Incidence of eating disorders in Navarra (Spain)

Background

To estimate the overall annual incidence and age group distribution of eating disorders in a representative sample of adolescent female residents of Navarra, Spain.

Methods

We studied a representative sample of 2734 adolescent Navarran females between 13 and 22 years of age who were free of any eating disorder at the start of our study. Eighteen months into the study, we visited the established centers and the eating attitudes test (EAT-40) and eating disorder inventory (EDI) Questionnaires were administered to the entire study population. We obtained a final response of 92%. All adolescents whose EAT score was over 21 points and a randomized sample of those who scored 21 or below, were interviewed. Any person meeting the DSM-IV diagnostic criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN) or eating disorder not otherwise specified (EDNOS) was considered a case.

Results

We detected 90 new cases of eating disorders. Taking into consideration the randomly selected group whose EAT score was 21 points or below, we estimated the overall weighted incidence of eating disorders to be 4.8% (95% CI: 2.8–6.8), after 18 months of observation, in which EDNOS predominated with an incidence of 4.2% (95% CI: 2.0–6.3). The incidence of AN was 0.3% (95% CI: 0.2–0.5), while that of BN was also found to be 0.3% (95% CI: 0.2–0.5). The highest incidence was observed in the group of adolescents between 15 and 16 years of age.

Conclusions

The overall incidence of ED in a cohort of 2509 adolescents after 18 months of follow-up was 4.8% (95% CI: 2.8–6.8), with EDNOS outweighing the other diagnoses. The majority of new cases of eating disorders were diagnosed between ages 15 and 16.

Personality: a determinant in marital dissatisfaction in individuals with major depression and their couples

INTRODUCTION

Prior research suggests that some factors account for the association between marital dissatisfaction and Major Depression. We examined whether personality determines the association between marital dissatisfaction and a First Episode of Major Depression (FEMD), and whether specific personality factors are linked to marital dissatisfaction depending on the outcome of the FEMD.

METHODS

The Hamilton Rating Scale for Depression and the Dyadic Adjustment Scale were administered both at baseline (T1) and six months later (T2), at 6 outpatient settings. We counted on the participation of 59 married couples with one member fulfilling DSM-IV criteria for a FEMD, and a healthy partner. Depressed participants also completed the NEO Personality Inventory-Revised.

RESULTS

Certain personality factors mediate the association of a FEMD and Marital Dissatisfaction. “Neuroticism” mediates the association both at T1 and T2. However, the relationship between personality factors and Marital Dissatisfaction depends on the outcome of the Episode. If it has remitted by T2, personality might not be associated with marital interaction. However, if depression persists, “openness” and “conscientiousness” are related to less marital dissatisfaction.

CONCLUSION

The most important mediating personality factor between marital dissatisfaction and a First Episode of Major Depression is “neuroticism”.

[Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population]

BACKGROUND AND OBJECTIVE

To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population.

SUBJECTS AND METHOD

The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30.

RESULTS

The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained.

CONCLUSIONS

The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire.

Regional cerebral blood flow SPECT study, at rest and during Wisconsin Card Sorting Test (WCST) performance, in schizophrenia naive patients or treated with atypical neuroleptics

INTRODUCTION

To corroborate the hypothesis of hypofrontality in schizophrenia and to study the relationship between positive/negative symptoms (measured by the positive and negative syndrome scale [PANSS]) and regional cortical blood flow (rCBF), both at rest and during the Wisconsin Card Sorting Test (WCST) performance (activation).

METHODS

We compared a control group (n = 18) to a group of patients with schizophrenia (n = 21) in terms of rCBF, measured by single photon emission computed tomography (SPECT).

RESULTS

We found significantly higher left-frontal- CBF (during the WCST performance and at rest) and right-frontal-CBF (only at rest) in control subjects. Only the control group showed a right-frontal-CBF increase during activation. Only the patients group showed a significant right-occipital-CBF increase during the activation. We observed a positive significant correlation between the PANSS-P score and the left- frontal index at rest. Some negative symptoms such as difficulty in abstract thinking (N5) and lack of spontaneity and flow of conversation (N6) are associated to low frontal blood flow at rest. Affective blunting (N1) is associated to low left-frontal blood flow during activation.

CONCLUSIONS

Our data support the hypothesis of hypofrontality, at rest and during activation, which means the incapacity of schizophrenic patients to increase the frontal CBF while performing the WCST (activation). Schizophrenia positive symptoms are associated to high left-frontal blood flow.

Lymphocyte subsets and lymphokine production in patients with melancholic versus nonmelancholic depression

Several studies have reported immune changes during depression, but the results have not been fully consistent. Some of these changes could be related to the presence of melancholic features. A total of 42 depressed patients (melancholic [MEL] and nonmelancholic [non-MEL]) and 20 healthy controls participated in the study. We detected a higher CD4+ lymphocyte subset in MEL patients than in controls during the depressive state, which disappeared after clinical remission. We also found an increase in interleukin-2 (IL-2) production both in MEL and non-MEL patients, but these values did not differ from control values after clinical remission. Some of these changes may be related to the melancholic characteristics of depression.

