A Randomized Trial of Deep Brain Stimulation to the Subcallosal Cingulate and Nucleus Accumbens in Patients with Treatment-Refractory, Chronic, and Severe Anorexia Nervosa: Initial Results at 6 Months of Follow Up.

BACKGROUND: The main objective of this study was to assess the safety and efficacy of deep brain stimulation (DBS) in patients with severe anorexia nervosa (AN). METHODS: Eight participants received active DBS to the subcallosal cingulate (SCC) or nucleus accumbens (NAcc) depending on comorbidities (affective or anxiety disorders, respectively) and type of AN. The primary outcome measure was body mass index (BMI). RESULTS: Overall, we found no significant difference (p = 0.84) between mean preoperative and postoperative (month 6) BMI. A BMI reference value (BMI-RV) was calculated. In patients that received preoperative inpatient care to raise the BMI, the BMI-RV was defined as the mean BMI value in the 12 months prior to surgery. In patients that did not require inpatient care, the BMI-RV was defined as the mean BMI in the 3-month period before surgery. This value was compared to the postoperative BMI (month 6), revealing a significant increase (p = 0.02). After 6 months of DBS, five participants showed an increase of ≥10% in the BMI-RV. Quality of life was improved (p = 0.03). Three cases presented cutaneous complications. CONCLUSION: DBS may be effective for some patients with severe AN. Cutaneous complications were observed. Longer term data are needed.

Cognitive impairment in eating disorder patients of short and long-term duration: a case-control study.

Introduction: Several studies have noted the potentially negative effect of eating disorders (ED) on cognitive performance. Objective: To compare the impact of the duration of abnormal eating behaviors on cognitive performance in a sample of people with short- and long-term eating disorders and in two control groups matched for age. Method: The neuropsychological performance of 82 women diagnosed with an eating disorder were compared with two control groups from the community of 66 healthy women. Time of duration of the disorder was less than two years in half of the clinical sample, and more than 10 years in the other half. The following instruments were used to measure neuropsychological performance: the Matrix Test, the Stroop task, the Trail-Making Test, the Tower of London Test, the Posner Spatial Task, the Rey's Complex Figure, the Wechsler Vocabulary Test, and the Hayling Completion Test. Results: It showed that persons with long-term ED presented more impaired neuropsychological profiles, but not in all areas. In contrast, the short-term ED group presented similar profiles to the control groups. Discussion: This study highlights the positive association between cognitive impairment and time of evolution of ED, above all in perceptual measures and non-verbal memory. Considering the effect of the evolution of ED cognitive performance (especially in long-term patients) may further our understanding of the development of the disorder and the factors that may favor its persistence.

Benefits of a Secondary Prevention Program in Suicide.

BACKGROUND: The effectiveness of suicide intervention programs has not been assessed with experimental designs. AIM: To determine the risk of suicide reattempts in patients engaged in a secondary prevention program. METHOD: We included 154 patients with suicidal behavior in a quasi-experimental study with a nontreatment concurrent control group. In all, 77 patients with suicidal behavior underwent the Suicide Behavior Prevention Program (SBPP), which includes specialized early assistance during a period of 3-6 months. A matched sample of patients with suicidal behavior (n = 77) was selected without undergoing any specific suicide prevention program. Data on sociodemographics, clinical characteristics, and suicidal behavior were collected at baseline (before SBPP) and at 12 months. RESULTS: After 12 months, SBPP patients showed a 67% lower relative risk of reattempt (χ2 = 11.75, p = .001, RR = 0.33 95% CI = 0.17-0.66). Cox proportional hazards models revealed that patients under SBPP made a new suicidal attempt significantly much later than control patients did (Cox regression = 0.293, 95% CI = 0.138-0.624, p = .001). The effect was even stronger among first attempters. LIMITATIONS: Sampling was naturalistic and patients were not randomized. CONCLUSION: The SBPP was effective in delaying and preventing suicide reattempts at least within the first year after the suicide behavior. In light of our results, implementation of suicide prevention programs is strongly advisable.

