The Florence Emotional Eating Drive (FEED): a validation study of a self-report questionnaire for emotional eating.

PURPOSE: Emotional eating is a trans-diagnostic dimension in eating disorders and is present in many other conditions that could affect eating attitudes. At present, there is no instrument that measures emotional eating evaluating both the intensity and the frequency of emotion-induced desire to eat. The aim of the study was the validation of the Florence Emotional Eating Drive (FEED). METHODS: A sample of healthy volunteers was initially enrolled to explore internal consistency and test-retest reliability. The Emotional Eating Scale (EES), Eating Disorders Evaluation-Questionnaire (EDE-Q), Binge Eating Scale (BES) and Symptom Checklist-90 (SCL-90-R), together with the final version of FEED, were administered to a clinical sample composed by patients with eating disorders, obesity, and type 2 diabetes, to explore the underlying structure of the questionnaire and verify its validity. RESULTS: FEED showed excellent internal consistency (Cronbach's alpha = 0.96) and test-retest reliability (r = 0.93). FEED scores were higher in patients with BN and BED than in AN patients, negatively correlated with age and positively with BES and EES. Multiple regression analysis showed that FEED, but not EES, was independently associated with SCL-90-R and EDE-Q scores. CONCLUSION: FEED internal consistency and test-retest reliability were excellent. The addition of specific questions on the frequency of behaviours led to a better component structure and robustness compared to EES. A tool that reliably and specifically assesses eating behaviours driven by emotional states may be extremely useful in clinical settings. LEVEL OF EVIDENCE: Level V, cross-sectional study.

Long-term metabolic and cardiovascular effects of antipsychotic drugs. A meta-analysis of randomized controlled trials.

Most of the randomized controlled trials (RCTs) on antipsychotics (APs) have efficacy as their primary endpoint, leading to a lack of evidence on long-term metabolic effects of APs. The aim of the present meta-analysis is to compare different APs for the long-term modification of risk of major adverse cardiovascular events (MACE) and related mortality, in patients with schizophrenia and bipolar disorder. All RCTs found on Medline/Embase of at least 52 weeks up to 19 December 2017, enrolling patients with bipolar disorder or schizophrenia and comparing an AP with another AP or placebo were included. The primary outcome of this analysis was the association of APs with the incidence of cardiovascular death, myocardial infarction (MI), and stroke. 3013 studies were screened, 92 met the selection criteria. MI, stroke and cardiovascular death were reported in 11, 6 and 24 studies, respectively. No significant difference was observed with respect to MI and Stroke; a significantly higher cardiovascular mortality was observed for sertindole when compared to risperidone (Mantel-Haenszel Odds Ratio: 2.56, 95% CI: 1.33 - 5). Long-term cardiovascular effects of APs deserve to be studied more extensively. The request by regulatory authorities of cardiovascular safety data from specifically designed trials would be useful.

Comparison of two different treatments in depressed pregnant women: fetal growth characteristics and neonatal outcomes.

Background In this pilot study, the effects of selective serotonin reuptake inhibitors (SSRIs) and psychological intervention on fetal growth characteristics and neonatal outcomes were evaluated in two different groups of women affected by prenatal depression. Methods Forty-seven pregnant women diagnosed with major depression were divided into two different treatment groups according to the severity of their depression. The first group was treated with a combination of pharmacotherapy and psychological support. The second group (milder depression) was treated with psychological support only. The control group (CG) was made up of 26 healthy pregnant women. All of the patients and controls were assessed by means of a structured clinical interview and different self-reported questionnaires. Fetal ultrasonography assessments were performed in the second and third trimesters. Neonatal outcomes were evaluated at delivery. Results The infants of both treatment groups showed significant alterations in fetal biometry and a higher rate of low birth weight (LBW) with respect to controls. The infants of the patients treated with psychological support showed only a significantly higher rate of head circumference, <10th percentile with respect to controls. No significant difference was found between the two patient groups when fetal growth characteristics and neonatal outcomes were taken into account. Conclusion The data obtained from this study shed light on the effects of pharmacological and psychological treatment of prenatal depression on fetal growth.

Emotional eating and temperamental traits in Eating Disorders: A dimensional approach.

