Toronto alexithymia scale for patients with eating disorder: [corrected] performance using the non-parametric item response theory.

BACKGROUND: The aim of this study was to investigate the performance of the Toronto Alexithymia Scale (TAS-20) in patients with eating disorders. As a secondary objective, we analyzed a subset of items in order to determine whether the total score is a good tool for classifying these patients and whether the items are ordered according to the difficulty of choosing a particular answer depending on the severity of the patient's condition. SUBJECTS AND METHODS: We administered the TAS-20 to 103 consecutive patients who met DSM-IV-R criteria for anorexia nervosa, bulimia nervosa, or eating disorders not otherwise specified. Mokken scale analysis, nonparametric item response theory (NIRT), and confirmatory factor analysis (CFA) were used to test the psychometric properties of the scale. To improve our understanding of the structure underlying the TAS-20, we used an automated item selection procedure based on the Mokken scale. RESULTS: We identified a subset of 13 independent and clinically interpretable items that are potentially sufficient to rate patients with alexithymia. This subset was considered a unidimensional reduction of the TAS-20. However, the scale composed of this subset needs to be validated. Thirteen of the 20 items were maximally related to alexithymia because they have a one-dimensional structure. The NIRT and CFA enabled us to identify a maximal subset of items that conform to the requirements for good measurement of alexithymia in patients with eating disorders.

Working memory as a predictor of negative symptoms and functional outcome in first episode psychosis.

The relationship of neurocognitive course with clinical and functional outcomes in psychosis is not well known, especially in the long term. The aim of the study was to examine the clinical and neuropsychological course of first-episode psychosis patients at 5-year follow-up and analyze the relationship of cognitive performance with clinical and functional outcome. The 5-year follow-up was conducted with 26 first-episode psychosis patients. Psychotic symptoms were measured by the Positive and Negative Syndrome Scale, manic and depressive symptoms by the Young Mania Rating Scale and Hamilton Depression Rating Scale respectively, and psychosocial functioning by the Functioning Assessment Short Test. The cognitive domains were assessed by the Wechsler Adult Intelligence Scale, the Wisconsin Card Sorting Test, the Trail Making Test, the Verbal Fluency Test, the Stroop Colour-Word Test and the Wechsler Memory Scale. Patients showed symptomatic improvement in the follow-up except in negative psychotic symptoms. There was also improvement in most cognitive domains except in working memory and processing speed in the follow-up. Working memory impairment was associated to negative psychotic symptoms and poor functional outcomes. Negative symptoms mediated the relationship between working memory and outcome. Therefore, negative symptoms should be a primary target of treatment to improve functional outcomes.

Depressive dimensions and item response analysis of the Hamilton Depression Rating Scale-17 in eating disorders.

BACKGROUND: Most patients having eating disorders (EDs) experience depressive symptoms. To date, there have been few reports about the different depressive dimensions in EDs. OBJECTIVE: The aim of this study was to investigate the dimensions of depressive symptoms and highlight the distribution of the symptoms. The psychometric properties of these measures were tested using item response theory methods. METHODS: A total of 103 consecutively admitted inpatients and outpatients who met the Diagnostic and Statistical Manual of Mental Disorders, Revised Fourth Edition, criteria for anorexia nervosa, bulimia nervosa, and EDs not otherwise specified were rated with the Hamilton Depression Rating Scale (HDRS-17). A factor analysis of the HDRS-17 was carried out with the Cf-varimax rotation. RESULTS: Factor analysis showed 2 independent and clinically interpretable factors corresponding to "anxious depression" and "somatic complaints" that constituted the core of depression. For the HDRS-17, item response theory analyses revealed that most of the items were maximally related to the core concept of depression and provided a good functioning. The 17 items were distributed in almost the same way as in the factor analyses found by other authors with different clinical groups. We conclude therefore that for the sample of EDs, 2 factors constitute the core symptoms of depression and most of the items provided a good functioning.

Shame, sensitivity to punishment and psychiatric disorders

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Background and objectives: Various studies have found significant correlations between feelings of shame and psychopathologies, as depression or eating disorders. Since some authors have shown an association between inhibition, neuroticism and shame, we hypothesize that Sensibility to Punishment (SP) would relate positively to shame. We also propose that patients diagnosed with depression should score higher in shame domain than the rest of the diagnostic groups. Finally we predict that psychotic patients, since they have poor self-consciousness, should score the lowest in shame proneness. Methods: The Spanish version of the TOSCA, the Sensitivity to Punishment and Reward Questionnaire (SPSRQ) and The Clinical Global Impressions (CGI) were applied to a sample of 172 individuals, from which 93 were university students and 79 were patients receiving psychiatric treatment. Results: In the Sensitivity to Punishment domain we found statistically significant mean differences between patients with Major Depression and the comparative group. We have found a positive correlation between Sensitivity to Punishment and Shame in the general population and also for the Major depressive subgroup. The relation between depression and shame proneness was statistically significant. Shame and Guilt correlated in the TOSCA and the Major Depressive patients scores higher on both domains. Bipolar and schizophrenics patients showed lower scores in Shame than depressives. Conclusions: Among other conclusions we recommend that future studies in the field should use dimensional diagnoses besides the categorical ones (AU)

Short-term effects of a brief respiratory training on baroreceptor cardiac reflex function in normotensive and mild hypertensive subjects.

