"ZARPAR"-Educational Program for Cognitive and Behavioral Development: Results of an Experiment to Evaluate Its Impact on Antisocial and Pro-Social Behavior.

Using an experimental design and a multi-measure and multi-informant approach, the current study sought to evaluate the impact of the early developmental prevention program "ZARPAR"-an intervention designed as a social and cognitive skills training program, that seeks to promote children's behavioral adjustment. A sample of elementary school children (experimental group n = 37; control group n = 66), attending Portuguese schools, was assessed before and 6 months after the intervention on the program's key-dimensions: behavioral problems, social skills, and executive functioning. Based on parent and teacher reports, the results largely suggested that the intervention had no effect or, for some dimensions, even the existence of negative outcomes. Possible reasons for these results are discussed. The current study highlights that, despite the overwhelmingly positive message about developmental prevention programs, not all interventions work, thus reinforcing the need for rigorous evaluations, in order to enhance the success of future interventions.

[The Short Nicotine Dependence Syndrome Scale (NDSS-S) in Spanish smokers]. / La escala breve de evaluación del Síndrome de Dependencia de la Nicotina (NDSS-S) en fumadores españoles.

We present a brief scale derived from the Nicotine Dependence Syndrome Scale (NDSS). We used a sample of 1.061 daily smokers, which was obtained from five Primary Care Health Centers, a Unit of Alcoholism, and a Smoking Cessation Unit. All smokers were evaluated with the NDSS and the SCID to assess nicotine dependence according to DSM-IV criteria. The results indicate the existence of a general factor of nicotine dependence according to the NDSS. We selected the items with a higher factor loading (>.50), obtaining a short scale of 6 items. With this brief scale, we obtained results similar to those of the total scale in the diverse variables (sociodemographic and smoking) of the study. Scale reliability is satisfactory (a= .79), the correlation between the short and the total scale is very high (r=.95, p<.001) and the short scale discriminates the smokers in terms of cigarette consumption and nicotine dependence, as assessed with the SCID. The operation under the ROC curve is excellent (area under the curve .84). The data indicate the usefulness of this brief scale (NDSS-S) to assess nicotine dependence in smokers.

Spanish adaptation of the NDSS (Nicotine Dependence Syndrome Scale) and assessment of nicotine-dependent individuals at primary care health centers in Spain.

The availability of adequate instruments for the assessment of nicotine dependence is an important factor that is relevant in the area of tobacco addiction. In this study, we present a Spanish validation of the Nicotine Dependence Syndrome Scale (NDSS) (Shiffman, Waters, & Hickcox, 2004). The sample was composed ofpatients, all daily smokers, who visited their General Practitioner (GP) at five Primary Health Care Centers in different cities of Spain (N = 637). The results indicated adequate reliability for the general factor that assesses nicotine dependence (NDSS-Total) (Cronbach's alpha = .76). Factor analysis confirms the five factors of the original validation: Drive, Continuity, Stereotypy, Priority, and Tolerance. It must be noted that reliability is adequate for the first, and moderate or low for the rest. The NDSS-T and its scales correlate significantly with the Fagerström Test for Nicotine Dependence (FTND), with the nicotine dependence criteria of the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV) as assessed through the Structured Clinical Interview for DSM-IV (SCID), with carbon monoxide levels in expired air (CO), and with the number of cigarettes smoked. The ROC curve indicates that the NDSS-T has a score of .79 which is under the curve (.69 for the FTND), thus the prediction of nicotine dependence is adequate. We conclude that this instrument is useful (in terms of its total score NDSS-T) for assessing nicotine dependence for Spanish smokers (in Spain), as has been found in other countries, language groups, and cultures.

Brief intervention in substance-use among adolescent psychiatric patients: a randomized controlled trial.

