[Intragastric balloon: a review concerning alternative balloons compared to the classical ones (Bioenterics)]. / Balón intragastrico: revisión de los dispositivos alternativos a los métodos clásicos (Bioenterics).

Since de Tarpon Springs Consensus Conference in 1987, the Bioenterics Intragastric Balloon represents the standard model for obesity treatment with this technique. Nevertheless, over the last 30 years, especially for the last ten years, novel concept of balloons has appeared, as well as new alternative models, which are reviewed in this paper.

Desde la Conferencia de Consenso de Tarpon Spring en 1987, el Balón Intragástrico de Bioenterics se ha impuesto como modelo en el tratamiento de la obesidad con esta técnica. No obstante, a lo largo de los 30 últimos años, y en especial en los 10 últimos, han aparecido nuevos conceptos de balón intragástrico así como modelos alternativos de balón que revisamos en este trabajo.

Multivariate therapeutic approach to binge-eating disorder: combined nutritional, psychological and pharmacological treatment.

Treatment for binge-eating disorder (BED) is directed towards either the physical or psychopathological impairments, and often does not cover all the alterations characterizing the disease. In 30 BED patients, we monitored the effects of three types of 6-month treatment, randomly assigned to one of the three treatment groups, each consisting of 10 patients. Group 1 received a 1700-kcal diet (21% proteins, 27% lipids, 52% carbohydrate), cognitive-behavioural therapy (CBT), sertraline (50-150 mg/day) and topiramate (25-150 mg/day); group 2 received the same diet, CBT, sertraline; and group 3 received nutritional counselling and CBT. Binge frequency and weight were assessed every month. The Eating Disorder Inventory-2, the Symptoms Check List-90-Revised (SCL-90-R) and the Personality Diagnostic Questionnaire-4-Revised (PDQ-4-R) were administered before and after treatment. Binge frequency and excessive weight decreased significantly only in group 1 patients, in whom improvement was noted in total Eating Disorder Inventory-2 scores and the subitems 'bulimia', 'drive for thinness', 'maturity fear', 'ascetism', in total SCL-90-R scores and in the subitem 'somatization', in PDQ-4-R subitems 'schizotypic personality' and 'dependent personality'. Group 2 patients improved on the SCL-90-R subitems 'depression' and 'interpersonal relationship' and in the PDQ-4-R 'schizoid personality'. Combination therapy seems to be the only fully effective treatment in BED patients.

Olanzapine therapy in anorexia nervosa: psychobiological effects.

Dopamine impairments occur in anorexia nervosa. The aim of this study was to see whether treatment with the atypical dopamine antagonist antipsychotic olanzapine improves the disorder. Thirty anorexics, 18 restricted and 12 bingeing-purging, underwent a 3-month course of cognitive behavioral therapy, plus at random and double-blinded oral olanzapine (2.5 mg for 1 month, 5 mg for 2 months) in half and oral placebo in the other half of them. BMI, psychopathological aspects (eating disorder inventory, Hamilton Rating Scale, Buss-Durkee Rating Scale, Yale Brown Cornell for Eating Disorders Rating Scale, temperament-character inventory), and homovanillic acid blood concentrations for dopamine secretion, were monitored at baseline and then monthly during the trial. At the end of the trial BMI, total eating disorder inventory, total Yale Brown Cornell for Eating Disorders Rating Scale, Buss-Durkee Rating Scale, Hamilton Rating Scale scores and in olanzapine-treated patients the subitems of eating disorder inventory ineffectiveness and maturity fear, of Buss-Durkee Rating Scale direct aggressiveness, of temperament-characteristic inventory persistence had improved significantly. When stratified for anorexia nervosa subtype, BMI changes were significant among anorexia nervosa bingeing-purging patient, 'depression' (Hamilton Rating Scale) and 'direct aggressiveness' (Buss-Durkee Rating Scale) among anorexia nervosa bingeing-purging patients, 'persistence' (temprerament-characteristic inventory), among anorexics restricted patients, with a trend toward significance for obsessivity-compulsivity (Yale Brown Cornell for Eating Disorders Rating Scale). homovanilic acid blood levels increased significantly in the cognitive behavioral therapy+olanzapine group. No correlations were observed between homovanilic acid concentrations and psychopathological parameters. The pharmacological treatment can significantly improve specific aspects of anorexia nervosa.

