Introduction

Few studies have involved patients with binge eating disorder (BED) regarding the social cognition ability, in particular in the metacognition functioning. No studies have investigated the relationship between negative urgency and metacognition functioning in BED patients.

Objectives

The aim of the present study was to test a model where low self-monitoring (a sub-function of first-person domain of metacognition) and high negative urgency lead to a higher binge severity through the mediation of high level of emotional dysregulation.

Methods

Eighty-six obese participants (46 BED and 40 non-BED) completed self-report questionnaires. To test our hypothesized model, a structural equation model using maximum likelihood estimation was run.

Results

Regarding the psychopathological scales, BED-obese patients had significantly higher scores in binge eating severity, Negative urgency, emotional dysregulation and metacognition self-monitoring while there were no differences in the metacognition others-monitoring subscale. The structural model demonstrated very good fit (c²= 1.377, df= 2; P= .502, CMIN/DF=.688, CFI=1.000, RMSEA=.000, TLI=1.047) and all paths were significant in the predicted directions.

Conclusions

According to our data, BED patients showed low self-monitoring and high negative urgency that lead them to express higher binge severity through the mediation of high level of emotional dysregulation. These preliminary findings can be useful for further research to understand the etiopathogenetic process of BED. This could be helpful in the clinical practice in order to develop a tailor-made treatment for the patient, in particular psychotherapeutic treatment with Metacognitive Interpersonal Therapy, which has never been used in BED patients.

Introduction

Eating disorders are one of the most difficult psychiatric illness to manage with a high mortality rate due to organic complications. Avoidant /restrictive food intake disorder (ARFID) is one of these eating disorders that has recently been described in DSM-5. This disorder is more characteristic in children, but we need to have in our minds also in the adult’s population.

Objectives

We reported a case of a 26 years old man who was admitted in internal medicine for fever, deafness, dermatitis and distal sensory polyneuropathy. During this admission was necessary to examine the patient because these symptoms are related to his diet

Methods

Review of the clinical case and literature.

Results

At the beginning of admission the doctors thought that the patient had a metabolic disease and a complete study of these diseases was carried out. In addition, they requested a psychiatric evaluation because during this process they realized that he did not eat the hospital food. The patient has not any previous psychiatry history. He did not report any symptoms or problems with the diet. When we interviewed the family, they said that he only eats chips, apples and churros for years. Besides, they describe many difficulties to introduce meals since he was young. The patient throughout the admission was progressively improving with the introduction of some foods and nutritional supplements.

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Conclusions

It is important to record adult feeding routines for a complete approach to their dangerous consequences. And the importance of liaison psychiatry in hospitals to work as a multidisciplinary team

Introduction

Assessing the quality of life of patients with various mental disorders allows us to identify the greatest risks of the disease, therefore, choose the best methods for its treatment and rehabilitation. For patients with eating disorders, many questions about their quality of life remain open.

Objectives

To establish quality of life parameters for patients with eating disorders, this study was conducted.

Methods

The study of 130 female patients with Anorexia nervosa (AN), and bulimia nervosa (BN) at the age of 13-44 years (average age is 18). The disease duration from 6 months to 24 years. Non-specific questionnaire to assess life quality, created on the basis of the WHO methodology (SF-36).

Results

The following regularities of the evaluation of physical (PH) and psychological (MH) health components are established. The reduced PH value is identified in 26,92% of patients; the average PH value in 65,38% of patients; the increased PH value in 7,69% of patients. The low MH value is identified in 26,92% of patients; the reduced MH value in 53,08% of patients; the average MH value in 20% of patients. High value of life quality on physical and psychological components is not registered.

Conclusions

AN and BN are associated with a low quality of life for patients in the field of physical and mental health, as well as with poor social functioning. These data confirm the thesis about the need for timely and active treatment and rehabilitation measures in relation to this patient population.

Introduction

Anorexia nervosa is a widespread disease that occurs more often in adolescence and adolescence. Anorexic syndrome can be observed in schizophrenia and schizophrenic spectrum disorders.

Objectives

To describe the manifestations and identify patterns of anorectic symptoms in pseudopsychopathic schizophrenia and schizotypal disorder.

Methods

200 patients with anorexia nervosa (150 women and 50 men), mainly of adolescent and youthful age, were comprehensively studied. The Research Methods: clinical-and-psychopathological, catamnestic, psychometric and statistical methods.

Results

Along with symptoms of anorexia nervosa, schizotypic disorder was revealed in 115 patients, and pseudopsychopathic schizophrenia was revealed in 85 patients. Anorexia nervosa was a manifest syndrome of the underlying disease in 80% of patients; anorexia syndrome appeared with pre-existing manifestations of schizotypal disorder and pseudopsychopathic schizophrenia in 20% of patients. The patients had delusional beliefs of having excess weight. The motives for weight loss were not considered dysmorfofobic, but rather delusional hypochondriac or nonsensical ideas of self-improvement. The negative manifestations of the underlying disease increased relatively slowly. Doses of antipsychotic medications depended not only on the clinical presentation of the underlying disease, but also on the degree of exhaustion due to anorectic behavior.

Conclusions

Anorexia nervosa syndrome is more often manifest in schizotypal disorder and pseudopsychopathic schizophrenia. Anorexic symptoms differ polymorphism and undergoes typical dynamics of the underlying disease.

Introduction

In the last decades, interest has grown for a clinical condition called Orthorexia Nervosa (ON), firstly described by Steven Bratman in 1997.

Objectives

The aim of our work is to review current knowledge on this controversial condition, with focus on its definition, diagnostic criteria, psychometric scales and treatment, and a discussion about limitations of the concept and needs for future investigation.

Methods

Non-systematic review of literature, through search on the PubMed electronic database for publications up to 2019, following the terms “orthorexia” and “orthorexia nervosa”.

Results

The term “orthorexia” has its origin on the Greek orthos ("correct") and orexis ("appetite"). ON describes a pathological obsession with healthy nutrition, that is characterized by a restrictive diet, ritualized patterns of eating, and rigid avoidance of foods believed to be unhealthy. This condition may have a significant emotional and functional impact, leading to nutritional deficiencies, medical complications and a poor quality of life. Despite being described in many scientific publications, it is not yet recognized as a psychiatric disorder in the International Classification of Diseases or the Diagnostic and Statistic Manual of Mental Disorders (DSM-5). There is still a lack of consensus in its definition, diagnostic criteria and treatment.

