Monoamine oxidase A (MAOA) interaction with parenting practices on callous-unemotional traits in preschoolers

Background and Objectives: From a gene-by-environment perspective, parenting in interaction with the polymorphism in the Monoamine oxidase A (MAOA) gene (MAOA-uVNTR) might also be associated with increased callous-unemotional traits (CU) in preschoolers. MAOA-uVNTR results in differential enzyme activity, so that high-activity alleles (MAOA-H) are linked to reduced dopamine, serotonin, and norepinephrine availability in comparison to low-activity allele (MAOA-L). As MAOA-uVNTR has been previously described to moderate the relationship between childhood parental maltreatment and aggressive and antisocial behavior, it may also play a role in CU traits etiology.MethodsData was collected through questionnaires answered by parents and teachers. MAOA-uVNTR was genotyped in 368 Caucasian children from a community sample (51.9% male). Multiple linear regression analyses were conducted to analyze the interaction effect of MAOA genotypes and both positive parenting and punitive parenting practices on CU traits at two different periods (3 and 5 years old) and separately by sex.ResultsNo significant interactions were found for boys. Among girls, a significant interaction effect was found for MAOA-LL carriers, who showed higher CU traits at age 5 when exposed to higher punitive or positive parenting at age 3.ConclusionsOur study provides the first evidence for significant MAOA × early parenting effects on CU traits in preschoolers, specifically among female MAOA-LL carriers. This suggests that the MAOA-LL genotype for girls is associated with higher sensitivity to both positive and punitive parenting in girls, so that MAOA-LL emerges as a genotype that confers higher vulnerability to parental influences. (AU)

[Spanish adaptation and validation of the Perception of Restraint Use Questionnaire (PRUQ) on the use of physical restraints on the elderly]. / Adaptación y validación española del Perception of RestraintUse Questionnaire (PRUQ) sobre el uso de restricciones físicasen personas mayors.

BACKGROUND: To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. METHODS: After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. RESULTS: 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications.All were considered acceptable by an expert panel(content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbach's alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95%CI: 0.78 to 0.92) over an interval of three weeks. CONCLUSIONS: The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application.

Adaptación y validación española del Perception of Restraint Use Questionnaire (PRUQ) sobre el uso de restricciones físicas en personas mayores / Spanish adaptation and validation of the Perception of Restraint Use Questionnaire (PRUQ) on the use of physical restraints on the elderly

Fundamento: Adaptar y estudiar las propiedades psicométricas en población española del Perception of Restraint Use Questionnaire (PRUQ), que mide la importancia que dan los profesionales al uso de restricciones físicas en personas mayores. Material y métodos: Tras un proceso de traducción-retrotraducción y de adaptación lingüística, se obtuvo una versión en español. A continuación, se realizó un estudio multicéntrico, descriptivo y transversal para evaluar sus propiedades psicométricas. Mediante un muestreo no probabilístico se seleccionaron 20 centros de tres comunidades autónomas; aceptaron participar 830 profesionales. Resultados: De los 17 ítems del cuestionario, 15 pudieron traducirse de manera literal; en dos hubo que realizar modificaciones menores. Un panel de expertos consideró todos aceptables (índice de validez de contenido de 0,89); un estudio piloto confirmó la adecuada factibilidad del cuestionario. El análisis en componentes principales identificó tres dimensiones que explicaban el 66,2% de la varianza. El análisis factorial confirmatorio de este modelo tridimensional mostró un ajuste aceptable [CFI = 0,936; RMSEA = 0,080], siendo las cargas y las correlaciones factoriales estadísticamente significativas (p < 0,001). La consistencia interna (alfa de Cronbach) de la puntuación total fue de 0,92, y la fiabilidad test-retest (CCIa) de 0,87 (IC 95%: 0,78 a 0,92) en un intervalo de tres semanas. Conclusiones: La versión española del PRUQ muestra buenas propiedades psicométricas y se adapta al contexto cultural de este país. Puede considerarse útil para evaluar en qué situaciones se consideran más necesarias las restricciones físicas, lo que ayudaría a diseñar actividades de formación encaminadas a racionalizar su aplicación (AU)

