Motivation to change in adolescents with bulimia nervosa mediates clinical change after treatment.

Several studies have related motivation to change and treatment response in adult patients with bulimia nervosa but there are no longitudinal studies analysing this relationship in adolescents. The objective was to determine whether motivation to change is related to clinical improvement after treatment in adolescent patients with bulimia nervosa. The Bulimia Nervosa Stages of Change Questionnaire, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI) were administered at the beginning of treatment to 40 adolescent patients with bulimia nervosa (DSM-IV) (mean age = 16.2 years). Thirty-one patients were re-assessed after 6 months of treatment. The majority of clinical and psychological variables improved significantly at the second evaluation. There were significant correlations between initial motivation to change and improvement in number of binges and the EDI-2 scales of Bulimia and Interoceptive Awareness. In the stepwise multiple linear regression analysis, which included initial motivation to change and other potential confounding variables such as age, BDI, duration of disorder and body mass index, only motivation to change was selected as a predictor of improvement in number of binges (standardized ß coefficient = 0.45; p = 0.012) and of decrease on the Bulimia scale (standardized ß coefficient = 0.43; p = 0.029). Regarding improvement in Interoceptive Awareness, only the BDI score was selected as an independent predictor (ß coefficient = 0.58; p = 0.002). In conclusion, in adolescent patients receiving treatment for bulimia nervosa, improvement in bulimic symptomatology seems to be especially related to initial motivation to change.

Changes in regional cerebral blood flow after body image exposure in eating disorders.

Relationships of 'perceptual distortion' and 'cognitive evaluation' components of body image disturbances to brain activity were investigated. Changes in regional cerebral blood (rCBF) of nine patients with anorexia nervosa restrictive type (AN), 13 patients with bulimia nervosa purging type (BN) and 12 controls following three experiments with single photon emission computed tomography (SPECT) were compared: at rest, following a landscape video presentation (neutral stimulus), and after their filmed body image (positive stimulus) exposure. Body distortion was measured with the Silhouette test and body dissatisfaction with the Body Shape Questionnaire (BSQ). Patients with AN showed a hyperactivation of the left parietal and right superior frontal from neutral to positive stimulus. Patients with BN showed a hyperactivation of the right temporal and right occipital areas. Changes in BSQ responses were associated with changes in the right inferior frontal and right temporal rCBF, whereas changes in body distortion were related to the left parietal. The activation of the right temporal after the own body image exposure might be in accordance with the aversive events' response. Functional abnormalities in AN might be related to the storage of a distorted prototypical image of the body in the left parietal lobe.

Plasma homovanillic acid in adolescents with bulimia nervosa.

Dopaminergic abnormalities in bulimia nervosa have been reported in some studies, but results are not consistent across studies. In the present study, clinical characteristics, plasma level of homovanillic acid (pHVA) and two scales - the Eating Attitudes Test (EAT) and the Beck Depression Inventory (BDI) - were assessed in 36 adolescent bulimia nervosa patients (mean age16.3 years, S.D. 1.1) who were consecutively seen on an Eating Disorder Unit. Levels of pHVA were also measured in 16 healthy control adolescents from the general population. Patients had significantly higher mean pHVA than controls. Eighteen patients (50%) had a pHVA level equal to or higher than the mean of control subjects plus one standard deviation, and this group of patients had significantly higher mean BDI scores and non-significantly higher mean EAT scores, although they did not differ from the other patients in age, time elapsed since the onset of disorder, body mass index and number of binges or vomits. Moreover, in logistic regression analysis the BDI score proved to be an independent predictor of high pHVA. The level of pHVA is increased in bulimia nervosa patients with high scores on measures of depressive and eating symptomatology.

Eating disorders in ballet dancing students: problems and risk factors.