Conclusions

The existing literature on ON is limited and very heterogeneous. One of the main challenges is to establish a limit between normal and pathological “healthy eating” behaviours. Future investigation is crucial for a better understanding of this (possible) new eating disorder.

Introduction

Binge eating disorder (BED) is frequently associated with obesity. Available treatments have shown low response rate and high relapse. The new combination of naltrexone and bupropion sustained release (NB) acts on the systems at the basis of food intake regulation (the hypothalamic and reward circuits) by reducing hunger and appetite.

Objectives

The aim of this study was to evaluate the efficacy of NB in losing weight and improving pathological eating behaviour among patients with BED

Methods

Overall, 41 obese patients with and without BED (Groups 1 and 2, respectively) who had previously undergone at least five weight-loss programmes without success were treated with NB in addition to a reduced-calorie diet and physical activity. Evaluation at t0 and after 16 weeks of treatment (t1) included anthropometric measurement, eating behaviour assessment and psychopathological questionnaires (EDE-Q, BES, YFAS, BDI and STAI).

Results

Significant weight loss was evident (p < 0.001) in both groups. Average weight loss was > 7%. Pathological eating behaviour (i.e. binge, grazing, craving for carbohydrates, post-dinner eating and hyperphagia) improved significantly, especially among patients with BED. The BES score and YFAS severity decreased significantly at t1 (p < 0.01) for BED patients.

Conclusions

Treatment with NB, in addition to a reduced-calorie diet and increased physical activity, is an effective and well-tolerated option for losing weight and improving pathological eating behaviour in obese patients with BED.

Introduction

Coprophagia is a relatively rare phenomenon characterized by the ingestion of feces, and it is usually classified as a rare form of pica. It has been associated with multiple organic causes or mental disorders such as brain tumors, alcoholism, mental retardation, dementia, schizophrenia, depressive disorders or fetishism.

Objectives

Case report and reflection on its etiology.

Methods

A Pubmed search was performed with the MeSH terms “Coprophagy” and “pica”. Relevant articles obtained from the respective bibliographic references were also consulted.

Results

A 56-year-old man with a history of psychiatric follow-up with a diagnosis of schizophrenia and cognitive impairment, assessed for behavioral changes such as cat feces intake. After possible organic causes were excluded, treatment with supportive psychotherapy and pharmacologically began with a selective serotonin reuptake inhibitor, fluoxetine, along with treatment for schizophrenia with haloperidol and risperidone.

Conclusions

According to literature, coprophagia often occurs associated with other medical or neuropsychiatric conditions. Although the etiology, pathophysiology and management remains unclear, several pharmacologic treatments have been attempted with some degree of success. We describe a case of unusual behavior, coprophagia, associated with cognitive impairment and schizophrenia that responded favorably to fluoxetine although without complete remission, in order to contribute to a future nosological redefinition.

Introduction

In bariatric surgery outpatient population, Binge Eating Disorder (BED) has high prevalence and impact on long term post-surgical outcome.

Objectives

The aims of our study were : validate the French version of the Binge Eating Scale (BES) and evaluate it as a screening tool for BED in this population.

Methods

Between 2016 and 2017, 274 adult outpatients at the Claude-Bernard-Bichat Hospital in Paris were included in the context of a prospective screening, 145 (52,9%) were first-time candidates to a bariatric surgery and 129 (47,1%) had already undergone surgery. Non-inclusion criteria were : age <18, bad command of French language and refusal to join the study. We tested the construct validity of the BES whose correlation with Bulimic Investigatory Test of Edinburgh (BITE) and Hospital Anxiety and Depression scale (HAD). Diagnosis of BES was established by an interview assessing DSM 5 criteria. ROC curve was used to determine BES screening quality of the BED.

Results

Of the 274 patients, 22 (8.0%) had a BED, there were 222 (81.0%) women and the mean age was 42.3 +/- 12.6 years. The BES had a one-dimensional structure, good internal consistency (α = 0.87) and was strongly correlated with BITE symptom score (r = 0.75, p <0.001), depression (r = 0.50, p <0.001) and anxiety score (r = 0.39, p <0.001). For a score> 17, we found a VPP of 0.99 and a VPN of 0.22.

Conclusions

The french version of the BES appears as a valid and reliable scale and a very good screening tool for BED in the context of bariatric surgery.

Introduction

Eating disorders (ED) present low diagnosis stability based on current diagnostic classifications. That’s why, transdiagnosis approach and endophenothype concept take relevance.

Objectives

The aim of the present study was to perform a descriptive analysis of neuropsychological variables, which could be related, considering demographical and psychopathological aspects.

Methods

A descriptive analyse was performed with 81 female patients with ED between 18-50 years old. Socio-demographical, clinical and neuropsychological variables were collected.

Results

From the 81 initially included patients, 7 did not meet some of the inclusion criteria and 24 were lost during the follow-up. The sample was reduced to 51 patients. The Rey Complex Figure Test (ROCFT) analysis yielded the following results: Copy time: mean (M) 2.94 (standar deviation, SD 1.12), Copy: M 34.28 (SD 2.76), Memory: M 19.47 (SD 6.02), Order: M 2.14 (SD 0.73), Style: M 1.54 (SD 0.32), Coherence: M 1.42 (SD 0.34).

Conclusions

Time of ROCTF copy was found in the 50th percentile. The accuracy and richness of the copy were on average in the 80th percentile, due to the perfectionism patients’ tendency. However, in the memory figure, the mean was in the 40th percentile with greater variability. Probably, because of fact that 27% of the patients developed it with an unusual pattern in order to their age, similar found in others studies that highlighted deficiencies in central coherence.

The global analysis of the sample, only show promising results regarding executive functions, especially central coherence, congruent with those expected and found in previous studies.

Introduction

The overlap between autism spectrum disorders (ASD) and eating disorders (ED) has been studied for years, finding similarities in certain cognitive characteristics.

