Transdiagnostic Study of Impulsivity and Self-Injurious Behaviour in Unstable and Impulsive Disorders.

High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour.

Estudio Transdiagnóstico de la Impulsividad y de la Conducta Autolítica en los Trastornos Impulsivos e Inestables / Transdiagnostic study of impulsivity and self-injurious behavior in unstable and impulsive disorders

Introducción. La elevada comorbilidad entre el trastorno límite de la personalidad (TLP) y los trastornos de la conducta alimentaria (TCA) pone de manifiesto la necesidad de establecer modelos transdiagnósticos, donde la impulsividad podría tener un papel relevante en las manifestaciones dela conducta autolítica. Objetivos: 1) Comparar los niveles de impulsividad y conducta autolítica entre personas con TLP, personas con TCA y controles. 2) Predecir la presencia de conductas autolíticas a partir de la impulsividad y otras variables clínicas relevantes, como la vivencia de acontecimientos traumáticos y la sensibilidad al rechazo. Método. 108 mujeres (23 controles; 29 con diagnóstico de TCA restrictivo (TCAr); 21 con diagnóstico de TCA purgativo (TCAp); y 35 con diagnóstico de TLP) fueron evaluadas a través de la Escala de Impulsividad de Barratt, el Cuestionario para Experiencias Traumáticas y el Cuestionario de Sensibilidad al Rechazo. La información sobre conducta autolítica fue recogida a través de entrevista e historia clínica. Resultados. Se encontraron diferencias en las puntuaciones de impulsividad y conducta autolítica entre los grupos, encontrándose mayor impulsividad en los grupos TLP y TCAp, y mayores índices de conducta autolítica en el grupo TLP seguido de ambos grupos de TCA. Por otro lado, la impulsividad predecía los intentos de suicidio, y junto con la sensibilidad al rechazo interpersonal predecía las autolesiones no suicidas (ANS).Conclusión. La impulsividad es una variable dimensional en el TLP y en los TCA, que a su vez juega un papel relevante en la predicción de las conductas autolíticas. (AU)

Introduction. High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations ofself-injurious behaviour. Objectives: 1) To compare the levelsof impulsivity and self-injurious behaviour among peoplewith BPD, people with ED and controls. 2) To predict the presence of self-injurious behaviour based on impulsivity andother relevant clinical variables, such as the experience oftraumatic events and sensitivity to rejection. Methods. 108 women (23 controls; 29 with a diagnosis of restrictive ACT (rED); 21 with a diagnosis of purgative ACT(pED); and 35 with a diagnosis of BPD) were assessed usingthe Barratt Impulsivity Scale, the Traumatic Experiences Questionnaire and the Sensitivity to Rejection Questionnaire. Information about self-injurious behaviour was collectedthrough interview and clinical history. Results. Differences in impulsivity and self-injurious behaviour scores were found between the groups, with higherimpulsivity in the BPD and pED groups, and higher rates ofself-injurious behaviour in the BPD group followed by both ED groups. On the other hand, impulsivity predicted suicideattempts, and together with sensitivity to interpersonal rejection predicted nonsuicidal self-harm (NSSH). Conclusion. Impulsivity is a dimensional variable in BPD and ED, which in turn plays a relevant role in the prediction of self-injurious behaviour. (AU)

Análisis descriptivo del suicidio en el bienio 2018-2019 en Valladolid (España) / Descriptive analysis of suicide in the 2018-2019 biennium in Valladolid (Spain)

Introducción: El suicidio y su prevención suponen un reto esencial en salud pública. Como primera causa externa de muerte en nuestro país, parece escapar a nuestra comprensión y control en vista de los numerosos estudios e intervenciones realizadas. Llevamos a cabo un estudio de los suicidios mortales estudiados por el Instituto de Medicina Legal y Ciencias Forenses de Valladolid durante el bienio 2018-2019. Material y métodos: Se recogieron todas las muertes por suicidio durante 2018-2019 y se cruzaron con los datos anonimizados del Servicio de Psiquiatría del Hospital Clínico Universitario de Valladolid en 2019. Resultados: La tasa de suicidios fue de 8,5/100.000 habitantes, 49 casos en 2018 y 44 en 2019, con una distribución de 3:1 para varones frente a mujeres, principalmente en el medio rural. La franja de edad con mayor incidencia fue la de 31-70 años. La ahorcadura en el medio rural y la precipitación en el urbano fueron los principales métodos. La comorbilidad psiquiátrica identificada más frecuente fueron los trastornos del estado de ánimo-afectivos (F30-39 CIE-10). Conclusiones: Las tasas de suicidio presentan un ligero descenso, mientras que el perfil de riesgo y las características del suicidio mortal se mantienen constantes en nuestro medio más de 20 años después, lo que indica una escasa eficacia de los esfuerzos preventivos realizados hasta ahora. La prevención efectiva del suicidio debe partir de la mejor identificación, prevención y tratamiento de los trastornos psiquiátricos, pudiendo resultar esencial la participación de los Institutos de Medicina Legal y Ciencias Forenses en programas poblacionales multinivel. (AU)