Growing evidence shows that temperamental features and emotional dysregulation are linked to Eating Disorders (EDs). Aim of this study was to explore the possible relationship between temperament and emotional eating (EE) from a dimensional standpoint, and the association of specific temperamental dimensions with overeating triggered by specific emotions. We enrolled 253 women with Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder. Of those, 189 (74.7%), 73 (28.8%), and 80 (31.6%) reported binge eating, purging, or restrictive behaviors, respectively (the categories are not mutually exclusive). Participants completed the Emotional Eating Scale (EES), the Temperament and Character Inventory, the Eating Disorder Examination Questionnaire (EDE-Q) and the Symptom Checklist 90-Revised (SCL-90-R). Higher Persistence scores were found in the Restriction group, while the Binge group reported lower Persistence and higher Novelty Seeking scores. The Purge group showed lower Reward Dependence, Self Directedness and Cooperativeness scores. Patients with Purge also reported lower BMI and higher scores on EDE-Q restriction and eating concern subscales as well as higher scores for all SCL 90-R subscales. Patterns of association between temperamental traits and specific emotions were found in each group. Therefore, some temperamental features could be considered predictors of specific associations between emotions and the tendency to eat.

Assessment of psychological predictors of weight loss: How and what for?

Obesity is a multifactorial disease and the prominent factors playing a role in its pathogenesis are biological, environmental and psychological. There is a growing interest in understanding psychological functioning of obese subjects and the influence of psychological factors on treatment outcome. The aim of the present narrative review is to critically analyze the current literature, in order to point out the most common psychological constructs studied in obesity and to give an overview of the main existing tools investigating psychological features which have been considered significant for the prediction of success in weight loss and maintenance programs in obese patients. In this framework, the most common psychological constructs studied are: self-motivation, self-efficacy, locus of control, health related quality of life, self-esteem, self-control, concerns about body image, outcome expectations, and personality traits. These features have been explored through a wide variety of psychometric instruments. However, as an overall, studies evaluating the association between psychological features and treatment outcome failed to give consistent results. A possible explanation may consist on the fact that many tools widely used to explore psychological features were not specifically designed for obese patients and none of them was comprehensive of all possible psychological features involved. The identification of well-defined sub-groups of patients and the validation of more reliable and comprehensive tools, specifically designed for obese subjects, should be forecasted in order to reach a better knowledge of psychological functioning of obese individuals and to improve the outcome of weight loss programs.

Association between resting energy expenditure, psychopathology and HPA-axis in eating disorders.

AIM: To investigate the complex relationships between resting energy expenditure (REE), eating psychopathology, and Hypothalamus Pituitary Adrenal axis functioning in patients with eating disorders. METHODS: The study was designed as a cross-sectional survey, and it was planned by the Clinic for Eating Disorders of the University of Florence (Italy). The protocol was approved by the Ethics Committee of the Institution. Twenty two anorexia nervosa and twenty one Bulimia Nervosa patients were assessed by means of a clinical interview and the structured clinical interview for diagnostic and statistical manual of mental disorders, fourth edition. Eating attitudes and behaviour were specifically investigated by means of the eating disorder examination questionnaire (EDE-Q). Patients were also evaluated by means of the symptom checklist (SCL 90-R), REE was measured by means of indirect calorimetry, and blood cortisol morning levels were evaluated. RESULTS: Both anorexia nervosa and bulimia nervosa patients showed a reduced REE as compared with predicted REE. Body mass index (BMI) was positively associated with resting energy expenditure in Bulimics, whereas a strong, negative association between BMI and REE was observed in Anorectics. The pattern of associations between variables supported a mediation model, where shape concern accounted for variations in REE and cortisol levels (mediator), and variations in the mediator significantly accounted for variations in REE. When these associations where taken into account together, the relationship between shape concern and REE was no longer significant, whereas the association between cortisol levels and REE retained its significance, showing strong evidence for a single, dominant mediator. Anorectics and Bulimics showed an opposite pattern of association between BMI and REE. In Anorectics only, a higher REE was associated with a more severe eating disorder specific psychopathology, and cortisol levels represent a possible mediating factor for this relationship. CONCLUSION: The data supported a mediation model where cortisol levels mediated the relationship between eating psychopathology (concern about body shape) and REE.

All roads bring to Rome: a different way for predicting success in the therapy of obesity through psychological features.