Objectives

The aim of this study is to analyze the available literature about the relationship between autism spectrum symptoms with different pathologies which are include in eating disorders.

Methods

Information was collected from different databases (Pubmed, Cochrane, Tripdatabase, UpToDate) between 2013 and 2018. Descriptors as "eating disorders", "autism", "treatment", "psychotherapy", "anorexia nervosa”, are used. "Bulimia nervosa", "food avoidant / restriction intake disorder", "binge eating disorder", "obesity" and "adolescence" and the same ones in Spanish are used

Results

The published studies, referred throughout the text, mainly refer to anorexia nervosa (AN) with less research in others eating disorders such as obesity, bulimia, and binge eating disorder.

Conclusions

However, despite of the fact that the relationship with the AN is especially mentioned, there are cognitive characteristics that are shared between the ED and the ASD that must be taken into account due to their implications, not only in treatment, also in the prognosis.

Introduction

Decreased pain sensitivity has been reported in anorexia (AN) and bulimia nervosa (BN), but data are scarce and inconclusive. Biological variables seem to play a causal role but subjective psychological features need to be addressed as underlying factors. Body image distortion, dissociative symptoms, emotional suppression have been investigated as putative causal factors but interoceptive awareness (IA) needs depeening. Moreover, a crucial effect of metacognition capabilities in detecting, monitoring and discriminating external-internal pain stimuli could be hypothesized.Finally, a comprehensive evaluation of pain perception in other eating disorders (EDs) subgroups is still missing.

Objectives

The study aims at: 1) comparing pain perception in EDs by means of self-report questionnaires and experimental stimulation of pain; and 2) assessing the relationship between pain perception, IA and metacognition in a sample of patients with EDs (DSM-5) or obesity.

Methods

Psychological, psychiatric, neuropathic and nociceptive pain perception assessments of 100 patients with AN, BN, BED and obesity were done.

Results

Low and similar scores in pain perception are evident for all ED subgroups. Linear regression analysis shows the association between nociceptive pain and depression, interoceptive awareness and alexithymia (TAS20 glob). Instead, neuropathic pain is associated with emotional regulation, metacognitive functioning and anxiety.

Conclusions

Patients with EDs have a low and similar perception of nociceptive and neuropathic pain. Weight does not affect pain perception. Enteroceptive awareness and metacognition dimensions are associated to pain perception in ED patients.

Introduction

Study wants explore, through rorschach test, with Exner method, salient statistical variables

Objectives

useful to differentiate and compare different DCA in comorbidity with obesity, but also to outline clearly a plan for diagnosis, intervention and prognosis, more functional to possible bariatric surgery; in line whit the guidelines of SICOB.

Methods

Within a larger sample of afferent at the psychodiagnostic and neuropsychological clinic , and obesity surgery of AOU Federico II of Naples, the study was conduced on a selection of 70 subjects, suffering from severe obesity and associated eating disorder.For exploratory purposes, of assesment was considered only rorschach test, according to the Exner methodology.

Results

Data emerged from study of structural summaries and constellations , shows:

Conclusions

coping style characterized by intense emotional fluctuations, which interfere with the activity of thought, attention and concentration in decision-making processes (M=0 WSumC>3,5) and therefore oriented for 55% of subjects to extratension and for the rest to ambitendency (M= WSumC)

Low suicidal risk (S-CON <8)

general poor ability to make decision and carry out actions aimed at dealing with internal or external demands, associated with organizations of unripe personalities, with a tendency to avoid complex situations and poorly capable of interpersonal relations (D<0 ; Adj.D -1 ; CDI>3; Lambda>0.99)

elevation of key variable CDI (>3) indicate possible social incompetence, interpersonal problems and ineffective coping;

DEPI (>5) indicates a depressive trend and a greater clinical interest in affective area;

DEPI & CDI , with activated simultaneously indicate the presence of mood disorder related to interpersonal relationships and general demoralization.

Introduction

Young ultra-Orthodox women in Israel have been faced in recent years with a greater risk of developing disordered eating, as they are more exposed to Westernized norms of the thin-body ideal, self-realization, and personal choice. Most are treated by mainstream Israeli psychotherapists who likely have different value systems and different perspectives on the nature of illness, aims of treatment, and recovery. Ultra-Orthodox psychotherapists may well experience a conflict between a need to be loyal to their patients and a concomitant need to honor the values of patients’ families and the community from which they come.

Objectives

The current article presents a theoretical background and four case studies highlighting the complexities and controversies inherent in the treatment of these women.

Methods

Theoretical background and four case studies highlighting the complexities and controversies treating these women.

Results

The description of the four cases suggests that young Ultraorthodox Jewish women may develop disordered eating because of conflicts that are specific to their own society, but that may simultaneously result from their growing exposure to mainstream Israeli Westernized norms. Solution of these conflicts may assist in improving the disordered eating symptoms, yet put these young women in a dispute with their families and their community at large.

Conclusions

Both ultraorthodox and secular psychotherapists treating Jewish Ultraorthodox women with disordered eating must be knowledgeable in both Judaism and psychology. They must also be flexible, creative, and emphatic to both the patient and her family and community, to arrive at a compromised definition of recovery that can be accepted by all parties concerned.

Introduction

In México obesity rates have been increasing in the last years. Food addiction (FA) has been considered a factor that could explain processes or behaviors associated with obesity.

Objectives

The aim of this study was the identification of risk patterns of FA and it association with other variables in healthy Mexican population.

Methods

We hypothesized that a higher risk of FA will be higher levels of impulsivity, emotion dysregulation, and emotional and external eating styles. The sample consisted of 81 female (61) and male (20) volunteers universitary students from Pachuca city in México, with an average age of 20.0 years old (SD = 1,7). The questionnaires EDI-2, YFAS 2.0, DERS, UPPS-P, and DEBQ were applied.

Results

Figure 1: Radar-chart (z-standardized means are plotted) (n=81)

Three groups were defined by the FA severity (Figure 1). The presence of FA was more strongly associated to higher scores in the three DEBQ scales, in the DERS impulse control, emotion regulation and total score, and in the UPPS-P lack of premeditation and negative urgency. Compared with the group without FA, the FA-probable scoring was related to higher levels in the DEBQ external and restrained scales, and in the DERS total; FA-probable group also registered the highest mean score in the DERS non acceptance scale compared with the other groups.