Background: To adapt and to validate in a Spanish population the Perception of Restraint Use Questionnaire (PRUQ), which assesses the importance that professionals give to the use of physical restraints when caring for older adults. Methods: After a process of forward-back translation and linguistic adaptation, a Spanish version of the original questionnaire was obtained. A descriptive cross-sectional multicenter study was then carried out. Based on non-probability sampling, 20 centers from three Spanish regions were selected; 830 professionals agreed to participate. Results: 15 of the 17 items of the original questionnaire were translated literally and two required minor modifications. All were considered acceptable by an expert panel (content validity index of 0.89); a pilot study confirmed the adequate feasibility of the questionnaire. The principal components analysis identified three dimensions that explained 66.2% of variance. The confirmatory factor analysis of this tridimensional model showed an acceptable fit [CFI = 0.936; RMSEA = 0.080], being factor loadings and factor correlations statistically significant (p<0.001). The internal consistency (Cronbach's alpha) for the total score was 0.92 and the test-retest reliability (ICCa) was 0.87 (95% CI: 0.78 to 0.92) over an interval of three weeks. Conclusions: The Spanish version of the PRUQ shows good psychometric characteristics and is adapted to the cultural context of this country. It may be considered a useful tool to assess in which situations professionals consider the use of physical restraints most necessary, helping to design training activities aimed at rationalizing its application (AU)

Clinical, Psychopathological, and Personality Characteristics Associated with ADHD among Individuals Seeking Treatment for Gambling Disorder.

OBJECTIVES: (1) To assess the current presence of ADHD symptoms among patients seeking treatment for gambling disorder; (2) to explore clinical and sociodemographic differences between patients who score high and low on the measure of ADHD symptoms; (3) to analyze whether the presence of ADHD symptoms is associated with more severe psychopathology and with specific personality traits; (4) to analyze the mediating role of ADHD symptoms in the relationship between novelty seeking and gambling severity. METHOD: A total of 354 consecutive patients were administered an extensive battery assessing gambling behavior, psychopathology, and personality traits. RESULTS: Male and female gamblers did not differ significantly in their mean scores on the ADHD measure. However, younger participants aged 18-35 scored higher. Higher ADHD scores were also associated with greater severity of gambling disorder and more general psychopathology. Regarding personality traits, high persistence and self-directedness were negatively related to ADHD scores, while in women alone a positive correlation was found between ADHD scores and scores on harm avoidance and self-transcendence. CONCLUSION: The presence of ADHD symptoms in both male and female gambling disorder patients may act as an indicator of the severity of gambling, general psychopathology, and dysfunctional personality traits.

Sex addiction and gambling disorder: similarities and differences.

OBJECTIVE: Recently, the DSM-5 has developed a new diagnostic category named "Substance-related and Addictive Disorders". This category includes gambling disorder (GD) as the sole behavioral addiction, but does not include sex addiction (SA). The aim of this study is to investigate whether SA should be classified more closely to other behavioral addictions, via a comparison of the personality characteristics and comorbid psychopathology of individuals with SA with those of individuals with GD, which comes under the category of addiction and related disorders. METHOD: The sample included 59 patients diagnosed with SA, who were compared to 2190 individuals diagnosed with GD and to 93 healthy controls. Assessment measures included the Diagnostic Questionnaire for Pathological Gambling, the South Oaks Gambling Screen, the Symptom CheckList-90 Items-Revised and the Temperament and Character Inventory-Revised. RESULTS: No statistically significant differences were found between the two clinical groups, except for socio-economic status. Although statistically significant differences were found between both clinical groups and controls for all scales on the SCL-90, no differences were found between the two clinical groups. The results were different for personality characteristics: logistic regression models showed that sex addictive behavior was predicted by a higher education level and by lower scores for TCI-R novelty-seeking, harm avoidance, persistence and self-transcendence. Being employed and lower scores in cooperativeness also tended to predict the presence of sex addiction. CONCLUSIONS: While SA and GD share some psychopathological and personality traits that are not present in healthy controls, there are also some diagnostic-specific characteristics that differentiate between the two clinical groups. These findings may help to increase our knowledge of phenotypes existing in behavioral addictions.

Reciprocal effects of stable and temporary components of neuroticism and affective disorders: results of a longitudinal cohort study.

BACKGROUND: Cross-sectional studies show that neuroticism is strongly associated with affective disorders. We investigated whether neuroticism and affective disorders mutually reinforce each other over time, setting off a potential downward spiral. METHOD: A total of 2981 adults aged 18-65 years, consisting of healthy controls, persons with a prior history of affective disorders and persons with a current affective disorder were assessed at baseline (T1) and 2 (T2) and 4 years (T3) later. At each wave, affective disorders according to DSM-IV criteria were assessed with the Composite Interview Diagnostic Instrument (CIDI) version 2.1 and neuroticism with the Neuroticism-Extraversion-Openness Five Factor Inventory (NEO-FFI). RESULTS: Using structural equation models the association of distress disorders (i.e. dysthymia, depressive disorder, generalized anxiety disorder) and fear disorders (i.e. social anxiety disorder, panic disorder, agoraphobia without panic) with neuroticism could be attributed to three components: (a) a strong correlation of the stable components of distress and fear disorders with the stable trait component of neuroticism; (b) a modest contemporaneous association of change in distress and fear disorders with change in neuroticism; (c) a small to modest delayed effect of change in distress and fear disorders on change in neuroticism. Moreover, neuroticism scores in participants newly affected at T2 but remitted at T3 did not differ from their pre-morbid scores at T1. CONCLUSIONS: Our results do not support a positive feedback cycle of changes in psychopathology and changes in neuroticism. In the context of a relative stability of neuroticism and affective disorders, only modest contemporaneous and small to modest delayed effects of psychopathology on neuroticism were observed.