Baroreceptor cardiac reflex sensitivity is reduced in hypertension and is considered a powerful prognostic factor in cardiovascular health. This study analyzes the acute effects of a brief respiratory training on baroreceptor sensitivity and on two new proposed baroreflex parameters: baroreceptor power (i.e., the percentage of cardiac beats regulated by the baroreflex) and effectiveness (i.e., the frequency in which the baroreflex responds to transient alterations in blood pressure). Twenty-two participants, 10 primary mild hypertensives and 12 normotensives, learned and practiced a respiratory pattern characterized by breathing at 6 bpm, with time of expiration being twice time of inspiration, predominantly abdominal, and with pursed lips. Baroreceptor parameters are differentiated in terms of increases ("up" sequences) or decreases ("down" sequences) in blood pressure. Irrespective of the groups, the breathing manipulation increased baroreceptor sensitivity (only in the "up" sequences), power, and effectiveness (only in the "down" sequences). These results suggest that this type of respiratory training could be used as a promising intervention to increase baroreceptor cardiac function in primary hypertension.

Efficacy of brief interventions for hazardous drinkers in primary care: systematic review and meta-analyses.

BACKGROUND: Because recent research in primary care has challenged the findings of previous reviews on the efficacy of brief interventions (BIs) on hazardous drinkers, we conducted a systematic review and meta-analysis to update the evidence of BIs as applied in the primary care setting. METHODS: We obtained source material by searching electronic databases and reference lists and hand-searching journals. We selected randomized trials providing frequency data that allowed assessment of the efficacy of BIs on an intention-to-treat basis. Results were summarized by the odds ratio (OR) of response. When appropriate, risk difference (RD) and its inverse (number needed to treat [NNT] to achieve a positive result) were also computed. Fixed and/or random effect models were fitted according to heterogeneity estimates. RESULTS: Thirteen studies provided data for a dose-effect analysis, 12 for comparison of BIs with reference categories. No clear evidence of a dose-effect relationship was found. BIs outperformed minimal interventions and usual care (random effects model OR = 1.55, 95% confidence interval [CI] = 1.27-1.90; RD = 0.11, 95% CI = 0.06-0.16; NNT = 10, 95% CI = 7-17). Similar results were obtained when two influential studies were removed (fixed effect model OR = 1.57, 95% CI = 1.32-1.87; RD = 0.11, 95% CI = 0.07-0.15; NNT = 9, 95% CI = 7-15). The heterogeneity between individual estimates was accounted for by the type of hazardous drinkers (heavy versus moderate) and by the characteristics of the included individuals (treatment seekers versus nontreatment seekers). The funnel plot did not show evidence of publication bias. CONCLUSION: Our results, although indicating smaller effect sizes than previous meta-analyses, do support the moderate efficacy of BIs. Further research is outlined.

Brief interventions for hazardous drinkers delivered in primary care are equally effective in men and women.

BACKGROUND: Despite the accumulated evidence on the efficacy of brief interventions in hazardous drinkers some ambiguity remains regarding their differential effectiveness by gender. METHODS: Meta-analysis of independent studies conducted in primary health care settings with a follow-up of 6-12 months which report results separately by gender. Two outcome measures were selected: the quantity of typical weekly alcohol consumption and the frequency of drinkers who reported consumption below hazardous levels after the intervention. RESULTS: Seven studies were included in the meta-analysis. The standardized effect sizes for the reduction of alcohol consumption were similar in men (d=- 0.25; 95% CI=- 0.34 to -0.17) and women (d=- 0.26; 95% CI=- 0.38 to - 0.13). The odds ratios (OR) for the frequency of individuals who drank below harmful levels were also similar (four studies; OR for men=2.32; 95% CI=1.78-2.93; OR for women=2.31; 95% CI=1.60-3.17). The difference between genders was negligible. CONCLUSION: Our results support the equality of outcomes among men and women achieved by brief interventions for hazardous alcohol consumption in primary care settings.

Estudio psicométrico de la escala de alexitimia "YAS" / A psycometric study of alexithimia scale "YAS"

Se hace un estudio psicométrico de la escala de alexitimia de 21 ítems del Prof. Luis Yllá (YAS = Yllá Alexithimia Scale) de forma que se queda en 20 ítems mejorando la consistencia interna (de 7746 a 7843) y el por ciento de explicación del total de la varianza (del 42,4 por ciento al 44,04 por ciento). Para ello se calculó el coeficiente de homogeneidad Alfa de Cronbach para valorar la consistencia interna de la escala. Se hizo también un análisis de "componentes principales." Tras determinar el número de factores, se hizo una rotación ortogonal varimax y después se seleccionaron para cada componente (de acuerdo a lo convencional) los ítems cuyo peso en la nueva variable fuese superior a 0,3.Se denominaron los factores resultantes y se hizo el análisis de correlaciones entre si y con los factores de otras escalas. Comprobando que la distribución de la muestra era normal se utilizaron los estadísticos: T de Student-Fischer para variables homogéneas, t de Student-Fischer para variables no homogéneas, ANOVA de una vía, correlación de Pearson y de Spearman respectivamente. También se utilizó el procedimiento de corrección de Bonferroni en los casos que fuesen varios los grupos a comparar, vg. diferentes facultades. También se tuvo en cuenta el tamaño de la muestra por lo que en los casos en que las correlaciones fueron significativas se estudió la relevancia de los hallazgos o importancia clínica del efecto empleando la fórmula de Rosenthal y Wolf (1986) (AU)