Conclusions

To our knowledge, this is the first study that explores FA in Mexican population. Considering that, the identification of different patterns of FA that could be associated with obesity, could lead to better prevention and treatment approaches.

Introduction

Avoidant Restrictive Food Intake Disorders (ARFID) are included as a category of eating disorders with a prevalence of 3 to 14% in child-youth population.
The difference of these patients is that their behavior is not mediated by fear of how much they weigh or how they look. Within this diagnostic category, described as a new diagnosis in DSM V, different clinical forms are characterized.

Objectives

Through this work, the characteristics that differentiate each clinical form are exposed through different clinical cases of the usual practice.

Methods

A bibliographic review of the ARFID using Pubmed and MeshDatabase is done. Child-youth clinical records are reviewed to describe characteristic clinical profiles.

Results

Available evidence demonstrates that ARFID is a real, identifiable and heterogeneous problem that shares some commonalities with classic eating disorders; although, core psycopathology is clearly distinct.
Three clinical profiles are described: 1. Sensory sensitivity (difficulty in the introduction of novel foods or textures), 2. Lack of interest in eating (filling up quickly), 3. Fear of aversive consequences of eating (fear swallowing, vomiting or allergies, often with a traumatic history).
Once this food avoidance pattern is established; It can be maintained in the long term with consequences as important as malnutrition at an early age.

Conclusions

The diagnosis of ARFID aims to provide a diagnostic entity to those patients who have a food restriction but do not meet criteria for traditionally described eating disorders that were previously classified as unspecified.
An adequate clinical differentiation will allow to define specific treatment protocols to modify this behavior pattern.

Introduction

As a requirement for a bariatric surgery, a multidisciplinary team must explore and evaluate each patient in order to ensure that candidate has not any psichopatological condition or a low knowledge or motivation that became a contraindication.

Objectives

The purpose of this study is to know if the motivation index built from ACTA subscales is an adecuate tool to evaluate potential bariatric surgery patients

Methods

This is a restrospective observational study. All patients evaluated for bariatric surgery were revised and two comparation groups were conformed. One with approved patients and other with rejected ones.

We compared the different values of test applied and we built a motivation index using the ACTA subscales in order to find if it was able to discriminate between both groups. The motivation index can be obtained adding the action plus the mantainance score and deducting the contemplation and the precontemplation scores. The comparison between groups was done using a t-test.

Results

145 patients were evaluated for bariatric surgery, ranging in age from 26 to 64 years with a mean age of 44,88 +/- 9,53. From those, 104 were aproved for this surgery, while 41 were denied.

The motivation index mean in the aproved group was 26,28 while it was 12,80 in the denied group. This differences is statistically significant (p>0'001)

Conclusions

The motivation index has a lower score in patients that have been denied to surgery, regardless of other patients' diagnoses.

Introduction

Medical education is intended to give future professionals knowledge about health care, which can be applied to them as well. How justified are expectations concerning eating behavior?

Objectives

The research goal is to explore prevalence, intensity and interconnections of disordered eating behavior manifestations in junior medical students.

Methods

Using the Eating Disorder Inventory (EDI) and Skugarevsky & Sivukha’s Body image questionnaire, we surveyed 101 male and female 1-2 year medical students (mean age 19.9).

Results

Every second student out of three (66.3%) showed medium or high level of drive for thinness, every second (48.5%) revealed signs of bulimia, with all the surveyed demonstrating dissatisfaction with their body. High level of drive for thinness and bulimia was noted in every tenth (9.9%) and every sixth (18.8%) accordingly. All of them were female. Every third of the surveyed students (31.6%) showed also a high level of perfectionism, every second (56.4%) – interpersonal distrust, every sixth (17.8%) – interoceptive awareness. Every third revealed a high level of dissatisfaction with their appearance (34.6%), every second showed a medium level of such dissatisfaction (48.5%). At the same time, body image dissatisfaction directly correlated with drive for thinness (p<0.05) and bulimia (p<0.05).

Conclusions

Medical students, more often females, have higher risks of developing eating behavior disorders. Trying to comply with the imposed standards of successfulness and beauty, being dissatisfied with their body image, they attempt at strict control of their meals. Knowledge of medicine acquired in their first two years of study does not always prevent this.

Introduction

Childhood adverse experience (ACEs) are stressful life events occurring during childhood that have lifelong impact on adulthood mental health. Moreover, emotional and physical abuse or neglect are thought to influence emotion regulation acquisition. Individuals with binge eating disorders (BED) report high levels of emotional abuse and binge episodes have already been associated with dysfunctional emotion regulation strategies. To the best of our knowledge, the association between ACEs, emotion regulation strategies and the severity of BED has not yet been deepened.

Objectives

The aim is to test two hypothesis: 1) individuals with BED report greater frequency of ACEs when compared to controls; 2) ACEs are highly correlated with emotion regulation strategies.

Methods

Sixty-five individuals with obesity, seeking for a weight loss program, were assessed for BED diagnosis, binge eating severity (BES), ACEs (CTQ) and emotion regulation (DERS). The final sample was constituted of 33 obese patients with BED and 32 obese non-BED as controls.

Results

BED-obese patients reported significantly higher rates of emotional abuse and emotion regulation impairment when compared to non-BED obese controls. Several ACEs were correlated with emotion regulation global impairment, less clarity of emotions and goal directed behaviors.

Conclusions

Subjects with BED refer more emotional abuse during childhood. Emotional abuse, together with other ACEs, are associated with proper emotion regulation acquisition. Nonetheless, given the cross-sectional design of the study, longitudinal data are needed to infer causality or directionality of this relation.

Introduction

Body mass index (BMI), in overweight and obese individuals, have been associated with sedentary habits, unhealthy use of internet, eating disturbances, sleep difficulties, and psychological distress.

