Life crisis and the body within.

The authors take into account body involvement during the existential critical periods. The concept of body involvement considers both the biological (organic) involvement of the body, i.e. all the 'psychosomatic' (in a wider sense) dimensions, and the involvement of the mental representation of one's body. This involvement refers to some clinical conditions as 'abnormal somatic styles of existence', hypochondriasis and dysmorphophobia (all grouping in the DSM-IV 'somatoform disorders') and the anorexic states. From a structural psychogenetic point of view, this firm involvement of the body (naturally we are referring to the 'experienced body') is stressed in light of its importance in self identity construction and maintenance, especially when, as in some existential critical periods, identity physiologically faces significant modifications and hazardous movements.

Screening for binge eating disorder in obese outpatients.

The prevalence of binge eating disorder (BED) in clinical samples of obese patients is controversial, and sensitive diagnostic protocols for use in routine clinical practice need to be further defined. Three hundred forty-four obese (body mass index [BMI] > or =30 kg/m2) patients were studied with the Structured Clinical Interview for DSM-III-R to investigate the lifetime prevalence of mental disorders. The current prevalence of BED was assessed using DSM-IV criteria. Eating attitudes and behavior were investigated with the Bulimic Investigation Test, Edinburgh (BITE) and the Binge Eating Scale (BES). The Beck Depression Inventory (BDI) and Spielberg's State-Trait Anxiety Inventory (STAI) were also applied. The prevalence of BED was 7.5%. Patients with BED had a higher BMI compared with obese patients without BED. Differences in the lifetime prevalence of mental disorders in patients with and without BED were not statistically significant. Using the BES as a screening instrument for BED with a threshold of 17, the sensitivity was 84.8%, specificity 74.6%, positive predictive value 26.2%, and negative predictive value 97.9%. Using the BITE with a threshold of at least 10, the sensitivity was 91%, specificity 51.4%, positive predictive value 71.8%, and negative predictive value 98.2%. The BITE can be a valid alternative to the BES as a screening method for BED in obese patients.

Anorexia nervosa and celiac disease: two case reports.

OBJECTIVE: Anorexia nervosa (AN) has been reported to be associated with several chronic medical illnesses. In this study, we report two cases of women suffering from AN and celiac disease. The former received the diagnosis of celiac disease before the onset of the eating disorder. For the latter, the diagnosis of celiac disease followed that of AN. Authors discuss the complex relationships between celiac disease and AN. They suggest that in the first case the dietary restriction could act as a trigger for the eating disorder, whereas in the second case, the onset of celiac disease could have exacerbated the clinical symptoms of AN.

Gabapentin as a promising treatment for antipsychotic-induced movement disorders in schizoaffective and bipolar patients.

Improvement of antipsychotic-induced blepharospasm and involuntary oral-mandibulo movements was observed with the use of the anticonvulsant drug gabapentin among 14 of 16 affectively ill patients who had been exposed to maintenance neuroleptics of the conventional type. In many cases, the movement disorders of these patients had not responded to more standard measures such as clozapine. This finding permits a potential strategy for patients with treatment-emergent tardive dyskinesia, a well-known complication of extended conventional neuroleptic use. Gabapentin, whose mood stabilizing properties have been reported in several clinical reports, represents a more natural treatment in the setting of bipolar spectrum disorders.

Quality of life and overweight: the obesity related well-being (Orwell 97) questionnaire.

The development and validation of a self-reported measure of obesity-related quality of life, the Obesity Related Well-Being (ORWELL 97), were undertaken to examine the intensity and the subjective relevance of physical and psychosocial distress. The questionnaire was validated in a sample of 147 obese patients (99 females, 48 males). The Eating Disorder Examination 12.0D interview, a structured diagnostic interview for DSM-III-R (DSM-IV criteria for binge eating disorder), Beck Depression Inventory, Binge Eating Scale, and the State-Trait Anxiety Inventory 1 and 2 scales were also applied. Internal consistency and test-retest reliability were satisfactory. Factor analysis allowed the identification of two subscales: ORWELL 97-1 related to psychological status and social adjustment, and ORWELL 97-2 related to physical symptoms impairment. Obese female patients showed a lower quality of life, and the severity of obesity appeared to interfere with physical functioning rather than psychological status and social adjustment. The ORWELL 97 questionnaire appears to be a simple and reliable measure of obesity-related quality of life, which can be used in current clinical practice.

