI), State and Trait Anxiety Inventory (STAI), Rosenberg Self Esteem Questionnaire (RSE), Eating Disorder Inventory (EDI-2) and Temperament and Character Inventory (TCI) were administered. RESULTS Depression at the beginning (t0) was severe in 22% of the cases. Harm Avoidance and Novelty Seeking had an effect on depressed mood at t0, mediated by Ineffectiveness. Responsibility (SD1) was associated with scores on the BDI at two-year follow up (β=-0.37, 95% CI -2.6, -0.6, p<0.01). CONCLUSION The evaluation of personality dimension in EDs has therapeutic and prognostic implications: To enhance self-efficacy and self-directness is crucial for good clinical outcome.

Valoración del flujo cortical cerebral mediante SPECT de perfusión cerebral en pacientes con diagnóstico de trastornos de la conducta alimentaria

Resumen Objetivo Valorar el flujo cortical cerebral mediante 99m Tc-HMPAO SPECT en pacientes con trastornos de la conducta alimentaria (TCA): anorexia restrictiva (AR) y bulimia purgativa (BP). Material y metodo Se estudiaron 7 mujeres con criterios de AR y 12 de BP. Se constituyo un grupo control de 12 mujeres sanas, realizando un estudio de SPECT cerebral con 99m Tc-HMPAO. Se obtuvieron indices semicuantitativos respecto a cerebelo en regiones frontales superiores, inferiores, parietales, temporales y occipitales. Se valoro la insatisfaccion corporal con el BSQ ( Body Shape Questionnaire ). El analisis de los datos se realizo utilizando la varianza de un factor (ANOVA), con un nivel de significacion estadistica de p Resultados Los valores medios obtenidos en el BSQ fueron de 98,28 (71-159) en el grupo de las AR, de 145,05 (73-191) en las BP y de 57,4 (37-88) en el grupo control. En sujetos normales se evidencio un predominio fisiologico de la perfusion en hemisferio derecho, mas evidente en lobulos temporales (11 %). Se evidencio una menor actividad global en todas las regiones corticales en el conjunto de los pacientes respecto al grupo control, aunque solo significacion estadistica en lobulo parietal izquierdo (p = 0,02), y lobulos temporales derecho (p = 0,004) e izquierdo (p = 0,015) en las AR, y en lobulos frontal superior derecho (p Conclusion Las pacientes con TCA mostraron una significativa hipoperfusion cortical respecto al grupo control en regiones parietotemporales, con predominio en lobulo temporal en AR y en parietal en BP. Ademas, las pacientes con BP mostraron afectacion concomitante de regiones frontales.

Assessment of cortical brain blood flood by brain perfusion spect in patients with a diagnosis of eating behavior disorders

OBJECTIVE To evaluate cortical brain blood flow by 99mTc-HMPAO SPECT in patients with Eating Disorders (ED): restrictive anorexia (RA) and purgative bulimia (PB). MATERIAL AND METHOD The study included 7 women with diagnostic criteria of RA and 12 with PB. The control group was made up of 12 healthy women. All subjects underwent brain 99mTc-HMPAO SPECT. The SPECT studies were quantified, yielding semiquantitative indexes relating to cerebellar activity in different regions. Body dissatisfaction was assessed by means of the BSQ (Body Shape Questionnaire). The results were analyzed with the ANOVA variance and had a statistical significance of p < 0.05. RESULTS Mean BSQ scores were 98.28 (range 71-159) in the RA group, 145.05 (range 73-191) in the PB group, and 57.4 (range 37-88) in the control group. All patients in the sample (i.e., both RA and PB) showed global cerebral hypoperfusion versus the controls, although the difference only reached statistical significance in the RA group in the left parietal lobe (p = 0.02) and in the right (p = 0.004) and left temporal lobes (p = 0.015). In the PB group, the significantly hypoperfused regions were the right (p < 0.001) and left (p = 0.008) superior frontal lobe, the right inferior frontal lobe (p = 0.042), the right (p = 0.042) and left (p = 0.002) parietal lobes, and the right temporal lobe (p = 0.002). CONCLUSION The results obtained showed that patients with ED had cerebral hypoperfusion compared with healthy subjects. This pattern is common in parietotemporal regions for both PB and AR although with temporal and parietal predominance in RA and PB, respectively. In addition, patients with PB had frontal region involvement.

Cross-cultural adaptation and validation of the psychometric properties of the Quality from the Patient's Perspective I Questionnaire translated into Spanish

OBJECTIVE translate the questionnaire Quality from the Patients Perspective-Intrapartal (QPP-I) into Spanish, carrying out a cross-cultural adaptation and validation of its validity and reliability DESIGN: observational multi-centre transversal study, with transcultural adaptation and validation of a scale. SETTING the study was carried out in two public Spanish hospitals. PARTICIPANTS 248 women in their postpartum period. METHODS the instrument was translated and back translated. Validity was determined in different ways: by comparing the QPP-I with an instrument which had already been validated (the COMFORTS scale); by carrying out an exploratory factor analysis by means of a principal component analysis (PCA), and by studying the relationship between the QPP-I and sociodemographic variables (level of studies, age, place of birth of the mother), clinical variables (number of children, type of childbirth, use of epidural, gestational age), positive feelings (control, pride, safety, being paid attention to) and negative feelings (failure, feeling ignored) experienced during childbirth, as well as physical and mental state as assessed by the woman. Reliability was estimated from the internal consistency, with the Cronbachs alpha (α), and the test-retest, with the intraclass correlation coefficient (ICC). FINDINGS eleven factors obtained an eigenvalue greater than the unit value in the PCA, explaining 70.5% of the total variance. A statistically significant association was found with the variables place of birth of the mother, level of studies, type of birth, positive and negative feelings during childbirth, and state of health of the mother. On comparing the QPP-I with the COMFORTS scale, the area under the received operating characteristic (ROC) curve was 0.824 (confidence interval of 95%, 0.764-0.884). For the total scale, the value of α was 0.96. The consistency ICC was 0.76 (CI 95%, 0.65-0.84) and the absolute agreement ICC was 0.76 (CI 95%, 0.66-0.84). KEY CONCLUSIONS the QPP-I with 39 items distributed among 11 factors seems adequate to measure womens satisfaction with the care received during childbirth in our setting. IMPLICATIONS FOR PRACTICE this tool can be used in both a clinical and a research setting for women to be able to evaluate the care they receive when they give birth. It is therefore a way of improving the care given to these users.

Role of dissociation in "false drug allergy".

Objective: The aim of the present study was to analyze the influence of dissociation on the “false allergy” phenomenon. Method: Fifty-five individuals (11 males and 44 females) who consecutively presented for the study of their suspected drug allergy were assessed. Results: After the challenge test, false allergy was found in 39.3% and placebo positive response in 12.5% of the patients. Seven patients (12.5%) scored above the cut-off point of 20 on the Dissociative Experiences Scale (DES), and 5 out of this group (71.4%) fit in the “false allergy” group. Pathological scores on the DES were associated with the diagnosis of “false allergy” (OR = 9.583, 95% CI = 1.002, 91.621). The effect of age, gender, and other psychopathological variables was controlled. Conclusions: High levels of dissociation might predispose to false drug allergy, which could complicate pharmacological treatment and therefore increase the patients complaints and demands for medical attention.