Objectives

To investigate the association between BMI and internet use patterns and problematic use, eating disturbances, sleep difficulties, and psychological distress among Portuguese university students

Methods

456 students (76.9% females; mean±SD age=20.30±1.90 years old) fulfilled a questionnaire that include questions on sociodemographic data, internet use patterns, eating habits during internet use, the Portuguese version of the Generalized Problematic Interne Use Scale 2 (GPIU), the Eating Attitudes Test 25, the Depression, Anxiety, Stress Scale 21, and the Basic Scale on Insomnia Complaints and Quality of Sleep (BaSIQS).

Results

BMI mean score was of 22.01 (SD=2.91, range 15-35), underweight were 6.1%, normal weight 81.1%, overweight 10.7% and obese 2%. Significant correlations were found between BMI and individual’s perception that online activity’s impair the quality of their interpersonal relationships (r=.104, p<.05), consume of sweet/salty/ starchy foods during online activity´s (r=.107, p<.05), global eating disturbances (r=.174, p<.01), diet concerns (r=.301, p<.01), bulimic behaviours (r=.204, p<.01), social pressure to eat (r=-.430, p<.01), psychological distress (r=.114, p<.05), stress (r=.101, p<.05), anxiety (r=.128, p<.01). None of the GPIU and BaSIQS total and dimensions scores were significantly related to BMI.

Conclusions

The results do not support the association between students BMI and internet use patterns and problematic use. The kind of food consumed during online activity´s, eating disturbances and psychological distress should be addressed by intervention strategies for overweight students.

Introduction

Hereditary alcoholism of parents was noted in 29% of patients. Regular alcohol abuse was rather normative in 71% of patients’ fathers, while being raised with an insufficient father role model (61% of patients with ED).

Objectives

The aim of the study was to investigate the role of alcoholism in the formation of eating disorders.

Methods

The etiological role of parental alcohol abuse in the development of ED has also been confirmed by the analysis of the terms of conception and duration of pregnancy in mothers of the patients.

Results

There was found a statistically significant (p < 0.01) prevalence of conception periods attributable to culture-mediated periods of mass alcoholism in Russia: a decade of New Year celebrations as well as the period of summer holidays. The prevalence of alcoholism among patients in the study group was 13% (16 cases) with a catamnestic follow-up duration of more than 5 years, while the prevalence of alcoholism in patients with bulimia nervosa was 3.2 times greater than that of anorexia nervosa.

Conclusions

The patients’ subjectively marked change in the attitude towards alcohol intake is noteworthy: with prolonged restriction in food and low body weight, more than half of patients noted the appearance of cravings for alcohol, while before the onset of the disease, anorexia nervosa and bulimia 92 (77%) patients experienced a neutral or negative attitude towards alcohol, felt unpleasant consequences when taking even small doses of low-alcohol drinks, noted "body intolerance to alcohol".

The publication was prepared with the support of the “RUDN University Program 5-100”

Introduction

120 patients were divided into 3 groups: 1) with frequent psychogenic vomiting; (ICD-10 F50.5 n=30) 2) with severe depletion due to the prolonged persistent refusal of food with episodes of induced vomiting to lose weight (ICD-10 F50.0 n=40) 3) with Bulimia Nervosa (F50.2 n=50).

Objectives

The aim was to assess the functional state of catecholamine system patients with ED.

Methods

The high-performance liquid chromatography was used.

Results

Laboratory studies have identified a marked reduction in the number of excreted free catecholamines in patient’s groups 1 and 2 (noradrenaline 0.8 ± 0.1 ng/min; adrenaline 0.5 ± 0.1 ng/min; dopamine 10.1 ± 0.26ng/min), that coincided with the indicators of severe asthenic depression.

In the third group, there was a marked increase in dopamine excretion (1147.8 ± 189 ng/min) during the period coinciding with the withdrawal in varying circumstances, that reached normal levels by the twentieth day of treatment (169.5 ± 7.5 ng/min). The normalization of the aforementioned marker confirms adherence to dietary plans, which is diagnostically relevant in the cases of dissimulation and obstinate attempts to continue binge-eating and purging.

Conclusions

The obtained data also indicates the active participation of catecholaminergic systems of the brain and its midline structures in the formation of the ED.

The publication was prepared with the support of the “RUDN University Program 5-100”

Introduction

The seventh art has helped Psychiatry in different ways throughout its history. First to train their professionals through productions specific to them and restricted to the field of training. Then in the field of psychoeducation of patients, starting to use parts of commercial films. Subsequently, therapists have used some sequences in psychotherapy and group sessions, to point out certain topics and emotions. Now some psychotherapeutic groups focus on the group viewing of a complete film as an emotion catalyst experience.

Objectives

Review of the available bibliography and describe the group cinematherapy program that takes place at the Day Hospital for patients with eating disorders at the Mostoles University Hospital in Madrid.

Methods

Bibliographic search on PUBMED and EMBASE databases with the following terms: "motion pictures"[mesh] and "mental health/therapy"[mesh]. Description of our program.

Results

18 results were found on bibliographical research, 2 of them on Eating Disorders.

In practice, the use of an external story allows the patient to project in a character their own narrative. That makes easier to explore feelings and relations. We experienced that the metaphors that are worked in the cinematherapy group are used in other settings of therapy. The group also strengthens the link between patients and therapists by being a more relaxed space in which the film acts as an intermediary in therapy.

Conclusions

Cinematherapy groups are useful in working with patients with eating disorders at the day hospital. Further investigation is required to measure the impact of cinematherapy groups on eating disorders symptoms.

Introduction

The hormonal and physiological changes that occur during pregnancy, influence the diet of the pregnant woman

Objectives

Identify pregnant women at risk of developing eating disorders (ED).

Methods

This is a cross-sectional descriptive study conducted at the consultation of the gynecology and obstetrics department University Hospital Center among 62 pregnant women. We used an information sheet on participants' socio-demographic and clinical data as well as the Sick, Control, One Stone, Fat, Food Screening (SCOFF) questionnaire to screen for the potential presence of ED.