Bipolar spectrum disorders in severely obese patients seeking surgical treatment.

BACKGROUND: Much of the literature investigating the link between mood disorders and obesity has focused on depression whereas historic polarity of mood has not been previously carefully assessed. The aim of the present study has been to evaluate the prevalence of the entire bipolar spectrum, by including subsyndromal hypomania, and its related demographic and clinical correlates, in severely obese patients seeking surgical treatment. METHODS: Eighty-three consecutive bariatric patients who presented for presurgical psychiatric consultation were systematically interviewed with both the SCID-CV questionnaire and, as a self-assessment instrument, with the Hypomania Symptom Checklist (HCL-32) on all past hypomanic behaviours (focusing more on prior overactivity than on mood changes) regardless of duration and initial negative response to the screening question on mood. RESULTS: A bipolar spectrum disorder was found in 89% of severely obese patients, with the highest prevalence rates for bipolar II disorder. Comorbidity with panic disorder was observed in 30% of bipolar spectrum patients. LIMITATIONS: The lack of normal-weight or general medical control groups and the reliance on self-report, retrospective assessment for the collection of some parameters warrant some caution in the interpretation of substantive findings. CONCLUSIONS: These findings suggest that bipolar spectrum illness, in particular a hypomanic condition characterized by overactivity, is very common in severely obese subjects, thus contradicting previous evidence of low levels of physical activity in this population. Given the high prevalence rates of bipolar spectrum in morbid obesity, this study encourages further research on the causal association.

Major depression-related immunological changes and combination antiretroviral therapy in HIV-seropositive patients.

BACKGROUND: In physically healthy subjects, major depression has been associated with several changes in immune function. In HIV-infected subjects too, lymphocyte subsets changes related to psychological conditions have been described. OBJECTIVE: The aim of this study was to investigate the effect of major depression on immunological parameters in HIV-infected subjects and to examine the influence of different potency antiretroviral therapies on depression-related immunological changes. METHOD: Thirty-six HIV-infected patients with major depression treated with different potency antiretroviral therapies (none, double, triple) were compared with 77 matched non-depressed HIV controls with regard to demographic, clinical and immunological parameters. RESULTS: The presence of depression was a significant predictor of natural killer (NK) cell number and percentage decline. Antiretroviral therapy and depression-antiretroviral therapy interaction do not significantly influence depression-related NK cell changes. CONCLUSIONS: The study confirms the role of depression in influencing the immune response in HIV-seropositive subjects and suggests that antiretroviral therapies may not be able to hamper the depression-related NK cell changes even using the most potent regimens such as Highly Active Antiretroviral Therapy (HAART).

Plasma concentrations of anxiolytic neuroactive steroids in men with panic disorder.

Plasma concentrations of neuroactive steroids in men with panic disorder (PD) were measured to evaluate their relations to psychopathology both before and during treatment. Participants comprised 13 men with PD and 10 normal controls. Patients were evaluated while drug-free as well as after 1 and 2 months of paroxetine therapy. Psychopathology was assessed by the State-Trait Anxiety Inventory (STAI), the Panic-Associated Symptom Scale, and the Fear Questionnaire total score. Plasma concentrations of steroids were measured by radioimmunoassay. The plasma concentrations of progesterone and dehydroepiandrosterone were greater in drug-free patients than in controls, whereas those of allopregnanolone and tetrahydrodeoxycorticosterone did not differ between the two groups. Paroxetine treatment for 2 months significantly increased the plasma concentration of allopregnanolone but did not affect those of the other steroids. At 2 months of therapy, allopregnanolone concentrations in patients were significantly greater than those in controls. The plasma concentrations of progesterone and tetrahydrodeoxycorticosterone correlated with the STAI state score in patients before treatment. Our data suggest that neuroactive steroids may play a role in PD in men.