Depression in primary care: effectiveness of venlafaxine extended-release in elderly patients; Observational study

Depression in the elderly is frequent but is often not recognized or treated as such. Few studies have assessed the effectiveness and tolerability of venlafaxine extended-release in patients over 60 years in primary care. This study aims to demonstrate the effectiveness and safety of venlafaxine extended-release in depressive disorders in this kind of population. Observational, multicenter and prospective study in an outpatient population over 60 years with depressive symptoms that needs pharmacological treatment and with a minimum score of 14 on the 17-items Hamilton rating scale for depression (HAM-D17). Effectiveness was assessed by HAM-D17. Physician's assessment of the patient's global status was also used and all the possible adverse effects were recorded. Venlafaxine extended-release was administered for 6 months at 75 mg per day dose, with the possibility of going up to 150 mg per day according to clinical criterion. Data of 1214 patients were obtained, with remission rates (HAM-D17 </= 7) in 70.2% of the patients and response rates (50% decrease in HAM-D17) of 83.2%. Global assessment of the patient's status significantly improved in each visit. After 6 months of treatment, 87.6% of the patients continued taking 75 mg per day of venlafaxine extended release. A total of 4.6% of the patients reported adverse events during the study. Venlafaxine extended-release is effective and safe for the treatment of depression in elderly patients managed by primary care physicians.

Monocytic parameters in patients with dysthymia versus major depression

BACKGROUND

The studies on monocytic function during depression are controversial. A better knowledge of affective disorders may improve the differential diagnosis of depression subtypes. Our goals are to examine if there are differences in monocytic function in patients with major depression and dysthymia.

METHOD

Twenty-two depressed patients (12 dysthymia and 10 major depression) and 15 healthy controls participated in the study. We analyzed monocyte count, monocyte subsets (CD14+, CD16+, and HLA class-II+), respiratory burst activity, phagocytic index and the interleukin (IL)-1beta, IL-6 and tumor necrosis factor (TNFalpha) production.

RESULTS

Depressed patients showed elevated IL-1beta (P<0.05) and IL-6 (P<0.01), elevated monocytic respiratory burst activity (P<0.01); and reduced surface molecule expression HLA class-II and phagocytosis (P<0.01) compared with controls. We found no differences in any monocytic parameters between dysthymia and major depression.

LIMITATIONS

The small sample size and the short wash-out reduce the reliability of the results.

CONCLUSIONS

Major depression and dysthymia show similar signs of both monocytic activation and suppression. These alterations may be due to the depressive syndrome and not to the characteristics of depression subtypes studied.

Quality of Life in 833 outpatients with major depression treated with open-label venlafaxine extended release: An observational 24-week study

BACKGROUND Quality of Life (QoL) assessments are common in medicine and, recently, in psychiatry, mostly in patients with chronic mental illness. We evaluated QoL in depressed outpatients treated with venlafaxine-XR over a period of 24 weeks. METHOD We evaluated 833 patients with DSM-IV major depression using the Hamilton Depression Rating Scale (HAM-D), the Hamilton Anxiety Rating Scale (HAM-A), the Montgomery-Åsberg Depression Rating Scale (MÅDRS), and the QoL in Depression Scale (QLDS). The patients received venlafaxine-XR and we evaluated them after 4, 8, and 24 weeks of treatment. RESULTS HAM-D scores decreased from a baseline of 24.6 &#45 6.3 to 6.0 &#45 5.5 (mean &#45 SD; P <0.0001) after 24 weeks. HAM-A scores decreased from a baseline of 32.3 &#45 7.9 to 6.8 &#45 6.8 ( P <0.0001) after 24 weeks. QLDS scores decreased from a baseline of 25.8 &#45 5.8 to 6.6 &#45 7.5 ( P <0.0001) after 24 weeks, indicating improvement in QoL. The response after 4 weeks was also significant and continued improving during the study. Venlafaxine-XR was shown to be safe and well tolerated. DISCUSSION Open-label venlafaxine-XR was safe, effective, well tolerated, and improved not only depression and anxiety symptoms, but also QoL, in outpatients with major depression. This study has the limitations of any non-randomized, non-blinded multiple-site clinical trial.

[Neuroanatomical bases of attention by means of PET-15O: the role of the prefrontal and parietal cortex in controlled processes]

AIM

The aim of this study was to investigate the changes in the cerebral blood flow that took place in normal subjects during an auditory attention paradigm which included automatic and controlled processing components.

METHOD

Participants consisted in 10 normal subjects who were submitted to medical, neuropsychological and neuroimaging evaluation. PET was used to carry out an exploration of each subject in the four experimental conditions: basal, listening to clicks (A), counting while listening to clicks (C+A) and counting without listening to clicks (C).