OBJECTIVE: To study the prevalence of symptoms of eating disorders and risk eating behaviours and the relationship between life at a dance school and the risk of developing an eating disorder (ED) in an adolescent population of Spanish dance students. METHODS: Questionnaires were used to assess attitudes to eating, cultural influences on the body shape model, eating disorders (DSM-IV) and risk factors for eating disorders in 76 adolescent dance students (age 12-17 years) at the Barcelona Theatre Institute. Subjects were compared with a community sample of 453 female adolescents. To study the relationship between ED and characteristics of this particular school, an original questionnaire was administered to 105 students at the school aged from 12 to 21 years. RESULTS: The prevalence of eating disorders and several risk attitudes and behaviours were similar in the dance students and the female adolescents from the general population. Students at risk of eating disorders perceived greater pressure from coaches concerning eating, appearance, weight and artistic performance; they felt less satisfied with their weight and weighed themselves more often; they avoided performing so as not to exhibit their body in public, disliked comparing their body with their peers and believed that audiences paid a great deal of attention to their bodies. In contrast, Body Mass Index (BMI) had hardly any influence on these experiences. Depressive symptoms were associated almost exclusively with experience of stressors and aversive situations. CONCLUSIONS: Dance school students do not necessarily present a greater risk of ED than other girls of the same age. The risk of ED may be associated with greater pressure from coaches, with attitudes related to the ED itself, or with depressive symptoms, rather than with the BMI.

Psychopathological and nutritional correlates of plasma homovanillic acid in adolescents with anorexia nervosa.

Dopaminergic abnormalities have been described in anorexia nervosa but studies about plasma level of homovanillic acid (pHVA) have yielded conflicting results probably due to the small number and the heterogeneity of patients. Plasma HVA, nutritional and hormonal parameters and several scales - the Eating Attitudes Test (EAT), the Beck Depression Inventory (BDI), the Leyton Obsessional Inventory-child version (LOI-C) and the State and Trait Anxiety Inventory (STAI) - were assessed in 44 adolescent anorexia nervosa patients (mean age 14.7 years, SD 1.7) consecutively admitted to an Eating Disorder Unit. They were evaluated at admission, at discharge and, in 34 cases, after 9 months of follow-up. pHVA was also assessed in 16 control adolescents. Patients had significantly higher pHVA than controls (p = .002). About 31% of patients had a very high level of pHVA, a significantly higher (p = .006) mean score in the BDI and a non significantly higher mean score in the EAT. After weight recovery some laboratory parameters improved as well as the EAT (p = .019), the BDI (p = 001) and the Interference score of the LOI-C (p = .004). Moreover, pHVA decreased significantly (p=.036). At follow-up, patients with normal weight had lower (p = .037) pHVA than patients with low weight. The conclusion would be that there is a dopaminergic dysfunction in anorexic patients, specially in a subgroup with high depressive and anorexic symptomatology. With weight recovery and psychopathological improvement, pHVA tends to normalization.

Assessing motivation to change in bulimia nervosa: the Bulimia Nervosa Stages of Change Questionnaire.

OBJECTIVE: To assess motivation to change in adolescent patients with bulimia nervosa through the Bulimia Nervosa Stages of Change Questionnaire (BNSOCQ), an instrument adapted from the Anorexia Nervosa Stages of Change Questionnaire (ANSOCQ) already validated in anorexic patients. METHOD: Subjects were 30 bulimia nervosa patients (mean age = 16.3 years) who were receiving treatment at an eating disorders unit. The evaluation instruments were: the BNSOCQ, the Eating Disorders Inventory (EDI-2) and the Beck Depression Inventory (BDI). The BNSOCQ was re-administered 1 week later to evaluate test-retest reliability. RESULTS: The BNSOCQ demonstrated good internal consistency (Cronbach's alpha = 0.94) and one week test-retest reliability (Pearson's r = 0.93). Negative significant correlations were found between the BNSOCQ and several EDI-2 scales (Pearson's r between -0.51 and -0.84) and the BDI (r = -0.74). CONCLUSION: The study provides initial support for the reliability and validity of the BNSOCQ as a self-report instrument for assessing motivation to change in adolescents with bulimia nervosa.

D8/17 monoclonal antibody: an unclear neuropsychiatric marker.

OBJECTIVE: It has been hypothesized that monoclonal antibody D8/17 identifies a B lymphocyte antigen with expanded expression in patients with rheumatic fever, childhood onset obsessive-compulsive disorder (OCD), Tourette syndrome (TS) or prepubertal anorexia nervosa (AN). Our purpose was to replicate these studies in a Spanish population and to determine whether D8/17 identifies a subgroup of these patients, focusing especially on OCD subjects. METHOD: D8/17 expression was assessed with double immunofluorescence and flow cytometry using monoclonal immunoglobulin M (IgM) in three groups of patients with diagnoses of OCD (n = 17), TS (n = 5) and prepubertal AN (n = 5), recruited during 2001. RESULTS: In the sample studied the average percentage of B cells expressing D8/17 was 4.8%. The D8/17 positive proportion of B lymphocytes was above 11% in only two out of 17 OCD patients (7.4% of total sample) and in none of the TS or prepubertal AN patients. No statistically significant differences were found in mean percentages of D8/17 between the three groups. CONCLUSIONS: In the sample studied the expression of D8/17 in B cells was very low and the great majority of patients were negative for the D8/17 marker. The molecular characterization of D8/17 would be a major step forward in clarifying its implication for these diseases.