Objective of the study is to assess the efficacy of a brief motivational enhancement intervention in adolescents referred to psychiatric treatment who reported substance-use. In a sample of adolescents (n = 237) consecutively admitted to a psychiatry department, 143 were identified as users. Subjects were randomly allocated to one of two groups: an experimental group that received a brief intervention aimed at increasing their awareness of the risks of substance-use, or a control group. All subjects received standard treatment according to the primary diagnosis. Structured questionnaires assessing knowledge, problems, perception of risks and intention of use of psychoactive substances were administered upon admission and 1 month later. Fifty-nine subjects entered the experimental group and 44 the control group. No significant differences between the two groups were identified in socio-demographic features or substance-use. Non-parametric analyses showed a significant increase across time in overall knowledge about drugs and perception of risk in the experimental group (P < 0.05). A significant increase in overall knowledge in the experimental group compared to controls was found (P < 0.05). No differences were observed for other variables such as intention of use or perception of risk. Brief intervention in adolescents entering psychiatric treatment led to a significant change in overall knowledge about psychoactive substances but not in other variables related to use. Our results point to the need of more intensive interventions.

Assessment of the increase in variability when combining volumetric data from different scanners.

In multicenter MRI studies, pooling of volumetric data requires a prior evaluation of compatibility between the different machines used. We tested the compatibility of five different scanners (2 General Electric Signa, 2 Siemens Symphony, and a Philips Gyroscan) at five different sites by repeating the scans of five volunteers at each of the sites. Using a semiautomatic method based on the Talairach atlas, and SPM algorithms for tissue segmentation (multimodal T1 and T2, or T1-only), we obtained volume measurements of the main brain lobes (frontal, parietal, occipital, temporal) and for each tissue type. Our results suggest that pooling of multisite data adds small error for whole brain measurements, intersite coefficient of variation (CV) ranging from 1.8 to 5.2%, respectively, for GM and CSF. However, in the occipital lobe, intersite CV can be as high as 11.7% for WM and 17.3% for CSF. Compared with the intersite, intrasite CV values were always much lower. Whenever possible, T1 and T2 tissue segmentation methods should be used because they yield more consistent volume measurements between sites than T1-only, especially when some of the scans were obtained with different sequence parameters and pixel size from those of the other sites. Our study shows that highest compatibility among scanners would be obtained using equipments of the same manufacturer and also image acquisition parameters as similar as possible. After validation, data from a specific ROI or scanner showing values markedly different from the other sites might be excluded from the analysis.

Eating disorders in ballet dancing students: problems and risk factors.

OBJECTIVE: To study the prevalence of symptoms of eating disorders and risk eating behaviours and the relationship between life at a dance school and the risk of developing an eating disorder (ED) in an adolescent population of Spanish dance students. METHODS: Questionnaires were used to assess attitudes to eating, cultural influences on the body shape model, eating disorders (DSM-IV) and risk factors for eating disorders in 76 adolescent dance students (age 12-17 years) at the Barcelona Theatre Institute. Subjects were compared with a community sample of 453 female adolescents. To study the relationship between ED and characteristics of this particular school, an original questionnaire was administered to 105 students at the school aged from 12 to 21 years. RESULTS: The prevalence of eating disorders and several risk attitudes and behaviours were similar in the dance students and the female adolescents from the general population. Students at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies. In contrast, Body Mass Index (BMI) had hardly any influence on these experiences. Depressive symptoms were associated almost exclusively with experience of stressors and aversive situations. CONCLUSIONS: Dance school students do not necessarily present a greater risk of ED than other girls of the same age. The risk of ED may be associated with greater pressure from coaches, with attitudes related to the ED itself, or with depressive symptoms, rather than with the BMI.

Antineuronal antibodies in a group of children with obsessive-compulsive disorder and Tourette syndrome.

An autoimmune hypothesis has been suggested for early onset obsessive-compulsive disorder and Tourette syndrome. The term: Paediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) has been proposed as an aetiological subtype of OCD and TS, related to a Group A beta haemolytic streptococcal (GABHS) infection that triggers an autoimmune response. Antineural antibodies have been studied and found in the sera of some patients with these disorders, and they are thought to cross-react with streptococcal and basal ganglia antigens. The present study included 32 prepubertal-onset OCD patients, 21 with TS diagnosis (some of them meeting criteria for PANDAS) and 19 normal children, all aged between 9 and 17 years. Antibodies were assayed by immunohistochemistry and immunoblot. Special attention was paid to the methodology and a high serum dilution was used to minimize non-specific binding. No anti-basal ganglia antibodies were detected by immunohistochemistry in any of the samples. Two proteins, with approximate molecular weights of 86 kDa and 55 kDa, were found in sera from 7 patients. Though the study supports the hypothesis of an autoimmune process underlying OCD or TS in some patients, further research is needed.

Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire.

OBJECTIVE: To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. METHOD: Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. RESULTS: The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). CONCLUSION: The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.

Parental psychopathology in child and adolescent obsessive-compulsive disorder.

PURPOSE: To identify the lifetime prevalence of obsessive-compulsive disorder (OCD) and other psychiatric diagnoses in parents of OCD pediatric patients as well as the frequency of onset of psychiatric disorders in the 6 months prior to evaluation. METHODS: Parents (n = 63) of 32 children and adolescents (20 males and 12 females; mean age of 13.3 +/- 2.4) with OCD and parents of (n = 63) 32 age and sex-matched controls with no psychiatric diagnosis were examined. The semi-structured SCID-I was used to identify axis I psychiatric disorders and SCID-II to evaluate personality disorders. RESULTS: Mothers of patients had significantly more psychiatric diagnoses than control mothers (P = 0.001). Only parents of patients had diagnosis of OCD (P = 0.01) and psychiatric diagnosis (Adjustment Disorders, Major Depression, Anxiety Disorders) with onset during the 6 months prior to evaluation (P = 0.001). The duration of disease in children appeared to be related to development of morbidity in parents (P = 0.04). Parents of patients also showed a higher incidence of personality disorders (P = 0.01), in particular avoidant (6 versus 1 parents, P < 0.055) and obsessive-compulsive (9 versus 2 parents, P = 0.016) personality disorders. CONCLUSIONS: The findings suggest that there may be an excess of psychopathology in parents of children with OCD as compared to parents of pediatric and non-psychiatric patients. Adjustment disorders with depressive and anxious symptoms are significantly more frequent in mothers of OCD children after the onset of the disease.

Eating disorders and body image in Spanish and Mexican female adolescents.

OBJECTIVE: To compare the prevalence of eating disorders (ED), socio-cultural risk factors, and body image characteristics in two populations of female adolescents, one Mexican and one Spanish, from similar socio-economic backgrounds. METHOD: A total of 467 Spanish and 329 Mexican girls aged from 11-12 to 17-18 years were assessed using the Eating Attitude Test-26 (EAT-26), the CETCA (Eating Disorders Assessment Questionnaire), the CIMEC (Questionnaire on Influences on Body Shape Model), and a survey of socio-demographic and risk factors produced for this study. RESULTS: One out of four subjects showed a significant risk of an eating disorder and 6-7% probably already had one. No significant differences were found between the two samples. Significant differences were found in risk behaviors: more Spanish girls reported body dissatisfaction and binging; more Mexican girls had a history of psychiatric and psychological treatment, pressure from parents and friends to lose weight, dieting, physical activity and vomiting to lose weight, and a history of greater weight loss. In both the groups around 50% of subjects wanted to increase the size of their breasts. However, significantly more Mexican girls desired thinner arms and narrower shoulders and back, and more Spanish girls wanted thinner hips, buttocks, and legs, parts of the body that many Mexicans wanted to increase. CONCLUSIONS: Risk behaviors and the ideal body models of these Spanish and Mexican adolescent girls varied significantly, indicating major socio-cultural differences. However, the prevalence of ED was similar. Further research should aim to clarify whether the similarities found between this Spanish sample and a Mexican sample taken from an upper-middle class urban environment, a minority that is unrepresentative of the general population, are also observed in samples from other sectors of Mexican society.

D8/17 monoclonal antibody: an unclear neuropsychiatric marker.