Resultados del programa de prevención de la conducta suicida. Distrito de la Dreta de l’Eixample de Barcelona / Outcomes of a suicide prevention program in the general population. Barcelona dreta eixample district

Fundamento y objetivo: el suicidio y las conductas autodestructivas son en parte un problema sanitario pero también social y personal. En este sentido, la actuación desde la salud pública y comunitaria es importante para aumentar la supervivencia de las personas en riesgo suicida. El objetivo de este trabajo es mostrar algunos resultados de un programa basado en la educación sanitaria de la población general y el establecimiento de circuitos asistenciales específicos para el seguimiento de esta población de riesgo. Material y método: El Programa de Prevención de la Conducta Suicida (PPCS), llevado a cabo en el distrito de la Dretade l’Eixample de Barcelona, incluyó a 219 pacientes de los que 148 (67,5%) completaron el seguimiento al año. Se seleccionó un grupo de comparación de 180 pacientes, procedentes de otros distritos colindantes en los que no se realizaba el PPCS, 167 de los cuales completaron el seguimiento. Resultados: en las comparaciones de ambos grupos las principales diferencias significativas fueron que los pacientes que entran en el PPCS consultaron más frecuentemente por ideas suicidas que el de comparación (36 % vs 25%), presentaron menos ingresos hospitalarios (6% vs 36%), repitieron menos tentativas suicidas al año de seguimiento (11%vs 32%) y el tiempo hasta la repetición fue mayor. Conclusiones: La detección precoz de las ideas suicidas y la adherencia a la terapia post-tentativa, como se observa en los pacientes del PPCS, disminuye las recidivas. Se requieren nuevos estudios más prolongados que reduzcan también la mortalidad suicida (AU)

Background and objective. Suicide and self destructive behaviors are not only health problems but are also related to social and personal aspects. Public health and community action can play an important role in increasing survival among those at risk. We present the results of a program based on health education among the general population and in a specific health care setting to monitor the at risk population. Subjects and Method. The Suicide Behavior Prevention Program (SBPP) developed in the Dreta del’Eixample district in Barcelona city included 219 patients, 148 (67.5%) of whom completed a 12-month follow-up. We selected a comparison group from a neighboring district that did not have a SBPP. This group was made up of 180 patients, 167 of whom completed the 12-monthfollow-up. Results. Main differences between the two groups were that patients who were enrolled in the SBPP consulted more often for suicidal thoughts than those in the comparative group (36% vs 25%), had fewer hospital admissions (6% vs 36%), presented fewer repeated suicide attempts over the 12-month follow-up (11% vs 32%) and showed longer time to repeat attempt. Conclusions. Early detection of suicidal ideation and adherence to post-suicide attempt treatment reduce the risk of recurrent suicide attempts. Further studies with longer follow up may help to reduce suicide mortality (AU)

[Outcomes of a suicide prevention program in the general population; Barcelona Dreta de L Eixample district]. / Resultados del programa de prevención de la conducta suicida. Distrito de la Dreta de l'Eixample de Barcelona

BACKGROUND AND OBJECTIVE. Suicide and self-destructive behaviors are not only health problems but are also related to social and personal aspects. Public health and community action can play an important role in increasing survival among those at risk. We present the results of a program based on health education among the general population and in a specific health care setting to monitor the at risk population. SUBJECTS AND METHOD. The Suicide Behavior Prevention Program (SBPP) developed in the Dreta de l'Eixample district in Barcelona city included 219 patients, 148 (67.5%) of whom completed a 12-month follow-up. We selected a comparison group from a neighboring district that did not have a SBPP. This group was made up of 180 patients, 167 of whom completed the 12-month follow-up. RESULTS. Main differences between the two groups were that patients who were enrolled in the SBPP consulted more often for suicidal thoughts than those in the comparative group (36% vs 25%), had fewer hospital admissions (6% vs 36%), presented fewer repeated suicide attempts over the 12- month follow-up (11% vs 32%) and showed longer time to repeat attempt. CONCLUSIONS. Early detection of suicidal ideation and adherence to post-suicide attempt treatment reduce the risk of recurrent suicide attempts. Further studies with longer follow up may help to reduce suicide mortality. Key words (MEDLINE MeSH): Suicide, "Suicide, attempted", Risk reduction behavior, Health education, Follow-up studies, "Outcome assessment (Health care)"