PURPOSE: Obesity treatment based on lifestyle modifications is characterized by a high proportion of treatment failures. The study of predictors of success could be useful for a better definition of therapeutic needs in individual patients. Few studies have attempted a comprehensive assessment of psychological factors related with treatment response. Aim of the study is the identification of psychological and psychopathological features associated with a good treatment response in patients referring for obesity. METHODS: This prospective observational study was conducted on a consecutive series of 270 obese patients and a six-month follow-up was performed. At enrollment, a complete medical history was collected and, psychopathology and psychological features were assessed with: General psychopathology: Symptom Checklist 90-revised, Eating Disorder Examination-Questionnaire, Obesity Related well-being and Treatment, Motivation and Readiness test. RESULTS: Among the 231 patients evaluated at follow-up, the mean weight loss was 3.2% of initial body weight and 68 patients (29.4%) reached the pre-defined therapeutic target of 5% weight loss. Higher psychopathology was associated with a worse outcome in women only; whereas motivation was higher in patients achieving therapeutic targets among men, but not in women. CONCLUSIONS: Mean weight loss obtained with lifestyle interventions is confirmed to be rather small and a more accurate selection of patients to be enrolled in lifestyle intervention programs is needed. The present study provides some intriguing information on predictors of weight loss, which could be useful for the identification of patients with a higher chance of succeeding with lifestyle programs for the treatment of obesity.

Is there a practical way of predicting therapeutic success in type 2 diabetes on the basis of psychological features? Development and validation of the Psychological Predictors of Therapeutic success in Diabetes (PPTD) questionnaire.

Many psychiatric disorders and symptoms have been associated with impaired metabolic control in type 2 diabetes; several studies focused on non-pathological psychological features. Aims of this observational, longitudinal study are: the assessment of the impact of a wide range of psychological factors on metabolic control in type 2 diabetes; and the development and validation of a simple questionnaire to assess the impact of psychological factors on therapeutic success. To identify psychological factors interfering with attainment of glycemic targets, a prospective 1-year study was performed on a sample of 250 patients with type 2 diabetes. The impact of identified factors on therapeutic outcome was then subsequently verified on a further, independent sample of 200 patients. The first phase of the study allowed the development of a 19-items questionnaire, the Psychological Predictors of Therapeutic success in Diabetes (PPTD) questionnaire. Validation analyses showed that the questionnaire was able to predict therapeutic success. Patients with HbA1c ≤7% (53 mmol/mol) at follow-up showed higher test scores than those with HbA1c >7% [31.0 (26.2; 35.0) vs 28.0 (23.0; 32.0); p = 0.016]. The attainment and maintenance of therapeutic goals in patients with type 2 diabetes depend on a wide range of factors. The PPTD is an attempt at condensing the complexity of psychological factors affecting glycemic control in a simple and easy-to-use self-reported questionnaire, which can be used in wide-scale research.

[Female sexual functioning: the role of psychopathology]. / Funzionamento sessuale femminile: il ruolo della psicopatologia.

BACKGROUND: In the study of the relationship between sexuality and psychopathology, female sexual functioning appears to be relatively poorly explored. In addition, most studies have been conducted on clinical samples, so that the question of whether non-clinically relevant psychopathological symptoms may have a negative impact on women's sexual response still remains unanswered. The aim of this study was to analyze the influence of psychopathology on specific phases of sexual functioning (desire, arousal, lubrication, orgasm, satisfaction) and pain in a sample of young women without psychiatric case history. METHODS: Two questionnaires were administered to a sample of female students in Psychology of the University of Florence (n=75): the Symptom Checklist (SCL-90) to evaluate psychic distress and the Female Sexual Function Index (FSFI) for data collection on sexual functioning. RESULTS: 44 questionnaires were valid. The dimensions of SCL-90 explain a relatively high percentage of variance of the global severity index of sexuality (R²=0.49); significant predictors were: somatization (Beta=-0.75), depression (Beta=-0.89), anxiety (Beta=-0.79), and hostility (Beta=-0.48). The same variables were significant predictors, though at a lesser extent, for all the single dimensions of sexuality, with the exception of pain, on which only hostility had a significant correlation (Beta=-0.55). CONCLUSIONS: Although the small size and the peculiar characteristics of the sample do not allow to extrapolate the results, the findings of this study show that psychopathological dimensions can affect female sexual functioning at subclinical level in the absence of the confounding effect of drug therapy.

The role of life events and HPA axis in anxiety disorders: a review.