Results

The average age of the participants was 29.7 years old. In our study, 29% had a positive SCOFF score before pregnancy. During pregnancy, this score was positive in 43.5% of women with no significant difference. The question of getting sick when feeling full, and question number 2 about the loss of control over the amount of food consumed were the most cited items. We found a low rate of positive response to item3 regarding weight loss since pregnancy. Mean weight and BMI, before pregnancy, were higher in women at risk for eating disorder. The maximum weight variation since pregnancy was not significantly significant between the two groups. The ED was correlated with the absence of professional activity (p = 0.02). There is no significant difference concerning pregnancy complications (p = 0.1). The number of female smokers was higher among women at risk for ED both before and since pregnancy, but this difference was not significant (p = 0.1).

Conclusions

Several physiological and psychological factors contribute to the appearance of ED.

Introduction

Diabulimia is a media-coined term that refers to an eating disorder in a person with diabetes, typically type I diabetes, wherein the person purposefully restricts insulin in order to lose weight. Treatment can be challenging and regimens must address both the diabetes and eating disorder aspects of the disorder.

Objectives

We analyze the difficulties that arise in the management of both concomitant disorders regarding a clinical case: 27-year-old woman with a diagnosis of borderline personality disorder, eating behavior disorder and type 1 diabetes, who comes on many occasions to the emergency department within a week with hyperglycemia secondary to binge eating and refusal to administer and control insulin.

Methods

Clinical case analysis, online bibliographic search

Results

Involuntary hospital admission was proposed given the vital risk she presented; emerging ethical conflict between professionals. Outpatient management was difficult due to poor socio-family support and frustrated attempts to adhere to the guidelines given, so it required several incomes over months.

Conclusions

In theese cases a complex care plan is needed; If diabetes specific aspects are not attended to then psychological therapy will be ineffective. If diabetes professionals ignore emotions around food and body shape then diabetes education will be ineffective. One of the main barriers to long lasting recovery and effective treatment is mis/non—communication between professionals. The idea is to ensure that all parties involved in the patient’s recovery are providing consistent, compatible treatment.

Introduction

Eating disorders (ED) are illnesses with high sanitary repercussions because of their frequency and prognosis. Different investigations were conducted to determine which factors can influence the prognosis. Disassociation is one of them. Disassociation is the separation of the contents of the mind, which normally appear to be integrated into the conscious.

Objectives

The hypothesis proposes that high disassociation levels can interfere in the therapeutical response and, contrarily at lower levels, disassociation can show improvement in these patients.

Methods

119 patients were recruited from the Eating Disorders outpatient unit. Different questionnaires were administered. These questionnaires analysed general and eating psychopathology, the “Dissociative Experiences Scale” –DES- and the “Attitudes Toward Change in Eating Disorders” –ACTA-. After a year, the questionnaires were re-administered analysing the relationship between “DES” scores with other psychopathological scores.

Results

The dissociative levels which patients presented at the beginning influenced general and eating psychopathology. Moreover, we determined that final dissociative levels had influence on the attitude toward change and this one had influence in both general and eating psychopathology, except in “anxiety trait” which was associated with disassociative levels despite the “ACTA”scores.

Conclusions

Dissociation has influence on the prognosis of patients with an Eating Disorder, independent of the diagnosis category, because of the relationship with changes in eating and general psychopathology. Attitude towards change mediate this effect; lower levels of disassociation were associated with a proactive attitude in therapy and in the maintenance of change.

Introduction

Neuropsychological disturbances are shown in studies about eating disorders (ED). On the other hand, attention impairment is related with cronic depression and anxiety, with poor improvement with pharmachological treatment. Important comorbility between ED and other psychiatric diseases is described, specially with depression and anxiety.

Objectives

The aim of this study was to evaluate the influence of depression in neuropsychological variables in eating disordered patients.

Methods

A descriptive analyse was performed with 81 female patients with ED between 18-50 years old. Socio-demographical, clinical and neuropsychological variables were collected. Depression was measured by Beck Depression Inventory (BDI).

Results

A relationship between depression (dicotomic variable) and Symbol Digit Modalities Test (SDMT) was found (p<0.05, Z -1.69, average range without depression 32.64 vs average range with depression 23.49).

Attending to cuantitative result of BDI, relationships with Letter and Number Sequencing (total score: p<0.05, rho -0.29; SpanLN: p<0.05, rho -0.28) and SDMT (p<0.05, ρ Pearson -0.28) were found.

Conclusions

In ED impairment of attention and working memory have been related to executive function or stimuli distortion. In our sample the scores are similar to normal population but they’re related to severity of depression.

Introduction

Night Eating Syndrome (NES) is an important although not frequently reported eating pathology defined by recurrent episodes of nocturnal eating and extensive food consumption after the evening meal (more than 25% of the overall food intake).

Objectives

To monitor the evolution of three patients diagnosed with NES during their pharmacological treatment for 6 months.

Methods

Three patients who were diagnosed with NES, evaluated monthly using Night Eating Diagnostic Questionnaire (NEDQ) revised, Global Assessment of Functioning (GAF), Clinical Global Impressions-Severity (CGI-S) and body mass index (BMI), received treatment with sertraline 200 mg/day (one patient) and fluoxetine up to 60 mg/day (two patients).

Results

All patients presented full syndrome night eater according to the NDEQ-revised at baseline. The first patient was 40-year old and had a favourable evolution with significant changes in GAF, CGI and BMI after 3 months of treatment, and the symptoms remitted after 6 months. The second patient was 29-year old and presented a more fluctuant trend of NES core symptoms, reaching the level of mild night eater after 6 months of treatment. The third patient also had an oscillant evolution, but she reached the level of remission after 6 months. The mean BMI value dropped with 15.6% compared to baseline, and the GAF and CGI-S improved with 35% and 52%, respectively.

Conclusions

Sertraline and fluoxetine may be useful therapeutic choises in patients diagnosed with NES, but the doses needed are relatively high and the patients require close monitoring through validated clinical instruments.

Introduction

Ongoing research has highlighted the efficacy of family therapy (FT) in the treatment of adolescent anorexia nervosa (AN) and bulimia nervosa (BN).