Late onset eating disorders in Spain: clinical characteristics and therapeutic implications.

OBJECTIVE: The literature on later age of onset (LAO) in women with eating disorders is scarce. We compared the severity of eating disorders, eating disorder subtype, and personality profiles in a clinical sample of consecutively assessed women with eating disorders with later age of onset (LAO, > = 25 years) to women with typical age of onset (TAO, <25 years). METHOD: All eating disorder patients met the Diagnostic and Statistical Manual of Mental Disorders Fourth Edition (DSM-IV) criteria and were admitted to the Eating Disorder Unit of the University Hospital of Bellvitge in Barcelona, Spain. Ninety-six patients were classified as LAO and 759 as TAO. ASSESSMENT: Measures included the Eating Attitude Test-40 (EAT-40), Eating Disorders Inventory-2 (EDI-2), Bulimic Investigatory Test Edinburgh (BITE), Symptom Checklist Revised (SCL-90-R), and the Temperament and Character Inventory-Revised (TCI-R), as well as other clinical and psychopathological indices. RESULTS: LAO individuals reported significantly fewer weekly vomiting episodes, fewer self-harming behaviours, less drug abuse, and lower scores on the BITE symptoms, the EDI-2 drive for thinness, and the TCI-R harm avoidance scales than TAO individuals. Conversely, the LAO group reported more current and premorbid obesity than the TAO group. CONCLUSION: LAO eating disorder patients in this sample presented with milder symptomatology and less extreme personality traits. Premorbid obesity may be more relevant to LAO than TAO eating disorders and should be routinely assessed and considered when planning treatment.

Eating-related environmental factors in underweight eating disorders and obesity: are there common vulnerabilities during childhood and early adolescence?

OBJECTIVE: This study aimed to examine whether there is an association between individual, social and family influences and dysfunctional eating patterns early in life and the likelihood of developing a subsequent underweight eating disorder (ED) or obesity. METHOD: The total sample comprised 152 individuals (underweight ED, n = 45; obese patients, n = 65; healthy controls; n = 42) from Barcelona, Spain. The Cross-Cultural Questionnaire (CCQ) was used to assess early eating influences as well as individual and family eating patterns and attitudes towards food. RESULTS: Even though a few shared eating influences emerged for both groups, unique factors were also observed. Whereas relationship with friends, teasing about eating habits by family members and the mass media were of specific relevance to the underweight ED group, the patient's own physical appearance, body dissatisfaction, teasing about eating habits by friends, teasing about body shape by family members and dysfunctional eating patterns were unique to obesity. CONCLUSIONS: Overlapping environmental risk factors provide evidence for integral prevention and intervention approaches that simultaneously tackle a range of weight-related problems. The unique factors might be important for targeting high-risk individuals.

Importancia de los conocimientos en nutrición sobre las actitudes alimentarias, dieta e IMC en adolescentes escolarizados: un seguimiento a 30 meses / Importance of nutrition knowledge on eating disorders, dieting, and BMI in schooled adolescents: A 30-month follow-up

Objetivo: Evaluar el efecto de los conocimientos en nutrición sobre las actitudes alimentarias, la dieta y el índice de masa corporal (IMC) en una muestra de adolescentes a los 30 meses de recibir un programa preventivo. Método: Mediante un diseño cuasi-experimental longitudinal prospectivo, 317 adolescentes fueron a asignados a tres condiciones experimentales: Alfabetización en Medios (AM, 117 casos), Alfabetización en Medios y Conocimientos en Nutrición (AM+NUT, 70 casos) y grupo control (130 casos). Se evaluaron los conocimientos en nutrición (NUT), el IMC, las actitudes alimentarias (EAT) y la realización de dieta. Resultados: Las puntuaciones del NUT en el seguimiento influyen sobre las puntuaciones en el EAT en el seguimiento, mientras que sólo el grupo AM+NUT reduce la realización de dieta en el seguimiento. Conclusión: El grado de conocimientos en nutrición disminuye las actitudes alimentarias de riesgo en el seguimiento a largo plazo, pero no se asocia a cambios en el IMC ni sobre la realización de dieta. Ambas versiones del programa reducen las actitudes alimentarias alteradas, siendo AM+NUT preventivamente más potente, dado que también logra reducir el riesgo de hacer dieta (AU)

