[Are the neuropsychological alterations in eating disorders endophenotypes of the disease? Review and state of the art]. / Son las alteraciones neuropsicologicas de los trastornos de la conducta alimentaria endofenotipos de la enfermedad? Revision y estado actual del tema.

INTRODUCTION. Recent studies have shown that alterations to the executive cognitive functions may be endophenotypes of eating disorders. AIM. To perform a critical review of the literature on neuropsychological alterations in patients with eating disorders and their first-degree relatives. DEVELOPMENT. We review the papers written in English and in Spanish indexed in Medline and PsycINFO over the last 10 years. We included abstracts of papers that have still not been published and search terms were crossed. Excluding some isolated clinical cases, we obtained 41 studies on patients with anorexia nervosa (n = 17), bulimia nervosa (n = 5), both (n = 13) or a non-specific eating disorder (n = 6). CONCLUSIONS. The studies reviewed display important limitations due to their heterogeneous methodology and small samples, which give rise to contradictory results. Most of them were conducted on anorexia nervosa. Cognitive rigidity seems to be more frequent in patients with anorexia and their relatives, and alterations in decision-making or central coherence is more often found in bulimia nervosa. There is evidence suggesting that the neuropsychological alterations found in eating disorders are endophenotypes of the disease.

[Repercussions of the withdrawal of thioridazine]. / Repercusiones de la retirada de la tioridazina.

INTRODUCTION: As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. RESULTS: The sample obtained in our unit included 15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our health care area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27 % of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60 % of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. CONCLUSIONS: We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/ long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril (thioridazine) withdrawal of the market.