Objectives

In this study we aim to characterize patients treated in a specialized Eating Disorder Unit in São João University and Hospital Center over a period of 6 years with a treatment plan including FT. We aim to present the clinical results from engaged patients, comparing the mean Body Mass Index (BMI) and the number of inpatients admissions before and after they started FT and try to stablish a correlation between those.

Methods

Retrospective analysis of clinical processes of patients with ED enrolled in family therapy between 2013 and 2018. Statystical analysis using IBM SPSS Statistics26.

Results

49 patients were monitored during this period and had FT as a part of treatment plan (45 female and 4 male). Regarding diagnosis, 42 had AN and 7 had BN. After this period of treatment the number of inpatient admissions significantly decreased for all diagnosis patients. Patients with AN had an increase in the mean BMI after concluding FT, also statistically significant.

Conclusions

This program provides a stable and prolonged treatment aiming to be flexible and adapted to the patient needs. Despite limitations considering the small population and that FT was not the only intervention administered to these patients, our data suggests that FT was a useful intervention in the sample.

Introduction

Therapeutic Drug Monitoring (TDM) has several indications in psychiatry including patients with physical comorbidities, suspected non-compliance, severe adverse effects and tailored pharmacotherapy. Antidepressants (AD) are frequently prescribed in patients with Eating Disorders (ED) to reduce binge-eating and compensatory behaviours or to treat comorbid depression and anxiety.

Objectives

TDM by means of minimally-invasive biosampling approaches may represent a useful tool in this population, considering the limited efficacy of ED’s pharmacological treatment and the high rate of adverse effects.

Methods

Nineteen ED outpatients on AD treatment with a Body Mass Index (BMI) <20 kg/m² or >30 kg/m² agreed to take part in the present study. Participants were treated with Sertraline (N=5), Fluoxetine (N=5), Vortioxetine (N=5), Citalopram (N=2), Escitalopram (N=1), Fluvoxamine (N=1). Oral fluid samples were collected from patients, together with whole blood dried microsamples, obtained by finger puncture using Volumetric Absorptive Microsampling techniques.

Results

Preliminary results showed a significant correlation between plasmatic and salivary concentrations for Vortioxetine only; moreover, extreme BMI did not seem to significantly influence the AD’ plasmatic concentrations, when corrected for dosage.

Conclusions

Further analyses may permit to validate for the first time the use of these recent microsampling procedures for AD treatment. By increasing the population size, we aim to demonstrate that TDM may represent a valid tool to better understand the limited efficacy of AD in ED patients. Minimally-invasive biosampling approach is well tolerated in patients with belenophobia and, in our experience, is highly appreciated by all patients: it may represent in future a valid support for Precision Medicine.

Introduction

Eating Disorders(ED) are one of the psychiatric pathologies that cause the greatest morbimortality. Different studies have shown that early diagnosis and intervention achieve higher recovery rates and reduce long-term complications.

Objectives

The aim of this study was to analyze medical consultations carried out in the year prior to the diagnosis of an ED and the possible undetected prodromal symptoms.

Methods

For this purpose, 99 patients (94.4% women; 5.1% men) between ages of 15 and 25, treated during 2014-2018 in the ED Unit, were selected. They were compared with a control group of 60 healthy people. Their primary and specialized care medical records were both studied retrospectively:

Consultations related to weight variation.

Changes in analytical data.

Psychological symptoms.

Gynecologic symptoms.

Unspecified symptoms such as digestive discomfort.

Malnutrition.

Results

Upon analysis, it is concluded that most of the patients, before being diagnosed, attended different consultations, generally Primary Care, with an average of 2.84 visits. 87.6% of them attended a primary, specialized or emergency care consultation in the year prior to being treated compared to 67.2% of the controls (p = 0.002). 58% of the patients compared to 16.40% of the controls consulted for symptoms related to suspected ED(p 0.000). There were significant differences regarding the control group in the type of consultation. They consulted for psychological symtoms (22.8% of consultations), menstrual irregularities (19.3%of consultations ), variations in weight (14%) and analytical changes(8.8%).

Conclusions

These findings underscore the importance of professionals knowing how to identify the warning signs of an ED so they can refer patients to a specialized unit.

Introduction

Eating disorders are pathologies frequently described in young white women, generally of high socioeconomic status. Among the factors associated with a poorer progression of the disease is a delay in the identification and onset of treatment.

Objectives

The aim of this work was to study the socio-demographic profile of patients diagnosed with an Eating Disorder, according to DSM-V criteria, who came in to receive their first treatment at a specialized unit. At the same time, the aim was to compare two time periods differentiated by the establishment of an early detection and referral program.

Methods

A total of 187 patients seen consecutively after referral to the Eating Disorder Unit were selected, ninety-nine from March 2010 to March 2011 (time period 1), and 88 from September 2014 to February 2015 (time period 2).

Results

Among the findings, the presence of a significantly lower socioeconomic status among patients studied in time period 2 stands out. At the same time, a significant reduction in the time without treatment was observed in time period 2 compared to time period 1, after the establishment of the early referral protocol.

Conclusions

The predominance of patients belonging to social strata significantly lower than expected could correspond to a change in the type patient, demonstrating the wide distribution of these disorders today. Furthermore, decreasing the time without treatment could be a key measure to improve the prognosis of patients.

Introduction

Introduction: Major depressive disorder (MDD) is common in anorexia nervosa (AN), associated with worse outcome and greater suicide risk. Electroconvulsive therapy (ECT) is effective in the treatment of major depressive disorder (MDD) refractory to anti-depressive treatment.

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Objectives

To assess the place of ECT in the treatment of MDD in AN, using a case series of inpatients with AN receiving ECT for MDD resistant to treatment and/or with severe suicide risk.

Methods

We retrospectively analyzed the files of all 30 adolescent females hospitalized in our department because of AN between 1998-2017 and treated with ECT. Severity of eating disorder (ED) and depressive symptoms was retrospectively assessed using the Clinical Global Impression-Severity Scale (CGI-S).

