Relationship Power Imbalance and Known Predictors of Intimate Partner Violence in Couples Planning to Get Married: A Baseline Analysis of the AMAR Cohort Study.

The increased interest on measuring violence in romantic relationships has led to the identification of some risk factors for intimate partner violence (IPV) in its different forms. Some of them are often present from the onset of the relationships. However, little attention has been paid to the engagement period. This might be, in part, due to the cognitive dissonance that hinders partners reporting intimate violence when they are planning their wedding. The purpose of our study is to test the association between the individual perception of relationship power imbalance (RPI)-a possible indirect measure of intimate violence-and known predictors of IPV. To test this hypothesis, a total of 254 premarital couples taking part in a dynamic prospective cohort study completed a questionnaire with questions about the perception of RPI and referred predictors of IPV. Results showed a positive correlation between the perception of RPI and known predictors of IPV. These findings suggest that RPI is a powerful indirect measure to detect situations that might imply a mild form of IPV and that could evolve into stronger presentations of violence later in marriage. Noticing the presence of RPI before marriage could encourage the prevention and development of personal and relational strategies to avoid the consolidation of violent dynamics within the marital relationship.

Personalidad: un determinante de la satisfacción conyugal en matrimonios con un cónyuge diagnosticado de depresión mayor / Personality: a determinant in marital dissatisfaction in individuals with major depression and their couples

Introducción: La literatura sugiere que existen factores que explican la asociación entre insatisfacción conyugal y Depresión Mayor. Analizamos si la personalidad actúa como factor determinante en la asociación entre insatisfacción conyugal y la aparición de un Primer Episodio de Depresión Mayor (PEDM). Además, estudiamos si hay factores de personalidad específicos que se relacionen con la insatisfacción conyugal en función de la evolución del PEDM. Metodología: Administramos la Escala de Hamilton para la Depresión y la Escala de Ajuste Diádico en el momento del diagnóstico del trastorno depresivo (T1) y seis meses más tarde (T2), en seis centros ambulatorios. Participaron 59matrimonios con un cónyuge diagnosticado de PEDM y otro cónyuge sano. Además, los pacientes deprimidos completaron el Inventario de Personalidad NEO-PIR. Resultados: Hay factores de personalidad que median entre el PEDM y la insatisfacción conyugal. El “neuroticismo” media tanto en T1 como en T2. Sin embargo, la relación entre los factores de personalidad y la insatisfacción conyugal depende de la evolución del episodio. Si éste ha remitido enT2, la personalidad puede no asociarse con la interacción conyugal, pero si persiste, la “apertura” y la “responsabilidad” se asocian con menor insatisfacción conyugal. Conclusiones: El “neuroticismo” es el factor de personalidad más importante como mediador entre insatisfacción conyugal y la evolución de un PEDM (AU)

Introduction: Prior research suggests that some factors account for the association between marital dissatisfaction and Major Depression. We examined whether personality determines the association between marital dissatisfaction and a First Episode of Major Depression (FEMD), and whether specific personality factors are linked to marital dissatisfaction depending on the outcome of the FEMD. Methods: The Hamilton Rating Scale for Depression and the Dyadic Adjustment Scale were administered both at baseline (T1) and six months later (T2), at 6 outpatient settings. We counted on the participation of 59 married couples with one member fulfilling DSM-IV criteria for a FEMD, and a healthy partner. Depressed participants also completed the NEO Personality Inventory-Revised. Results: Certain personality factors mediate the association of a FEMD and Marital Dissatisfaction. “Neuroticism” mediates the association both at T1 and T2. However, the relationship between personality factors and Marital Dissatisfaction depends on the outcome of the Episode. If it has remitted by T2, personality might not be associated with marital interaction. However, if depression persists, “openness” and “conscientiousness” are related to less marital dissatisfaction. Conclusion: The most important mediating personality factor between marital dissatisfaction and a First Episode of Major Depression is “neuroticism” (AU)

Personality: a determinant in marital dissatisfaction in individuals with major depression and their couples.

INTRODUCTION: Prior research suggests that some factors account for the association between marital dissatisfaction and Major Depression. We examined whether personality determines the association between marital dissatisfaction and a First Episode of Major Depression (FEMD), and whether specific personality factors are linked to marital dissatisfaction depending on the outcome of the FEMD. METHODS: The Hamilton Rating Scale for Depression and the Dyadic Adjustment Scale were administered both at baseline (T1) and six months later (T2), at 6 outpatient settings. We counted on the participation of 59 married couples with one member fulfilling DSM-IV criteria for a FEMD, and a healthy partner. Depressed participants also completed the NEO Personality Inventory-Revised. RESULTS: Certain personality factors mediate the association of a FEMD and Marital Dissatisfaction. "Neuroticism" mediates the association both at T1 and T2. However, the relationship between personality factors and Marital Dissatisfaction depends on the outcome of the Episode. If it has remitted by T2, personality might not be associated with marital interaction. However, if depression persists, "openness" and "conscientiousness" are related to less marital dissatisfaction. CONCLUSION: The most important mediating personality factor between marital dissatisfaction and a First Episode of Major Depression is "neuroticism".