RESULTS

During the condition involving counting while listening to clicks (automatic processing) the subjects displayed a significant increase in the activation of the bilateral precentral convolutions, left dorsolateral prefrontal cortex (DLPFC), left inferior and superior frontal convolutions, left supplementary motor area and the left superior and inferior temporal convolution. During the condition involving counting without listening to clicks (controlled processing), the subjects activated the right precentral convolution, bilateral DLPFC, the right supplementary motor area, anterior cingulate and right inferior parietal convolution.

DISCUSSION

The results obtained support the suggestion that regions such as the DLPFC and the inferior parietal convolution play a part in attentional tasks in which the subject is required to make an effort to carry out the controlled processing of information.

Self-esteem, personality, and eating disorders: baseline assessment of a prospective population-based cohort

OBJECTIVE

To study the relationship of self-esteem and personality factors with eating disorders (ED).

METHODS

A region-wide representative sample of 2862 girls 12-21 years old from Navarre (Spain) participated in the baseline assessment of a prospective study. A two-stage procedure was used, consisting in a first screening phase followed by a psychiatrist interview (DSM-IV criteria). Multivariable logistic regression models were used to examine the association of self-esteem (36-item scale) and personality characteristics (Eysenck inventory) with psychiatrist-diagnosed ED while controlling for potential confounders.

RESULTS

Strong associations for ED were found with low self-esteem (adjusted odds ratio [adjOR] for the lowest quartile: 7.98, 95% CI: 3.4-18.8) and high levels of neuroticism (adjOR for the highest quartile: 9.49, 95% Cl: 3.7-24.5).

DISCUSSION

Our results, although based on a cross-sectional design, support the potential role of neuroticism and low self-esteem in the onset of ED.

Differences in interleukins' patterns between dysthymia and major depression

We assessed whether cytokine production-interleukin (IL)-1beta, IL-6 and tumour necrosis factor-alpha (TNFalpha)-is affected in depressed patients, dysthymia (Dt) and major depression (MD), and its association with various parameters of severity and clinical course. We found a possible different pattern of interleukin production between Dt and MD.

The development and validation of a Spanish version of the quality of life in depression scale (QLDS)

OBJECTIVE

The adaptation of the Quality of Life in Depression Scale, the QLDS, into Spanish.

METHODS

The original UK version of the QLDS was considered by two translation panels, who produced a Spanish translation. Priority was given to conceptual rather than semantic equivalence. This version was then field-tested with 15 depressed patients. The final stage of the research involved a postal survey of 62 patients, who were asked to complete the measure on two occasions.

RESULTS

The Spanish QLDS was found to be appropriate and acceptable by depressed patients. The questionnaire's test-retest reliability and internal consistency were both high, and QLDS scores correlated as predicted with scores on sections of the Nottingham Health Profile. The measure was sensitive to different levels of depression as assessed by the Hospital Anxiety and Depression Scale.

CONCLUSION

The Spanish version of the QLDS is suitable for use in clinical trials and for monitoring individual patients in routine clinical practice.

Perceived quality of life in depression: Effect of clinical and demographic variables

The objective of the study was the evaluation of the influence of various clinical and sociodemographic factors on the perception of quality of life in 141 patients with depression (CIE-10). We used a multivariate analysis of logistic regression to predict lower quality of life and well-being. The best predictive variables for quality of life were the Hamilton Rating Scale for Depression (HAM-D) score, the number of episodes, personality disorder and gender. For well-being, the best predictive variables were HAM-D score, type of family environment, Hamilton Rating Scale for Anxiety (HAM-A) score, educational level and marital status. We conclude that the severity of the symptoms is the main factor influencing the appraisal of the quality of life, while sociodemographic variables play a more limited role.

Neuroendocrine and immunological functions in depressed patients: a follow-up study

The development, evaluation and use of biological markers with a diagnostic purpose in psychiatry is extremely important. However, with certain exceptions, truly sensitive and specific markers have not yet emerged. In order to investigate the relationship between the immune apparatus and the hypothalamic-pituitary activity on the one hand, and the psychopathological state of the patients on the other, we used a longitudinal design and assessed monocyte parameters (HLA-DR, CD 35, vimentin filaments, and phagocytosis index) and neuroendocrine tests (dexamethasone suppression test [DST] and thyrotropin-releasing hormone [TRH] stimulation test) at intake and at follow-up in 49 depressed patients. Immunological parameters were compared with neuroendocrine tests in both phases of the study. The combined use of both immunological and neuroendocrine tests did not add sensitivity to the immunological identification of depressed patients. The findings lead us to consider the role of the monocyte parameters as sensitive depressive state markers, while the combined use of both neuroendocrine and immunological tests in current clinical practice would be debatable.