Results

Patients were severely depressed and suicidal on admission. All were resistant to anti-depressants. A significant deterioration in depression, with severe suicidality, occurred from admission to pre-ECT, with concomitant improvement in ED symptoms and increase in body mass index (BMI). Significant improvement in depressive and ED symptoms and increase in BMI occurred following ECT, continuing to discharge. Adverse effects were mostly minimal. Fifty-three percent of the patients were re-hospitalized within the first year after ECT, mostly because of deterioration of depression and attempted suicide. Several years after discharge, 46.6% of the patients had no evidence of depression, suicidality and ED-symptomatology, and another 23% had only evidence of ED symptomatology

Conclusions

ECT is safe, and well-tolerated in AN with severe comorbid treatment resistant MDD and/or increased suicide risk. Many AN patients undergoing ECT may be remitted at long-term follow-up.

Introduction

Little is known about the efficacy and safety of forced tube feeding in patients with life-threatening anorexia nervosa. Our aim is to investigate weight gain and complications during forced treatment in anorectic patients with a BMI < 13 kg/m2.

Objectives

Anorexia nervosa is a serious psychiatric condition with high mortality rates. When health becomes seriously endangered and the patient refuses to take necessary foods, involuntarily treatment is sometimes necessary to prevent serious morbidity and mortality. However, little is known about functional outcomes and complications.

Methods

12 patients with serious anorexia nervosa (BMI < 13), somatic complications and not able to take sufficient nutrients on a voluntarily basis received forced tube feeding under the Dutch mental health act. Weight was measured three times a week and weight targets and nutrition policy were determined accordingly. When patients reached the intended BMI, they were motivated to continue tube feeding on a voluntary basis and oral intake was introduced.

Results

During hospitalization all patients were able to gain the weight necessary to complete the treatment plan. Complications during treatment were hypothermia, pneumonia, hypoglycemia and intensieve care admission. After discharge at least two of the patients died. Factors relevant to positive outcome were a short duration of illness and a younger age.

Conclusions

Forced feeding in life-threatening anorexia nervosa is somatically safe, feasible and results in weight gain. On the short term it is life-saving. Further research should focus on the longer term effects of compulsory treatment and identify patient characteristics that predict chances to profit by forced feeding.

Introduction

Despite psychosis and anorexia nervosa are distinct disorders, they have complex relationships that carry clinical challenges.

Objectives

To present a case report and review the literature about the relationship between anorexia nervosa and psychosis.

Methods

Clinical interviews and records were used to build the case report.A review of the literature was performed in Pubmed, using the query “anorexia nervosa AND (psychosis OR schizophrenia)”.

Results

A female patient with 18 years old was evaluated in the emergency department due to frank weight loss, and was admitted into our inpatient unit for further diagnostic investigation.At the initial assessment she was inattentive, with anxious mood, presented disorganized speech with loose associations, insomnia and food restriction;her body mass index was 15 and she'd amenorrhea.Because of the disorganized speech and possible though disorder we couldn’t initially evaluate body image and fears about gaining weight.We started risperidone and in few days the patient presented normal speech and behaviour and started eating normally, gaining four kilograms;she denied any concerns about weight or body image.In the view of the clinical evolution, the diagnosis of psychotic episode was made.We interpreted the months before hospitalization as a prodromal phase with anorexic-like symptoms, with the food restriction contributing to the clinical picture.The published literature highlights the complex relationship between anorexia nervosa and psychosis, the difficulty in recognizing which one is primary and which is comorbid and the factors that link both.

Conclusions

The relationship between anorexia nervosa and psychosis is complex.Further studies on their shared and differential phenomenology are needed to improve diagnosis and treatment.

Introduction

Eating Disorders (ED) are complex and costly for patients, families, and society. Treatments of different types have shown some effectiveness for many sufferers with ED but are still far from satisfactory. Controlled efficacy studies provide evidence with internal validity but the external validity of complex treatment services is compromised. The ITA Model of Integrated Treatment of Eating Disorders (ITAMITED) combines outpatient, inpatient and day hospital adapted to every patient’s needs.

Objectives

To evaluate the changes occurred in patients with EDs after the ITAMITED service on the bases of a recently implemented routine outcome assessment system.

Methods

A cohort of 324 ED patients who entered the ITAMITED service between November of 2017 and October of 2018 was routinely assessed with the Clinical Outcomes in Routine Evaluation (CORE) system and measures specific for EDs (e.g., EAT). Data analysis included details from the patients’ health records such as diagnosis, BMI, previous treatments, and chronicity.

Results

Changes in CORE yielded large effect sizes for both inpatient and outpatient treatment modalities, and moderate for day hospital care (figure 1). Effect sizes for EAT (figure 2) were big for inpatient treatment and day hospital and moderate for outpatient treatment.

Conclusions

Overall, ITAMITED succeeded in improving EDs patients, especially in the inpatient facility. Day hospital care proved more effective for specific ED symptoms than for general functioning and well-being, while the inverse pattern was found for those in outpatient treatment. The effects of many more variables need to be brought into the equation to explain more detailed outcomes.

Introduction

Anorexia Nervosa (AN) is a serious psychiatric disorder, it may affect up to 4.2% of women during their lifetime and carries the highest mortality rates of any mental health disorder. The latest data suggest that a quarter of all people with AN fulfil diagnostic criteria for borderline personality disorder (BPD), and that a similar percentage of those with BPD have AN.

Objectives

This case report aims to describe a case of anorexia nervosa in a girl with BPD and to determine the prevalence and mechanism of association between AN and BPD.

Methods

A patient case is presented with associated literature review.

Results

Ms. MA, aged 19, with no medical history, is a student in the secondary school. She was referred by the emergency unit for suicidal thoughts.

The interview revealed, in addition to the depressive symptomatology, many criteria for BPD such as frantic efforts to avoid abandonment, interpersonal relationships instability, Impulsive and self-harming behaviour, substance abuse...

Additionally, MA is on a restrictive diet with a target weight of 44 kg ( previous target weight was 50 last year). The diagnosis of anorexia nervosa was retained according to DSM-5 criteria.

MA was put on antidepressant treatment combined with dialectical behavior therapy (DBT) with progressive improvement noted.
Psychopathological, neurobiological and endocrine models are incriminated in the association between AN and BPD

Conclusions

It is important that clinicians are aware of the frequency with which AN occurs in association with BPD because of the severity of this combination and the need for a specific and careful management.