Body mass index in female Spanish Olympic athletes.

The purpose of this study was to examine the Body Mass Index of 180 female Spanish Olympic athletes (M age = 27.1 yr., SD = 5.9 yr.) who participate in presentation sports and nonpresentation sports, in comparison with 114 female nonathletes (M age = 20.7, SD = 1.5 yr.). Presentation sports athletes have a profile similar to that of a university student but by age with a lower Body Mass Index. In particular, rhythmic gymnasts have a lower weight and Body Mass Index than other athletes and nonathletes.

Bone mineral density in male adolescents with anorexia nervosa.

OBJECTIVES: To determine the percentage of male adolescent patients with abnormal bone mineral density (BMD), to identify the variables related to BMD loss, and to study BMD change after follow-up. METHOD: Dual-energy-x-ray absorptiometry tests at the lumbar spine (L2-L4) and the femoral neck were administered in 20 male adolescents with anorexia nervosa (treated from 1997 until 2000 at the Department of Child and Adolescent Psychiatry and Psychology of the Hospital Clinic Universitari in Barcelona). Examinations were repeated in 15 patients after a follow-up of 6 to 24 months. RESULTS: Thirty-five percent of patients had osteopenia at the lumbar spine and femoral neck. The following variables were related to osteopenia: >12 months' duration of anorexia (p = .003), <3 hours/week of physical activity (p = .009), and calcium intake <600 mg/day (p = .015). In a stepwise logistic regression analysis to predict spinal BMD with the three variables mentioned above, only months of duration entered in the equation (beta = 3.5, SE = 1.3, p = .008) and correctly classified 85% of patients. At the follow-up, patients with only partial weight recovery had a BMD loss of 3.2% at lumbar spine and 6.4% at femoral neck, whereas patients with total weight recovery had an increase of 7.8% at lumbar spine and 6.7% at femoral neck. CONCLUSIONS: The risk of osteopenia in male adolescents with anorexia of more than 12 months' duration is high. In patients with total weight recovery, BMD increase is higher than normal.

Reversibility of cardiac abnormalities in adolescents with anorexia nervosa after weight recovery.

OBJECTIVE: Anorexia nervosa is a life-threatening condition, with significant risk for death due to cardiac complications. The objective of this study was to analyze the cardiac involvement in anorexia nervosa and to study the reversibility of cardiac abnormalities. METHOD: Thirty-one consecutive adolescents (aged 12 to 17 years) with a diagnosis of anorexia nervosa were evaluated from January 1998 to January 1999 at the Hospital Clínic (University of Barcelona, Catalonia, Spain). An electrocardiogram, an echocardiogram, a 24-hour Holter recording with heart rate variability, an exercise test, and a tilt test were performed at initial examination and after refeeding (3 to 18 months later). RESULTS: The basal body mass index was 15.2 +/- 2 kg/m2. Sinus bradycardia was found in 35% of patients, 93% showed a decreased left ventricular mass, and 70% had a diminished thickness of cardiac walls. The Holter recordings showed nocturnal bradycardia in 60% with an increased heart rate variability. After refeeding, a significant decrease in QT interval (p <.05) and QT dispersion (p <.01) was observed. Echocardiograms showed an increase in cardiac diameters (p <.01), left ventricular mass (p <.001), and cardiac output (p <.001). There was also an improvement in the exercise capacity (p <.05) and a normalization of the heart rate and heart rate variability (p <.05). CONCLUSION: Cardiac structural and functional abnormalities provoked by anorexia nervosa are reversible in young adolescents after refeeding.

Relationship between clinical and neuropsychological characteristics in child and adolescent first degree relatives of subjects with schizophrenia.