Depresión y distrofia miotónica: posibles factores de confusión / Depression and myotonic dystrophy: possible confusion factors

Introducción. La distrofia miotónica o enfermedad de Steinert es una afectación multisistémica que se manifiesta preferentemente en el músculo esquelético. Las características clínicas más relevantes son la debilidad muscular progresiva, la miotonía y la atrofia muscular. En ocasiones, las primeras manifestaciones no son musculares, lo que conlleva un retraso en el diagnóstico. Es necesario realizar un estudio genético en todos los familiares de riesgo. Métodos. Se describe el caso de una mujer con este síndrome. Resultados. En una paciente con un episodio depresivo se confirmó el diagnóstico clínico de enfermedad de Steinert por el estudio de la secuencia repetida del triplete de nucleótidos CTG en la región 19q13.2-13.3 en el gen DMPK. Conclusiones. A pesar de los antecedentes psicopatológicos de los pacientes, es necesario realizar una buena historia clínica junto con las pruebas complementarias pertinentes, con el fin de detectar patología orgánica de difícil diagnóstico que pueda desarrollarse junto con sintomatología psiquiátric (AU)

Introduction. Myotonic dystrophy, also called Steinert's disease, is a multisystemic illness which more frequently manifests in the skeletal muscle, with progressive muscle weakness, myotonia, and muscle atrophy, being the most relevant clinical features. Occasionally, first symptoms are not muscular, which implies a delay in diagnosis. It is necessary to perform a genetic study in all family members at risk. Methods. The case of a woman affected by this syndrome is described. Results. Steinert's disease diagnosis was confirmed in a female patient by studying the repeated sequence of CTG nucleotide triplet in DMPK gene, region 19q13.2-13.3. Conclusions. In spite of the psychological history of patients, it is necessary to gather a good clinical history and to perform the required complementary medical examinations in order to rule out any difficult to diagnose organic disease concomitant to the psychiatric symptoms (AU)

Síndrome de Gitelman: confusión diagnóstica en una paciente con antecedentes de Trastorno de la conducta alimentaria / Gitelman's Syndrome: diagnosis in a female patient with a history of eating disorders

Introducción. El síndrome de Gitelman es una tubulopatía distal, generalmente de herencia autosómica recesiva, que cursa como una alcalosis metabólica con hipomagnesemia e hipocalciuria. Mientras que la causa de la hipomagnesemia se desconoce, la hipocalciuria se explica por la disminución de la entrada de cloruro de sodio en el túbulo distal. Estos pacientes pueden presentar debilidad muscular, fatiga, hipotensión y condrocalcinosis secundaria a la hipomagnesemia crónica. Su tratamiento consiste en potasio, magnesio oral y diuréticos ahorradores de potasio. El diagnóstico puede retrasarse durante años, ya que los pacientes pueden mantenerse asintomáticos durante largos períodos de tiempo. Las alteraciones bioquímicas con las que cursa pueden orientar hacia otros diagnósticos. Métodos. Se describe el caso de una mujer afecta de este síndrome. Resultados. El diagnóstico clínico se confirmó por el estudio de las mutaciones del gen SLC12A3. Conclusiones. pesar de los antecedentes psicopatológicos de los pacientes, es preciso y necesario descartar siempre una enfermedad orgánica, que puede confundir el diagnóstico al tener en común las mismas alteraciones clínicas, bioquímicas y del medio interno (AU)

Gitelman Syndrome is a pathology in the distal tubule, generally of autosomal recessive inheritance, presenting as a metabolic alkalosis with hypomagnesemia and hypocalciuria. While the cause of hypomagnesemia is unknown, hypocalciuria is explained by the reduction of sodium chloride entrance in the distal tubule. Patients suffering from Gitelman Syndrome may present muscular weakness, fatigue, hypotension and chondrocalcinosis secondary to chronic hypomagnesemia. The treatment consists on potassium, oral magnesium and potasium-sparing diuretics. Diagnosis may be delayed for years, given that patients can remain asymptomatic for long periods of time. Biochemical alterations can lead to other diagnosis (AU)

The impact a first episode of major depression hason marital dissatisfaction: Is remission associatedwith improvement in dissatisfaction?