OBJECTIVE: It has been hypothesized that monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in patients with rheumatic fever, childhood onset obsessive-compulsive disorder (OCD), Tourette syndrome (TS) or prepubertal anorexia nervosa (AN). Our purpose was to replicate these studies in a Spanish population and to determine whether D8/17 identifies a subgroup of these patients, focusing especially on OCD subjects. METHOD: D8/17 expression was assessed with double immunofluorescence and flow cytometry using monoclonal immunoglobulin M (IgM) in three groups of patients with diagnoses of OCD (n = 17), TS (n = 5) and prepubertal AN (n = 5), recruited during 2001. RESULTS: In the sample studied the average percentage of B cells expressing D8/17 was 4.8%. The D8/17 positive proportion of B lymphocytes was above 11% in only two out of 17 OCD patients (7.4% of total sample) and in none of the TS or prepubertal AN patients. No statistically significant differences were found in mean percentages of D8/17 between the three groups. CONCLUSIONS: In the sample studied the expression of D8/17 in B cells was very low and the great majority of patients were negative for the D8/17 marker. The molecular characterization of D8/17 would be a major step forward in clarifying its implication for these diseases.

Anorexia nervosa and obsessive-compulsive disorder in a prepubertal patient with bone dysplasia: a case report.

OBJECTIVE: The current article describes the case of a 13-year-old girl with body dysplasia, anorexia nervosa, and obsessive-compulsive disorder (OCD). METHOD: She was given cognitive-behavioral therapy and pharmacologic treatment for the obsessive-compulsive symptomatology and exogenous growth hormone to increase her height. RESULTS: She experienced an adequate weight and height increase and remission of obsessive-compulsive symptomatology, and reestablished adequate social and academic functioning. CONCLUSION: After a follow-up of almost 2 years, she had had her menarche, continued her positive eating habits, and had not relapsed into OCD.

Anorexia nervosa in male adolescents: body image, eating attitudes and psychological traits.

PURPOSE: To evaluate body image and its relationship with psychological and behavioral traits associated with anorexia nervosa in male patients. METHODS: Thirty male adolescents with anorexia nervosa (AN) were compared with 421 male adolescents from the general population. Body image was evaluated with the Subjective Body Dimensions Apparatus. Eating attitudes were evaluated by the Eating Attitudes Test in its 26-item version (EAT-26). In 19 AN patients and 200 boys from the comparison group, the Eating Disorders Inventory (EDI) was also administered. RESULTS: AN patients had higher mean scores in the EAT-26 and the Body Dissatisfaction scale on the EDI, but not on the other EDI scales. Both groups overestimated all parts of their bodies but AN patients presented a greater overestimation of shoulders (p = .007), hips (p = .01) and thighs (p = .019). Correlations in the anorexic group were high and negative between body overestimation and body mass index and also high but positive between overestimation and the EAT and the Drive for Thinness scale on the EDI. Overestimation did not correlate significantly with other EDI scales. CONCLUSIONS: Male patients with anorexia nervosa overestimate some parts of their bodies more often than controls; this overestimation is related to body mass index, abnormal eating attitudes and drive for thinness, but not to other psychological traits evaluated by the EDI.

Perfectionism dimensions in children and adolescents with anorexia nervosa.

PURPOSE: To assess the dimensions of perfectionism in adolescents with anorexia nervosa in comparison with adolescents from the general population and to validate the Spanish versions of two measures of perfectionism. METHODS: The Child and Adolescents Perfectionism Scale (CAPS), the Perfectionistic Self-Presentation Scale (PSPS) scale, the Eating Attitudes Test (EAT), and the Beck Depression Inventory (BDI) were administered to a group of 71 anorexia nervosa patients (mean age 15.3 years). Moreover, the CAPS and the PSPS were also administered to 113 adolescents from the general population (mean age 14.6 years). The CAPS and the PSPS were administered again after 1 week in 68 subjects to evaluate test-retest reliability. RESULTS: Both the CAPS and the PSPS demonstrated good internal consistency (Cronbach alpha for anorexia nervosa patients = .91; Cronbach alpha for general population = .85) and the two scales of the CAPS also had alpha coefficients in excess of .7. One-week test-retest reliability was also adequate (r = .80). Anorexia nervosa patients had higher mean scores in Self-oriented perfectionism (p < .001) and Perfectionistic self-presentation (p < .001) but not in Socially prescribed perfectionism (p = .292). There were significant correlations among perfectionism and the EAT and the BDI. A percentage of anorexia nervosa patients between 39% and 42% obtained a score higher than the mean in the comparison group plus two standard deviations in Self-oriented perfectionism and Perfectionistics self-presentation. CONCLUSIONS: The Spanish version of the CAPS and the PSPS showed good psychometric properties. A percentage of 40% of adolescent patients with anorexia nervosa show high Self-oriented perfectionism and Perfectionistic self-presentation.