INTRODUCTION: Studies have shown higher rates of psychopathology and cognitive difficulties among relatives of schizophrenia patients than among the general population. This study aimed to analyze the relationship between clinical and neuropsychological characteristics in children and adolescents at high genetic risk for schizophrenia. METHODS: Participants were 26 children and adolescent first-degree relatives of subjects diagnosed with schizophrenia (high-risk [HR] group) and 20 controls whose parents and siblings did not meet DSM-IV criteria for any psychotic disorder. These two groups were matched by age, sex and socio-economic status and clinical and neuropsychological assessments were completed by all participants. RESULTS: Among HR children 42.3% were diagnosed with one or more DSM-IV axis I psychiatric disorders. The most common diagnoses were attention deficit/hyperactivity disorder (ADHD) (34.6%) and generalized anxiety disorder (3.8%) There were significant differences between HR children and controls with respect to prodromal symptoms, behavioral problems and premorbid adjustment, as well as on the majority of intelligence subscales, working memory and logical memory. When differences between HR with ADD (HR-ADD), HR without ADD (HR-NADD) and controls were analyzed, significantly higher scores on clinical scales of prodromal symptoms, behavioral problems and premorbid adjustment were found in HR-ADD than in HR-NADD or controls. There were no significant differences in cognitive domains between HR-ADD and HR-NADD, but there were between HR-ADD and controls and between HR-NADD and controls on the Verbal Comprehension Index, Perceptual Reasoning Index, Working Memory Index and GAI. CONCLUSIONS: Compared to controls, HR children showed more clinical symptoms and cognitive abnormalities. HR children with ADD had worse clinical symptoms than did HR without ADD, although there were no differences in terms of cognitive abnormalities. Both HR groups seem to have similar deficits in neuropsychological performance.

Parental psychopathology in child and adolescent obsessive-compulsive disorder.

PURPOSE: To identify the lifetime prevalence of obsessive-compulsive disorder (OCD) and other psychiatric diagnoses in parents of OCD pediatric patients as well as the frequency of onset of psychiatric disorders in the 6 months prior to evaluation. METHODS: Parents (n = 63) of 32 children and adolescents (20 males and 12 females; mean age of 13.3 +/- 2.4) with OCD and parents of (n = 63) 32 age and sex-matched controls with no psychiatric diagnosis were examined. The semi-structured SCID-I was used to identify axis I psychiatric disorders and SCID-II to evaluate personality disorders. RESULTS: Mothers of patients had significantly more psychiatric diagnoses than control mothers (P = 0.001). Only parents of patients had diagnosis of OCD (P = 0.01) and psychiatric diagnosis (Adjustment Disorders, Major Depression, Anxiety Disorders) with onset during the 6 months prior to evaluation (P = 0.001). The duration of disease in children appeared to be related to development of morbidity in parents (P = 0.04). Parents of patients also showed a higher incidence of personality disorders (P = 0.01), in particular avoidant (6 versus 1 parents, P < 0.055) and obsessive-compulsive (9 versus 2 parents, P = 0.016) personality disorders. CONCLUSIONS: The findings suggest that there may be an excess of psychopathology in parents of children with OCD as compared to parents of pediatric and non-psychiatric patients. Adjustment disorders with depressive and anxious symptoms are significantly more frequent in mothers of OCD children after the onset of the disease.

Cue exposure in the treatment of resistant adolescent bulimia nervosa.

OBJECTIVE: A percentage of bulimic patients do not greatly improve with the usual treatment. Therefore, the objective was to further evaluate cue exposure (CE), in order to attain better results in clinical settings. METHOD: Twenty-two adolescent patients who fulfilled DSM-IV diagnostic criteria for bulimia nervosa (mean age 16.7, SD 1.5) and who were resistant to the usual treatment followed a program of 12 CE sessions. Clinical characteristics were evaluated and different psychopathological scales were administered at the beginning and the end of the CE program and at 6 month follow-up. Subjective anxiety and physiological parameters were recorded during the sessions. RESULTS: A significant decrease was observed in subjective anxiety (p = .023), heart rate (p < .001), and blood pressure (p = .001) during the first session. A decrease in these parameters was also recorded between the first and the last session. The number of binges per week (p = .005) and the mean score for the psychopathological scales decreased significantly from the beginning of the treatment, and were significantly lower at the end of the CE program and at follow-up. Purging behaviors per week only decreased significantly after the end of the CE session during the follow-up (p = .04). CONCLUSION: Anxiety, binging, purging, and psychopathological scales improve with a CE program in resistant bulimia nervosa.

Self-oriented perfectionism in eating disorders.