Introduction: Suicide and its prevention are a serious public health challenge. As the primary external cause of death in our country, it seems to be beyond our understanding and control in view of the numerous studies and interventions carried out. We conducted a study of suicide at the Valladolid Institute of Legal Medicine from 2018-2019. Material and methods: All deaths by suicide from 2018-2019 were collected and crossed with anonymized data of the Psychiatry Service of the University Clinical Hospital of Valladolid in 2019. Results: The suicide rate was 8.5/100,000 inhabitants, 49 cases in 2018 and 44 in 2019, with a 3:1 male to female ratio, mainly in rural areas. The age group with the highest incidence was 31-70 years. Hanging in rural areas and precipitation in urban areas were the main methods. Affective disorders (F30-39 ICD-10) were the most common identified psychiatric disorders. Conclusions: Suicide rates are slightly lower, while the risk profile and features of suicide remain constant in our environment more than 20 years later, indicating that preventive efforts carried out have not been completely successful. The effective prevention of suicide must start with better identification, prevention, and treatment of psychiatric disorders, but the contribution of the Institutes of Legal Medicine in the implementation of multilevel population programmes is also essential. (AU)

Confinamiento y salud mental: análisis del impacto en una muestra de 194 pacientes de psiquiatría del niño y del adolescente / Lockdown and mental health: Analysis of the impact on a sample of 194 child and adolescent psychiatry patients

Introducción y objetivo: La pandemia por COVID-19 ha sembrado una sensación de miedo e incertidumbre en todo el mundo, generando un malestar emocional que podría favorecer la aparición de enfermedades mentales. Los menores suponen un grupo más vulnerable en función de su edad, estudios, enfermedad mental preexistente, economía familiar o allegado afecto por COVID-19. Este artículo pretende destacar la repercusión emocional y psicológica en los menores del área este de Valladolid durante el confinamiento por COVID-19. Métodos Ciento noventa y cuatro progenitores fueron entrevistados mediante encuesta telefónica desde el 20 de abril al 15 de mayo de 2020, proporcionando información acerca de los efectos de la cuarentena en los menores. Resultados El 50% de los participantes estaban diagnosticados de trastornos hipercinéticos. La situación clínica de los menores se mantuvo sin cambios reseñables en un 51,4% (período rígido de confinamiento) y del 47,4% (período flexible). El 11% de los pacientes utilizaron >8h diarias dispositivos electrónicos durante la flexibilización, respecto al 3,9% durante el período rígido. Acerca de los ritmos biológicos, hasta un 34% de los pacientes (período rígido) y un 40,7% (período flexible) se acostaron después de medianoche. Un 25,2% de los pacientes durante el período rígido confirmaron un aumento de apetito. Solo el 2,58% de los menores expresaron elevada preocupación por COVID-19. Conclusión El confinamiento por COVID-19 ha repercutido de manera global en los menores. En términos generales, los progenitores percibieron una mayor repercusión en el estado emocional y conductual de sus hijos durante el período rígido, sin objetivar grandes cambios tras la flexibilización del confinamiento. (AU)

Introduction and objective: The COVID-19 pandemic has sown a feeling of fear and uncertainty throughout the world, generating emotional distress that could favor the appearance of mental illnesses. Minors are a more vulnerable group based on their age, studies, pre-existing mental illness, family finances or close relatives affected by COVID-19. This article aims to highlight the emotional and psychological impact on minors in the eastern area of Valladolid during the lockdown for COVID-19. Methods 194 parents were interviewed by telephone survey from April 20 to May 15, 2020, providing information about the effects of quarantine on minors. Results 50% of the participants were diagnosed with hyperkinetic disorders. The clinical situation of the minors remained unremarkable in 51.4% (rigid period of lockdown) and 47.4% (flexible period). 11% of patients used electronic devices >8h a day during flexibilization, compared to 3.9% during the rigid period. Regarding biological rhythms, up to 34% of patients (rigid period) and 40.7% (flexible period) went to bed after midnight. 25.2% of the patients during the rigid period confirmed an increase in appetite. Only 2.58% of minors expressed high concern about COVID-19. Conclusion Lockdown due to COVID-19 has involved a global impact on minors. In general terms, the parents perceived a greater impact on the emotional and behavioral state of their children during the rigid period, without objectifying major changes after the flexibilization of lockdown. (AU)

AN-VR-BE. A Randomized Controlled Trial for Reducing Fear of Gaining Weight and Other Eating Disorder Symptoms in Anorexia Nervosa through Virtual Reality-Based Body Exposure.