Clinical experience with gabapentin in patients with bipolar or schizoaffective disorder: results of an open-label study.

BACKGROUND: This study was carried out to evaluate the efficacy, tolerability, and safety of gabapentin as an adjunctive treatment in patients with bipolar or schizoaffective disorder with manic or hypomanic symptoms. METHOD: Twenty-five patients fulfilling DSM-IV diagnostic criteria for bipolar I disorder or schizoaffective disorder underwent a 16-week, open-trial treatment with gabapentin. Symptom severity was measured using the Clinical Global Impressions scale (CGI) and the Brief Psychiatric Rating Scale (BPRS). Baseline scores and final scores were compared by using the Student t test and the Friedman range variance analysis. RESULTS: Twenty-two patients (88%) completed the 16 weeks of treatment with gabapentin; 19 (76%) had a positive response as measured by changes in CGI and BPRS scores. The mean dose was 1440 mg/day. The only side effect observed was oversedation, which decreased with continuing treatment. CONCLUSION: Gabapentin was effective in the treatment of mania and hypomania in patients with bipolar and schizoaffective disorders. If confirmed in controlled studies, these findings suggest that gabapentin represents a well-tolerated, rapidly acting antimanic agent.

Venlafaxine versus fluoxetine in the treatment of atypical anorectic outpatients: a preliminary study.

The efficacy of venlafaxine and fluoxetine in the treatment of atypical anorexia nervosa (AN) was compared in a controlled trial. A consecutive series of 24 atypical anorectic females was assigned to either venlafaxine (75 mg/day) or fluoxetine (40 mg/day) plus cognitive-behavioural therapy (CBT). Eating Disorder Examination (EDE12.0D), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI) scores were compared before and after 6 months of treatment. Venlafaxine and fluoxetine determined an increase of body mass index (BMI) and a significant reduction of EDE12.0D and BDI scores; venlafaxine alone reduced STAI scores. It would seem that venlafaxine is as effective as fluoxetine when combined with CBT in the treatment of atypical AN.

The psychopathological model of mental retardation: theoretical and therapeutic considerations.

Mental retardation has heterogenous elements including genetic-biological and environmental factors that occur in a complex relationship. One construction commonly utilized is the overlapping etiologies, pathogenesis, and symptomatology in a bio-psycho-social model framework. A new integrated bio-psycho-social model we call "universe line" provides the possibility of integrating data from different research areas, specially cognitive and psychopathologic indicators. However, further methodology to refine and experimentally verify that model need to be elaborated. Implications of this theoretical approach are discussed.

Cognitive-behavioral therapy versus combined treatment with group psychoeducation and fluoxetine in bulimic outpatients.

A series of 51 female bulimic outpatients, aged 23.4+/-3.9, were assigned either to Cognitive-Behavioral Therapy (CBT) or combined Group Psychoeducation and Fluoxetine (GPF) treatment. The Eating Disorder Examination (EDE) was performed at the beginning of treatment and after 6 months, together with the administration of self reported questionnaires for depression (BDI) and Anxiety (STAI). A significant (p<0.001) reduction of the number of monthly binge episodes (from 25.0+/-12.9 to 6.2+/-3.8 and from 24.8+/-9.1 to 8.0+/-4.3) for CBT and GPF respectively were observed. Similar reductions were obtained in the number of episodes of compensatory behaviors. Both treatments reduced depression and anxiety (p<0.001) while CBT only determined a significative improvement of EDE scores. The data obtained suggest that GPF is as effective as CBT in reducing bulimic symptomatology but its long-term efficacy should be evaluated in a follow-up study.

Psychopathology and mental retardation: an Italian epidemiological study using the PIMRA.

The incidence of psychopathology was studied in 176 adult patients with mental retardation through administration of the Psychopathology Instrument for Mentally Retarded Adults (PIMRA). Prevalence of answers relating to anxiety, tendency to live apart and body complaints in the group with mild mental retardation was documented. For people with severe intellectual impairments, mood disturbances with inconsistent behaviours was most prevalent. Implications of the findings are discussed.