Objective: To evaluate the effect of nutrition knowledge on eating attitudes, dieting and body mass index (BMI) in an adolescent student sample at a 30-month follow-up after receiving a prevention program. Method: Using a quasi-experimental prospective longitudinal design, 317 adolescents were assigned to three experimental conditions: Media Literacy (ML, 117 cases), Media Literacy plus Nutrition Knowledge (ML+NUT, 70 cases), and control group (130 cases). Nutritional knowledge (NUT), BMI, eating attitudes (EAT), and dieting were assessed. Results: NUT scores at follow-up influence on EAT scores at follow-up, while only the ML+NUT group reduces dieting at follow-up. Conclusions: The level of nutrition knowledge decreases risk eating attitudes in a long-term follow-up, not being associated with BMI changes neither dieting. Both versions of the program reduce disordered eating attitudes, although ML+NUT version shows a higher prevention power, reducing also dieting (AU)

Specific eating disorder clusters based on social anxiety and novelty seeking.

While social avoidance and distress (SAD), a key aspect of social phobia related to behavioral inhibition, is high in different eating disorders (EDs), novelty seeking (NS) is mainly linked to bulimic disorders. Since heterogeneity in NS levels (low/high) exists in social phobia and in about 55% of ED with a highly disturbed personality, we examined ED types based on SAD and NS and their relationships to eating and comorbid features. Scores of 825 ED women on SAD and NS were submitted to cluster analysis. Five clinically differentiated ED clusters emerged: two without SAD (45%) and three with high SAD and low (13%), mid (34%), high NS (8%) levels. High vs. low SAD groups showed greater eating and social impairment, ineffectiveness, ascetism, suicide attempts, and lower education. Among SAD clusters, "SAD-low NS" had the lowest rate of binge eating, vomit, substance use, stealing and compulsive buying, whereas "SAD-high NS" presented the opposite pattern. However, no differences across SAD clusters were found with regard to ED diagnostic category distribution or history of treatment. Findings show that SAD-ED types present heterogeneity of NS and greater severity.

Subtyping eating disordered patients along drive for thinness and depression.

Subtyping individuals who binge eat by "diet-DT" and "depression" has yielded two valid and clinically useful subtypes that predict eating severity, comorbid psychopathology and outcome. The present study aimed to find four subtypes based on these dimensions and test their validity. Besides, it explored the distribution of eating disorder (ED) diagnoses across subtypes given their known heterogeneity, crossover and binge-eating fluctuation. Cluster analysis grouped 1005 consecutively admitted ED adult women into four subtypes, those previously described "DT" (22%), "DT-depressive" (29%), and "mild DT" (25%) and "depressive-moderate DT" (24%). Overall "mild DT" presented lower and "DT-depressive" greater eating and comorbid psychopathology than the rest, whereas "pure DT" and "depressive-moderate DT" presented no differences on bulimic symptoms but in psychopathology (p < .01). Finally, while BN-P patients were mostly and similarly distributed in the "DT" and "DT-depressive" subtypes than in the other, AN were in the new "mild DT" and "depressive-moderate DT" (p < .01). However, BN-NP, BED and EDNOS were similarly represented across subtypes. Results are discussed with regard to 1) the newly emerged subtypes that may explain cases in which DT prevents or does not predict binge eating; 2) the confluence of DT-depression that signaled greater eating and comorbid pathology, particularly self-control problems; 3) ED-DSM-diagnostic criteria.

Comorbidity in pathological gambling: clinical variables, personality and treatment response.

INTRODUCTION: Pathological gambling shows high comorbidity rates, especially with substance use disorders, although affective, anxiety and other impulse control disorders, as well as personality disorders, are also frequently associated. OBJECTIVES: To explore comorbidity in pathological gambling with other mental disorders in a consecutive sample of patients attending a unit specialized in pathological gambling, and specifically the relationship between substance-related disorders, on the one hand, and personality and clinical variables in pathological gamblers, on the other. METHOD: A total of 498 patients with a DSM-IV-TR diagnosis of Pathological Gambling (11.8% women) were assessed with a semi-structured clinical interview and several clinical and personality scales. RESULTS: Higher comorbidity with affective disorders was found in women (30.5%), while higher comorbidity with substance-related disorders was found in men (11.2%). A positive association was also detected between a history of psychiatric disorders and current comorbidity with substance-use disorders, as well as between alcohol abuse and age. Finally, some personality traits such as low reward dependence (OR=0.964) and high impulsivity (OR=1.02) predicted other substance abuse (not alcohol). High selftranscendence scores predicted both alcohol and other substance abuse (OR=1.06). CONCLUSIONS: Our results suggest a high prevalence of comorbid disorders in pathologic gambling, mainly with affective and substance-related disorders. The results of the present study, conducted in a broad sample of consecutively admitted pathologic gamblers, may contribute to understanding of this complex disorder and treatment improvement.