Predictors of rehospitalization after total weight recovery in adolescents with anorexia nervosa.

OBJECTIVE: The current study analyzed the variables related to rehospitalization after total weight recovery in adolescents with anorexia nervosa. METHOD: One hundred and one patients first admitted for inpatient treatment, aged 11-19 years, were followed up for 12 months after discharge. RESULTS: Twenty-five subjects (24.8%) required readmission after complete weight recovery and 76 (75.2%) did not. Duration of disorder, weight loss, body mass index at first admission, and global body image distortion were similar in the two groups. Patients needing readmission had a lower rate of weight gain (p < .001), a lower mean age (p = . 007), a higher mean score on the Eating Attitudes Test (EAT; p = .009), and a higher percentage of hips overestimation (p = .049). In a stepwise logistic regression analysis, these three variables predicted readmission and correctly classified 77.6% of patients. Taken as discrete variables, age younger than 15 years old, EAT score above 55, and a rate of weight gain lower than 150 grams per day were associated with a higher percentage of readmissions. DISCUSSION: The variables most clearly related to readmission were young age, abnormal eating attitudes, and a low rate of weight gain.

Persistence of nutritional deficiencies after short-term weight recovery in adolescents with anorexia nervosa.

OBJECTIVES: To study nutritional abnormalities in adolescent anorexia nervosa and to establish whether certain abnormalities persist after short-term refeeding. METHOD: Sixty-one patients (10-19 years old) admitted to a reference unit for eating disorders between 1999 and 2000 with a diagnosis of anorexia nervosa were evaluated at admission and at discharge. A range of biochemical, nutritional, and hormonal parameters were determined. RESULTS: At admission, no protein or lipid deficiencies were found, although many patients presented with hormonal abnormalities and red blood cell folate and zinc deficiencies. Hormonal abnormalities reverted significantly (p <.000) after renutrition. There were decreases in erythrocytes and in levels of hemoglobin (p <.000) and folic acid (p <.05). Red blood cell folate and zinc increased but did not reach normal levels. CONCLUSIONS: In a large proportion of adolescent anorexic patients, supplementation of folic acid and zinc is recommended although protein or hormonal replacement does not seem to be necessary.

Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery.

OBJECTIVE: Anorexia nervosa is a life-threatening condition, with significant risk for death due to cardiac complications. The objective of this study was to analyze the cardiac involvement in anorexia nervosa and to study the reversibility of cardiac abnormalities. METHOD: Thirty-one consecutive adolescents (aged 12 to 17 years) with a diagnosis of anorexia nervosa were evaluated from January 1998 to January 1999 at the Hospital Clínic (University of Barcelona, Catalonia, Spain). An electrocardiogram, an echocardiogram, a 24-hour Holter recording with heart rate variability, an exercise test, and a tilt test were performed at initial examination and after refeeding (3 to 18 months later). RESULTS: The basal body mass index was 15.2 +/- 2 kg/m2. Sinus bradycardia was found in 35% of patients, 93% showed a decreased left ventricular mass, and 70% had a diminished thickness of cardiac walls. The Holter recordings showed nocturnal bradycardia in 60% with an increased heart rate variability. After refeeding, a significant decrease in QT interval (p <.05) and QT dispersion (p <.01) was observed. Echocardiograms showed an increase in cardiac diameters (p <.01), left ventricular mass (p <.001), and cardiac output (p <.001). There was also an improvement in the exercise capacity (p <.05) and a normalization of the heart rate and heart rate variability (p <.05). CONCLUSION: Cardiac structural and functional abnormalities provoked by anorexia nervosa are reversible in young adolescents after refeeding.