Stressful life events and dysfunctional Hypothalamic Pituitary Adrenal (HPA) axis have been implicated in the pathogenesis of psychiatric disorders, including anxiety disorders. This paper attempts to review the existing literature on childhood traumata, recent life events, HPA axis functioning and their relationship in Post-Traumatic Stress Disorder, Panic Disorder, Generalized Anxiety Disorder, Obsessive Compulsive Disorder and Social Phobia. Preclinical and clinical models will be analyzed. Stressful life events seem to have a role in the onset and in the course of these disorders and HPA axis abnormalities have been reported in almost all anxiety disorders. The hypothesis that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology, will be evaluated.

Emotional eating in anorexia nervosa and bulimia nervosa.

OBJECTIVES: The relationship between emotional states and eating behaviors is complex, and emotional eating has been identified as a possible factor triggering binge eating in bulimia nervosa (BN) and binge eating disorder. Few studies considered emotional eating in patients with anorexia nervosa. METHODS: The present study evaluated the clinical correlates of emotional eating in 251 eating-disordered (EDs) subjects (70 AN restricting type, 71 AN binge eating/purging type, 110 BN purging type) and in a group of 89 healthy control subjects. Subjects were assessed by means of a clinical interview (Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) and several self-reported questionnaires, including the Emotional Eating Scale (EES). RESULTS: No significant differences were found between the 3 EDs groups in terms of EES total score, and all patients with ED showed higher EES scores compared with control subjects. Emotional eating was associated with subjective binge eating in AN binge eating/purging type and with objective binge eating in patients with BN. Among patients with AN restricting type, emotional eating was associated with restraint, but this association was lost when controlling for fear of loss of control over eating, which was the principal determinant of restraint. CONCLUSION: Emotional eating and fear of loss of control over eating are significantly associated with specific eating attitudes and behaviors, according to the different diagnoses. Emotional eating is a relevant psychopathologic dimension that deserves a careful investigation in both anorectic and bulimic patients.

Different moderators of cognitive-behavioral therapy on subjective and objective binge eating in bulimia nervosa and binge eating disorder: a three-year follow-up study.

BACKGROUND: Different studies considered the mechanisms involved in the maintenance of binge eating in bulimia nervosa (BN) and binge eating disorder (BED), suggesting different pathways. The present 3-year follow-up study evaluated the relationships between psychopathological variables, and objective and subjective binge eating episodes in the two syndromes. METHODS: 85 BN and 133 BED patients were studied. Objective and subjective binge eating, and psychopathological data were collected in a face-to-face interview, and by means of different self-reported questionnaires. The same assessment was repeated at baseline (T0), at the end of an individual cognitive-behavioral treatment (T1), and 3 years after the end of treatment (T2). RESULTS: At baseline, BN and BED patients showed different emotions associated with binge eating: anger/frustration for BN and depression for BED patients. Objective binge eating frequency reduction across time was associated with lower impulsivity and shape concern in BN patients, and with lower emotional eating and depressive symptoms in BED patients. Lower subjective binge eating frequency at baseline predicted recovery, in both BN and BED patients. Recovery was associated with lower impulsivity and body shape concern at baseline for BN patients, and lower depression and emotional eating for BED patients. CONCLUSIONS: Eating psychopathology, psychiatric comorbidity, impulsivity and emotional eating have a different pattern of association with objective and subjective binge eating in BN and BED patients, and they act as different moderators of treatment. A different target of intervention for these two syndromes might be taken into account, and subjective binge eating deserves an accurate assessment.

Childhood stressful events, HPA axis and anxiety disorders.

Anxiety disorders are among the most common of all mental disorders and their pathogenesis is a major topic in psychiatry, both for prevention and treatment. Early stressful life events and alterations of hypothalamic pituitary adrenal (HPA) axis function seem to have a significant role in the onset of anxiety. Existing data appear to support the mediating effect of the HPA axis between childhood traumata and posttraumatic stress disorder. Findings on the HPA axis activity at baseline and after stimuli in panic disordered patients are inconclusive, even if stressful life events may have a triggering function in the development of this disorder. Data on the relationship between stress, HPA axis functioning and obsessive-compulsive disorder (OCD) are scarce and discordant, but an increased activity of the HPA axis is reported in OCD patients. Moreover, normal basal cortisol levels and hyper-responsiveness of the adrenal cortex during a psychosocial stressor are observed in social phobics. Finally, abnormal HPA axis activity has also been observed in generalized anxiety disordered patients. While several hypothesis have attempted to explain these findings over time, currently the most widely accepted theory is that early stressful life events may provoke alterations of the stress response and thus of the HPA axis, that can endure during adulthood, predisposing individuals to develop psychopathology. All theories are reviewed and the authors conclude that childhood life events and HPA abnormalities may be specifically and transnosographically related to all anxiety disorders, as well as, more broadly, to all psychiatric disorders.