Background and Objectives: Prior research suggests that marital dissatisfactionis associated with Major Depression (MD). The purpose of this study was to investigatewhether remission from a first episode of MD is associated with improvement inmarital dissatisfaction and whether the degree of marital dissatisfaction at the time of diagnosishas an influence on the outcome of MD.Methods: The Hamilton Rating Scale for Depression, the Dyadic Adjustment Scaleand the Areas of Change Questionnaire were administered to 59 married couples in whichone member fulfilled DSM-IV criteria for a first Episode of MD, but her husband (or hiswife) did not suffer any mental disorder, and to 53 control couples at 6 outpatient clinics,at baseline and after a 6-months follow-up.Results: The level of marital dissatisfaction in couples with a persistent depressed participantdecreased in comparison to couples without a depressed subject (p < 0.05 CI: -10.6 and -0.2), but there were no significant differences between couples in which the depressedspouse recovered from MD and comparison couples. Regardless of MD’s severity,high levels of satisfaction were associated with a higher probability to recover.Limitations: The follow-up period was short and we assessed the level of marital dissatisfactionusing self-report measures (AU)

A Spanish version of the Family Assessment Device.

INTRODUCTION: This paper presents the results of a study on the psychometric properties of an authorized Spanish version of the McMaster Family Assessment Device, a self-report measure of family functioning. MATERIALS AND METHODS: The study sample comprised 60 psychiatric patients and their family member and 60 controls, without mental health problems, and their family member. RESULTS: Compared to other studies, all subscales displayed adequate temporal stability and acceptable reliability. While the instrument discriminated well between the two groups of families on all subscales, the results nevertheless indicated limitations in the inter-item discriminant capacity of the "Roles" subscale. Factor analysis resulted in a three-factor model that does not coincide with the established structure of this instrument. CONCLUSION: Proposals to improve and adapt questionnaire are discussed with a view to make it applicable to cultures other than the one it was developed. Theoretical models relating to psychosocial aspects such as family functioning, albeit compatible in some areas, should be viewed with caution in cultures different to that in which the model originates.

[Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population]. / Validación del cuestionario Eating Attitudes Test (EAT) como prueba de cribado de trastornos de la conducta alimentaria en la población general.

BACKGROUND AND OBJECTIVE: To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population. SUBJECTS AND METHOD: The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30. RESULTS: The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained. CONCLUSIONS: The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire.

Validación del cuestionario Eating Attitudes Test (EAT) como prueba de cribado de trastornos de la conducta alimentaria en la población general / Validation of the Eating Attitudes Test (EAT) as a screening tool in the general population

Fundamento y objetivo: Validar un punto de corte alternativo de la versión española del Eating Attitudes Test (EAT-40) para el cribado de casos de trastornos de la conducta alimentaria en la población general. Sujetos y método: Se administró el cuestionario traducido a una muestra representativa de 2.734 mujeres estudiantes de entre 13 y 22 años de edad. Se entrevistó a las participantes cuya puntuación en el cuestionario fue superior a 21 y a una muestra aleatoria del resto. Se estimaron los parámetros de validez interna y externa obtenidos con puntos de corte distintos de 30, que es el utilizado habitualmente en el EAT. Resultados: La mejor predicción diagnóstica se obtuvo con 21 puntos (sensibilidad del 73,3% y especificidad del 85,1%). El valor predictivo positivo fue del 20% y el valor predictivo negativo, del 98,4%. Conclusiones: La mejor predicción diagnóstica del EAT-40 en un entorno no clínico se obtiene con un punto de corte de 21 puntos, algo inferior al recomendado por los autores del cuestionario (AU)

Background and objective: To validate the best alternative cut-off point of a Spanish version of the Eating Attitudes Test (EAT-40) for the screening of eating disorders cases in the general population. Subjects and method: The translated questionnaire was administered to a representative sample of 2,734 female students who ranged in age from 13 to 22 years. Participants who scored above 21 points were interviewed, as were a random sample of participants who scored 21 or below. Internal and external validity parameters were estimated for different alternative cut-off scores below the usual EAT score of 30. Results: The best diagnostic prediction was obtained with a cut-off score of 21 points (sensitivity: 73.3%; specificity: 85.1%). A positive predictive value of 20% and a negative predictive value of 98.4% were obtained. Conclusions: The best diagnostic prediction in a non-clinical setting is obtained with a cut-off score of 21, below that recommended by the authors of the questionnaire (AU)