In vivo body exposure therapy is considered an effective and suitable intervention to help patients with anorexia nervosa (AN) reduce their body image disturbances (BIDs). However, these interventions have notable limitations and cannot effectively reproduce certain fears usually found in AN, such as the fear of gaining weight (FGW). The latest developments in virtual reality (VR) technology and embodiment-based procedures could overcome these limitations and allow AN patients to confront their FGW and BIDs. This study aimed to provide further evidence of the efficacy of an enhanced (by means of embodiment) VR-based body exposure therapy for the treatment of AN. Thirty-five AN patients (16 in the experimental group, 19 in the control group) participated in the study. FGW, BIDs, and other body-related and ED measures were assessed before and after the intervention and three months later. The experimental group received treatment as usual (TAU) and five additional sessions of VR-based body exposure therapy, while the control group received only TAU. After the intervention, ED symptoms were clearly reduced in both groups, with most of the changes being more noticeable in the experimental group. Specifically, after the intervention and at follow-up, significant group differences were found in the FGW and BIDs, with the experimental group showing significantly lower values than the control group. The current study provides new insights and encouraging findings in the field of exposure-based therapies in AN. VR technology might improve research and clinical practice in AN by providing new tools to help patients confront their core fears (i.e., food- or weight-related cues) and improve their emotional, cognitive, and behavioral responses to their body image.

Validity of Virtual Reality Body Exposure to Elicit Fear of Gaining Weight, Body Anxiety and Body-Related Attentional Bias in Patients with Anorexia Nervosa.

Fear of gaining weight (FGW), body image disturbances, associated anxiety and body-related attentional bias are the core symptoms of anorexia nervosa (AN) and play critical roles in its development and maintenance. The aim of the current study is to evaluate the usefulness of virtual reality-based body exposure software for the assessment of important body-related cognitive and emotional responses in AN. Thirty female patients with AN, one of them subclinical, and 43 healthy college women, 25 with low body dissatisfaction (BD) and 18 with high BD, owned a virtual body that had their silhouette and body mass index. Full-body illusion (FBI) over the virtual body was induced using both visuo-motor and visuo-tactile stimulation. Once the FBI was induced, the FBI itself, FGW, body anxiety and body-related attentional bias toward weight-related and non-weight-related body areas were assessed. One-way analyses of covariance (ANCOVA), controlling for age, showed that AN patients reported higher FGW, body anxiety and body-related attentional bias than healthy controls. Unexpectedly, patients with AN reported significantly lower FBI levels than healthy participants. Finally, Pearson correlations showed significant relationships between visual analog scales and body-related attentional bias measures, compared to other eating disorder measures. These results provide evidence about the usefulness of virtual reality-based body exposure to elicit FGW and other body-related disturbances in AN patients. Thus, it may be a suitable intervention for reducing these emotional responses and for easing weight recovery.

Síndrome opsoclonus-mioclonus secundario a intoxicación por duloxetina / Opsoclonus-myoclonus syndrome secondary to duloxetine poisoning

Introducción: El síndrome opsoclonus-mioclonus es una entidad poco frecuente, de origen autoinmune y que puede aparecer a cualquier edad, siendo mucho más frecuente en la edad pediátrica. Su etiología es muy diversa, frecuentemente paraneoplásica o de origen infeccioso. Los casos secundarios a intoxicación por drogas o medicamentos son infrecuentes. Caso clínico: Mujer de 43 años valorada por Psiquiatría de Enlace por sobreingesta de 80 comprimidos de duloxetina 30mg. Acude a Urgencias por un cuadro de inicio brusco de visión borrosa, temblor generalizado, dificultad para caminar y alucinaciones visuales. Ingresa en Neurología por sospecha de síndrome opsoclonus-mioclonus, recibe tratamiento esteroideo precoz, tras el que se observa mejoría clínica y recuperación temprana. Las pruebas complementarias resultan normales, excepto los niveles de duloxetina, que están muy por encima del rango normal. Discusión: El síndrome opsoclonus-mioclonus es un trastorno del movimiento infrecuente, que requiere una correcta evaluación debido a la posibilidad de estar relacionado con neoplasias subyacentes

Introduction: Opsoclonus-myoclonus syndrome is a rare entity of autoimmune origin, which can appear at any age, being much more common in paediatric patients. Its aetiology is very diverse, often of para-neoplastic or of infectious origin. Cases secondary to poisoning by drugs or other kind of medication are uncommon. Clinical case: A 43 year-old woman was examined by Liaison Psychiatry due to an overdose of 80 tablets of duloxetine 30mg. The patient went to the Emergency Service due to a sudden onset of blurred vision, general tremor, difficulty to walk, and visual hallucinations. She was admitted to the Neurology Department due to a clinical suspicion of opsoclonus-myoclonus syndrome. She received early steroid treatment, after which both clinical improvement and early recovery were observed. Complementary tests were normal except for duloxetine levels, which were found to be well above their normal range. Discussion: Opsoclonus-myoclonus syndrome is an uncommon disorder, which requires a correct diagnostic evaluation and analysis, as it could possibly be related to underlying neoplasms