OBJECTIVE: To assess perfectionism dimensions in eating disorders in comparison with other psychiatric disorders and subjects from the general population. METHOD: The Child and Adolescent Perfectionism Scale (CAPS), the Eating Disorders Inventory (EDI-2), and the Eating Attitudes Test (EAT) were administered to a group of 108 female eating-disordered patients (75 anorexia nervosa and 33 bulimia nervosa), to a group of 86 female psychiatric patients with anxiety (N = 32), depressive (N = 38), or adaptive disorders (N = 16), and to 213 healthy female participants. RESULTS: Both bulimic and anorexic patients scored higher on Self-Oriented Perfectionism (p < 0.001) than the other two groups but not on Socially-Prescribed Perfectionism (p = 0.054). Among patients with eating disorder, 17.6% obtained a score two standard deviations higher than the mean in the healthy comparison group on self-oriented perfectionism; this percentage was significantly higher than in the other two groups. The percentage of eating disorder patients with high socially-prescribed perfectionism was similar to that found in other psychiatric disorders. Moreover, self-oriented perfectionism was a predictor of an eating disorder. CONCLUSION: Self-oriented perfectionism is more specific to eating disorders than to depressive or anxiety disorders.

Predictors of weight maintenance after hospital discharge in adolescent anorexia nervosa.

OBJECTIVE: To analyze variables that predict weight maintenance in adolescent anorexia nervosa. METHOD: The Eating Attitudes Test, the Beck Depression Inventory, the Leyton Obsessional Inventory, the State and Trait Anxiety Inventory, and the Anorexia Nervosa Stages of Change Questionnaire were administered to 49 anorexia nervosa patients (mean age 14.3 years, SD 1.7) consecutively admitted to an eating disorder unit. They were evaluated at admission, at discharge, and after nine months follow-up. RESULTS: At discharge, patients had improved in body mass index (p < .001), eating attitudes (p = .002), depressive symptomatology (p = .001), and motivation to change (p < .001). Patients with good weight maintenance at follow-up had higher body mass index (p = .017) at admission, lower abnormal eating attitudes (p = .035), depressive symptomatology (p = .026), and higher motivation to change (p = .004) at discharge. Logistic regression analysis showed a high motivation to change at discharge and a high body mass index at admission to be predictors of weight maintenance. CONCLUSION: High motivation to change, low abnormal eating attitudes, depressive symptomatology at discharge, and high body mass index at admission are associated with weight maintenance in adolescent anorexia nervosa.

Diseño y validación del "Cuestionario para la evaluación de síntomas obsesivo compulsivos para padres" (CESOC-P) / Design and validation of the Compulsive Obsessive Symptoms Scale for Parents (CESOC-P)

El objetivo del estudio fue desarrollar un instrumento para la detección de síntomas obsesivo compulsivos (OC) en niños, a través de la información de los padres. 492 padres de escolares contestaron el «Cuestionario para la evaluación de síntomas obsesivo compulsivos para padres» (CESOC-P). Para reducir el número de ítems, se realizó un análisis factorial exploratorio (AFE) y se seleccionaron aquellos que obtuvieron saturaciones ≥ 0,5 y los que se consideraron clínicamente relevantes. Luego, se realizó otro AFE utilizando el método de rotación oblimin. Los 13 ítems seleccionados configuraron la versión final del CESOC-P, con un solo factor (índice KMO= 0,86; GFI= 0,96) y una adecuada fiabilidad (α= 0,84). La puntuación total del CESOC-P se relacionó significativamente con el diagnostico de trastorno OC y con la puntuación de OC del Inventario de síntomas infantiles-4». El punto de corte de 3 mostró una adecuada sensibilidad y especificidad. El CESOC-P es un instrumento breve, fiable y valido para la detección de los síntomas OC y puede ser útil para complementar la información de los propios niños y/o adolescentes

The aim of this study was to develop an instrument for the detection of obsessive compulsive (OC) symptoms through parent information. 492 parents of schoolchildren answered the 41preliminary items of the «Questionnaire for the Evaluation of Obsessive Compulsive Symptoms- Parent» (CESOC-P). A first exploratory factor analysis (EFA) was made to reduce the number of items, and with the items that obtained loads equal to or higher than 0.50 and some items considered clinically relevant another EFA using the oblimin rotation method was performed. The 13 items selected made up the final version, which showed a single factor (KMO index = .86, GFI= .96) and adequate reliability (α= .84). CESOC-P scores were significantly related to OC diagnoses and Child Symptoms Inventory-4 OC scores. A cut-off score of 3 presented adequate sensitivity and specificity. The CESOC-P is a quick, reliable and valid tool for the detection of obsessive-compulsive symptoms and can be useful to supplement the information reported by children and/or teenagers