Assessment of basic symptoms in schizophrenia, schizoaffective and bipolar disorders.

In order to evaluate the basic symptoms differences of schizophrenics, schizoaffectives and bipolar patients, a consecutive series of 72 outpatients participated in the study. According to DSM III-R criteria, 28 had a diagnosis of schizophrenia, 29 of bipolar disorder and 15 of schizoaffective disorder. The assessment of basic symptoms was performed using the Frankfurter Beschwerde-Fragebogen (FBF). Data obtained suggest that perception and thought disturbances are the most characteristic experiences of schizophrenic patients in comparison with bipolar patients. The FBF questionnaire did not highlight a characteristic basic symptoms profile of schizoaffective disorder, when compared with bipolar affective disorder and schizophrenia.

Psychometric properties of EDE 12.0D in obese adult patients without binge eating disorder.

The aim of the present study is to assess the psychometric properties of the Eating Disorder Examination (EDE) 12.0D in obese adult patients without Binge Eating Disorder (BED). A consecutive series of 115 obese patients without BED (23 M; 92 F), seeking treatment for obesity at the Outpatient Clinic of the Section of Metabolic Diseases and Diabetology of the University of Florence was studied using the EDE 12.0D. Patients had a mean (+/- SD) age of 40.8 +/- 15.1 years, and a Body Mass Index (BMI) of 36.3 +/- 5.9 Kg/m2. Internal consistency of EDE and its scales was evaluated through Cronbach's alpha; factor structure of EDE 12.0D was studied with factor analysis. EDE total and Shape Concern (SC) scores were found to be higher in females than in males. EDE total, SC and Eating Concern (EC) scores were inversely correlated to age, but not BMI. Factor analysis suggested the grouping of items in two subscales. The first scale includes all the items from EC, Weight Concern (WC) and SC except reaction to prescribed weighing; the second scale consists of all the items from Restraint. Data obtained show that items from EC, WC and SC all converge into the same factor analysis derived scale in obese patients without BED. EDE 12.0D provides relevant information about psychopathological features of obese patients, but a grouping of items into subscales different from those originally described could be indicated.

Sertraline enhances the effects of cognitive-behavioral treatment on weight reduction of obese patients.

Serotonin reuptake inhibitors, such as dexfenfluramine, fluoxetine and fluvoxamine, have been proposed as therapeutical tools for the treatment of eating disorders and obesity. Sertraline, a SSRI used in the treatment of depression, interferes with eating behavior in animal models, but it has not been tested in obese humans. Aim of this study is the assessment of the effects of sertraline on eating attitudes and body weight in obese patients with and without mood disorders. A consecutive series of 65 obese out-patients aged 18-65 years, with a body mass index (BMI) > 30 kg/m2, was treated for 6 months with sertraline 150 mg/day per os, in addition to a cognitive-behavioral treatment (CBT). A consecutive series of 60 obese patients with similar characteristics, who were treated with CBT only, were used as control group. A greater reduction of BMI (mean +/- SD) was observed in sertraline-treated patients when compared to controls (from 35.3 +/- 5.7 to 32.0 +/- 5.4 kg/m2 in sertraline-treated patients, from 37.1 +/- 7.0 to 36.0 +/- 7.1 kg/m2 in controls; 6.5 +/- 5.4% vs. 3.0 +/- 6.3%; p < 0.01), while a similar change in eating attitudes (evaluated through the BITE questionnaire) was observed in both groups. Effects of sertraline on eating attitude and body weight were similar in patients with and without mood disorders. In conclusion, sertraline, administered together with CBT, seems to be more effective in inducing weight loss in obese patients when compared with CBT alone, and therefore it could be a useful tool in the first months of CBT for severe obesity.

[Psychopathological and clinical features among the ambulatory population of obese patients]. / Caratteristiche psicopatologiche e cliniche di una popolazione ambulatoriale di pazienti obesi.