[Sexuality and eating disorders]. / Sessualità e disturbi del comportamento alimentare.

AIM: The aim of the present study is to explore the sexual functioning of an Eating Disorders (ED) sample composed by Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Eating Disorders Not Otherwise Specified (EDNOS) patients. METHODS: 98 patients (AN: 23; BN: 14; EDNOS: 61) have been compared with 88 health subjects. All participants have filled in the following questionnaires: Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI), Symptom Checklist-90 (SCL-90), Eating Disorders Examination (EDE-q), Binge Eating Scale (BES), Emotional Empathy Scale (EES). For the evaluation of the sexual activity Female Sexual Function Index (FSFI) was applied. RESULTS: 67 patients (68.4%) and 80 healthy controls (90.9%) reported a sexual activity with a partner or masturbation in the four latest weeks. Only one healthy control (1.1%) reported masturbation and 79 (89.8%) controls showed sexual activity with a partner, on the contrary 11 patients (11.2) reported masturbation and 56 (57.1%) patients showed sexual activity with a partner. Moreover patients showed higher scores on every FSFI subscales. No significant differences were observed between AN, BN and BED in terms of FSFI scores. DISCUSSION: Women with ED show a lower sexual activity with a partner, a six-fold increase in the risk of sexual dysfunction and an higher frequency of masturbation as the only sexual activity when compared with healthy controls. The cognitive distraction produced by the discomfort to show own body during a sexual intercourse with the partner may explain our results.

[Use of psychotropic drugs in children, adolescents and subjects with intellectual disability: a review]. / Revisione dell'uso di psicofarmaci in età evolutiva e in pazienti con disabilità intellettiva.

AIM: In children, adolescents and subjects with intellectual disability (ID), psychotropic drugs are being used in large and increasing quantities. The aim of this article is to review efficacy and safety evidences of psychotropic drugs use in the above-mentioned patients. METHODS: A literature search on this argument was conducted on Medline electronic archives encompassing english-language and other languages publications. RESULTS: In children, adolescents and subjects with ID, the use of antidepressants, antipsychotics and mood stabilizers, besides being effective for indications in psychiatric disorders of adults without ID, is proved to have good clinical efficacy in disorders which are characteristic of such patients categories, such as pervasive developmental disorders, disruptive behavior disorders and problem behaviours. In both patients populations non-medication based strategies should be considered first. The adverse effects profiles of psychotropic drugs administered in children, adolescents and subjects with ID seems to be different from the ones registered in adults without ID, thus particular caution and precautions are recommended. DISCUSSION: Given the paucity of data (especially in the long term) and the metodological limitations of currently available researches, more studies are needed to develop scientific evidences able to guide practitioners in the use of psychotropic medications among childhood, adolescence and ID.

[Neuroimaging and neurobiology of social anxiety]. / Neuroimaging e neurobiologia dell'ansia sociale.

AIM: Social Anxiety Disorder (SAD) represents one of the most frequent psychiatric disorders. The results of a systematic review of the literature published until January 2010 on the neurobiology of SAD are reported, giving prominence to functional neuroimaging (fNI) findings. METHODS: A literature search of neuroimaging and neurobiology studies of SAD was conducted on PubMed and Medline electronic archives and by canvassing English-language and other European languages publications. Eligible studies were restricted to those on adult population (age 16 to 65) and using DSM and ICD criteria. RESULTS: The 19 reviewed fNI studies on SAD agree in identifying a dysfunction of five main cerebral areas: the amygdala, the medial prefrontal cortex, the insula, the hippocampus and the dorsolateral prefrontal cortex. Those findings strongly suggest the presence, in this disorder, of functional alterations in the neural systems involved in the genesis of fear, in the processing of emotional stimuli, in the "self" perception and in the evaluation of others' intentions. DISCUSSION: Neurobiology research on SAD is still relatively young and, up to today, available findings are still not exhaustive. Nonetheless, a growing evidence from different lines of research seems to suggest that SAD patients may present a distinct biologic background compared to control subjects. Until now, however, no specific neurobiological aspect has been proposed for the SAD only. Per contra, results from fNI studies seem to indicate the presence of a common pattern of neural dysfunction in all the major anxiety disorders.