Mejoría del dolor articular en un cuadro depresivo concomitante tratado con duloxetina / Improvement in joint pain in concomitant depression treated with duloxetine

Los pacientes con trastornos depresivos frecuentemente manifiestan quejas somáticas como, por ejemplo, dolor. La mejoría en la percepción del dolor que se produce en pacientes con síntomas depresivos tratados con antidepresivos puede deberse a una mejoría en la depresión. Varias publicaciones indican que la actividad antinociceptiva de los antidepresivos es independiente de la mejoría del estado de ánimo y que está en relación con el efecto de estos fármacos en vías noradrenérgicas y serotoninérgicas ascendentes y descendentes. En modelos animales, sustancias que inhiben selectivamente la recaptación de noradrenalina disminuyen la percepción del dolor; compuestos que inhiben de manera selectiva la recaptación de serotonina no tienen ese efecto pero potencian el efecto antinociceptivo de las que inhiben la recaptación de noradrenalina. Disminuyendo la percepción del dolor se contribuye a mejorar los síntomas depresivos que pudieran coexistir. Una mejoría en los síntomas depresivos que pudieran magnificar la percepción del dolor contribuiría a disminuir esta última; el efecto de algunos fármacos en el sistema límbico puede conducir a mejorar tanto la percepción del dolor como el estado de ánimo. Duloxetina posee acción dual como inhibidor de la recaptación de serotonina y noradrenalina. Investigaciones recientes señalan que no es posible discernir entre el efecto analgésico y antidepresivo de duloxetina. Otros estudios evidencian que el efecto de duloxetina en la percepción del dolor es independiente del efecto antidepresivo. La evolución del caso presentado parece apoyar la hipótesis de que duloxetina contribuye de manera independiente a la mejoría de ambos tipos de síntomas (AU)

Patients with depressive disorders commonly report somatic complaints, such as pain. The improvement in pain perception produced in patients with somatic symptoms of depression under treatment with antidepressants may be related to recovery from depression. Several publications suggest that the antinociceptive activity of antidepressants is independent from mood improvement and is related to the effect of these drugs on the ascending and descending noradrenergic and serotoninergic pathways. In animal samples, selective noradrenaline reuptake inhibitors decrease pain perception; selective serotonin reuptake inhibitors do not have such an effect but they do potentiate the antinociceptive effect of noradrenaline inhibitors. Decreasing pain perception helps to improve the depressive symptoms that may coexist. Improvement in the depressive symptoms that could magnify pain perception would help to reduce this perception. The effect of some drugs on the limbic system could produce improvements in both pain perception and mood state. Duloxetine has a dual action both as a serotonin and as a noradrenaline reuptake inhibitor. While some recent research shows that the analgesic effects cannot be distinguished from the antidepressant effects of this drug, other investigations show that the effect of duloxetine on pain perception is independent from the antidepressive effect. The clinical course of the case presented herein seems to support the hypothesis that duloxetine contributes independently to improvement of both somatic and pain symptoms (AU)

Incidence of eating disorders in Navarra (Spain).

PURPOSE: To estimate the overall annual incidence and age group distribution of eating disorders in a representative sample of adolescent female residents of Navarra, Spain. METHODS: We studied a representative sample of 2734 adolescent Navarran females between 13 and 22 years of age who were free of any eating disorder at the start of our study. Eighteen months into the study, we visited the established centers and the eating attitudes test (EAT-40) and eating disorder inventory (EDI) Questionnaires were administered to the entire study population. We obtained a final response of 92%. All adolescents whose EAT score was over 21 points and a randomized sample of those who scored 21 or below, were interviewed. Any person meeting the DSM-IV diagnostic criteria for Anorexia Nervosa (AN), Bulimia Nervosa (BN) or eating disorder not otherwise specified (EDNOS) was considered a case. RESULTS: We detected 90 new cases of eating disorders. Taking into consideration the randomly selected group whose EAT score was 21 points or below, we estimated the overall weighted incidence of eating disorders to be 4.8% (95% CI: 2.8-6.8), after 18 months of observation, in which EDNOS predominated with an incidence of 4.2% (95% CI: 2.0-6.3). The incidence of AN was 0.3% (95% CI: 0.2-0.5), while that of BN was also found to be 0.3% (95% CI: 0.2-0.5). The highest incidence was observed in the group of adolescents between 15 and 16 years of age. CONCLUSIONS: The overall incidence of ED in a cohort of 2509 adolescents after 18 months of follow-up was 4.8% (95% CI: 2.8-6.8), with EDNOS outweighing the other diagnoses. The majority of new cases of eating disorders were diagnosed between ages 15 and 16.