Aim of the present study is the evaluation of psychopathological and clinical features of these outpatients followed by the Outpatient Clinic of the Section of Metabolic Diseases and Diabetes, University of Florence. 84 obese patients and 217 non-obese control subjects were studied using the Structured Clinical Interview for DSM-III-R (SCID), and applying DSM-IV criteria for Binge Eating Disorder. BITE self-reported questionnaire, STAI inventory and Ham-D rating scale were also used. Lifetime prevalence of Binge Eating Disorder in obese patient was 11.9%, markedly lower than that reported in studies on North American samples. Prevalence of depressive disorder (Major Depression and Dysthymia) was significantly higher (p < 0.005) in obese patients than in control subjects. This confirms the important relationships between eating and mood disorders. The prevalence of subclinical eating disorders resulted to be significantly higher in obese patients (p < 0.01) when compared with control subjects. Significant correlations (p < 0.01) of BITE scores were observed with STAI and Ham-D scores, but not with body mass index. These results underline the need for an accurate psychopathological assessment in obese patients, in order to formulate a correct diagnosis and plan adequate therapeutical interventions.

Puerperal psychoses: a clinical case study with follow-up.

Thirty cases of post-partum psychotic disorders occurred between 1973 and 1987 and hospitalized at the Psychiatric Ward of Florence University were studied and followed up. A structured diagnostic interview was used, which explored DSM Ill-R diagnosis both for mood disorders and for psychotic features. The psychotic symptoms had started within 8 weeks of parturition in all cases. Only 36.7% of the patients showed no subsequent pathology after the puerperal symptoms. The diagnoses, both at the index episode and at the follow-up, revealed a great predominance of mood disorders and the absence of schizophrenia. The follow-up survey showed a greater proportion of bipolar disorders than it appeared at the puerperal onset of the disease. A high frequency of puerperal psychotic relapses has also occurred after subsequent deliveries during the follow-up period.

[The problem of "middle cases". Psychopathologic and nosographic evaluation]. / Il problema dei "casi a mezzo". Valutazione psicopatologica e nosografica.

A group of 246 psychotic patients diagnosed on the basis of DSM III R was compared to standard parameters in order to define the so-called "middle cases". A group of 12 patients who matched these parameters was thus obtained independently of the initial diagnosis. This group was then compared with two other groups of similar sizes made up of schizophrenic patients and patients suffering from major depressive disorders respectively; neither of the latter groups corresponded to the above mentioned standard parameters. This comparison revealed a substantial equi-distance between the three groups, thus confirming the inadequacy of a method of classification into categories when applied to such a complex and articulated field as psychosis.

[Evaluation of the efficacy and tolerability of fluoxetine in major depression, Multicenter clinical study]. / Valutazione dell'efficacia e della tollerabilità della fluoxetina nella depressione maggiore. Studio clinico multicentrico.

In an Italian multicenter study, 296 patients (115 males, 181 females) affected with major depression diagnosed according to the criteria of the DSM III-R, were treated for 8 weeks with 20 mg/die fluoxetine (Fluoxeren-Menarini s.r.l.). At the end of the therapy the mean scores on the Hamilton Depression Scale had improved considerably, going down from 27.42 to 10.05. 69.6% of the patients had improved by at least in the 50% in the HAM-D scores (responders). At the CGI the overall improvement was evaluated with a mean score of 2.05 (marked improvement), while the patients assessed themselves at the end of treatment as being from "improved" to "greatly improved". No significant differences in efficacy were found to depend on age, type of depression or response to previous treatment, though younger patients (18-40 years), and those with single or recurring episodes, with atypical depression and good response to other antidepressants, showed a more marked improvement. The tolerability of the drug was found to be good. The laboratory tests, ECG and body weight stayed within normal limits.

[Changes in family perception in a group of chronic alcoholics in treatment]. / Modificazione dei vissuti familiari in un gruppo di alcolisti cronici in trattamento.

By means of the Symbolic Drawing of the Family Life Space and Social Adjustment Scale, administered to a group of alcoholics under treatment with Hudolin's method, it is possible to evidence a definite improvement in subjective perception of family relationships. General Social Adjustment of these patients also is better than that of a group of non-treated alcoholics. This improvement in subjective perception of family relationships is less relevant than that in other relationships explored.