Mentalizing Subtypes in Eating Disorders: A Latent Profile Analysis

Background: Mentalizing, the mental capacity to understand oneself and others in terms of mental states, has been found to be reduced in several mental disorders. Some studies have suggested that eating disorders (EDs) may also be associated with impairments in mentalizing. The aim of this work is to investigate the possible presence of mentalizing subtypes in a sample of patients with EDs. Method: A sample of patients with eating disorders (N = 157) completed a battery of measures assessing mentalization and related variables, including the Reflective Functioning Questionnaire (RFQ), the Difficulties in Emotion Regulation Strategies (DERS), the Interpersonal Reactivity Index (IRI). Clinicians rated patients in relation to imbalances in different dimensions of mentalization to prementalizing modes and attachment style by using the Mentalization Imbalances Scale, the Modes of Mentalization Scale (MMS), and the Adult Attachment Questionnaire. A latent profile analysis was conducted to test the possible presence of different subgroups. MANOVA was used to test the possible differences between the four mentalizing profiles in relation to emotion dysregulation (DERS), empathy (IRI), and adequate and impairments in mentalizing (MMS and RFQ). Results: The latent profile analysis suggested the presence of four different profiles in relation to impairments in the dimensions of mentalization: (1) affective/self/automatic imbalances, (2) external imbalance, (3) cognitive/self/automatic imbalances, and (4) cognitive/other/automatic imbalances. Patients belonging to profile 1 are characterized by the prevalence of affective mentalization that overwhelms the capacity to reflect on mental states with an imbalance on the self-dimension; profile 2 patients are excessively focused on the external cues of mentalization; profile 3 patients are characterized by an over-involvement on the cognitive and self-facets of mentalization, with an impairment in adopting the other mind perspective; and profile 4 patients have similar impairments compared to profile 3 patients but with an excessive focus on others and deficits in self-reflection. These profiles were heterogeneous in terms of EDs represented in each group and presented significant differences on various variables such as attachment style, emotion dysregulation, empathy, interpersonal reactivity, and reflective function. This study represents, so far, the first work that confirms the presence of different mentalizing patterns in ED patients. Conclusions: ED patients can be classified in relation to impairments in different dimensions of mentalization above and beyond ED diagnosis

AORTIC STIFFNESS AND INDEXES OF DISEASE SEVERITY IN SUBJECTS WITH PREVIOUS COVID-19 PNEUMONIA: A FOLLOW-UP STUDY

OBJECTIVE: Up to date the possibility of a vascular damage due to COVID-19 pneumonia is a not clarified. We searched for relationships between the carotid-femoral pulse wave velocity (cfPWV) and clinical and biochemical markers of severity of the infectious disease, after hospital discharge, in a group of patients who had been admitted in care units. DESIGN AND METHOD: In 69 subjects (age 58 ± 13 years, 36 males), previously admitted in hospital because of COVID-19 pneumonia, we evaluated at the time of hospital admission anthropometric parameters, blood pressure, history of arterial hypertension or other diseases, drugs, smoking and alcohol habit, physical activity level, and indexes of infectious disease severity, such as the SIMEU score, need for invasive oxygen delivery, PaO2, PaCo2, inflammatory markers such as white blood cells count, levels of proadrenomedulline (proADM), reactive C protein, procalcitonin, IL- 6, glomerular filtration rate (GFR), troponin, mioglobin, B natriuretic peptide. After an average 2 months follow-up the cfPWV was measured. RESULTS: At univariate analysis the cfPWV was significantly and positively related to age (r = 0.454, P < 0.001), body mass index (r = 0.436, P = 0.016), waist circumference (r = 0.345, P = 0.004), levels of plasma glucose (r = 0.430, P = 0.001), proADM (r = 0.456, P = 0.006), IL-6 (r = 0.280, P = 0.037), mioglobin (r = 0.443, P = 0.001) and inversely related to GFR (r = -0.289, P = 0.023). The cfPWV was higher in diabetics subjects than in non-diabetics (P = 0.011), and in patients who had needed invasive oxygen support (P = 0.044). There was no difference in cfPWV in patients with or without history of arterial hypertension or with different blood pressure levels at admission. At multivariate analysis the cfPWV was independently associated with invasive oxygen support (B = 0.168, P = 0.012), body mass index (B = 0.180, P = 0.001), waist circumference (B = 0.162, P = 0.002), GFR (B = 0.078, P = 0.008), and proADM levels (B = 0.161, P = 0.003). CONCLUSIONS: In patients who recovered from COVID-19 pneumonia the aortic stiffness is associated with severity of disease and levels of proADM, but not with history of hypertension. Patients with more higher proADM levels in acute phase of the infectious disease could need a longer follow-up evaluation of the CFPWV after the recovering from disease to search for long time vascular damage

RELATIONSHIPS BETWEEN NAFLD BIOCHEMICAL SCORES AND LEFT VENTRICULAR GEOMETRIC PATTERN IN NAÏVE ESSENTIAL HYPERTENSIVE PATIENTS

OBJECTIVE: The not alcoholic fatty liver disease (NAFLD) is associated with an increased cardiovascular mortality and morbidity. An hypothesis for this association could be the left ventricular (LV) geometric alteration sometime found in hypertension that is a known prognostic factor for cardiovascular events in hypertension. We searched for a relationship between biochemical scores of NAFLD and left ventricular (LV) hypertrophy (LVH) or LV geometric patterns changes in a large group of never treated essential hypertensive (EH) patients. DESIGN AND METHOD: In 434 naïve (49 ± 14 years, 234 males) we evaluated BMI, waist circumference, liver steatosis at abdominal echography, the biochemical scores of liver steatosis: Liver Fat Score (LFS), Fatty Liver Index (FLI), Hepatic Steatosis Index (NAÏVE), and the fibrosis scores: NAFLD Fibrosis Score (NFS), APRI, FIB-4, parameters of glucose and insulin homeostasis, liver blood tests, lipids, platelets count, glomerular filtration rate (GFR), reactive C protein. LV mass and relative wall thickness was calculated with echocardiography. Patients were classified in 4 groups of LV geometry: 1 = LV normal geometry, 2 = LV concentric remodeling, 3 = concentric LVH, 4 = eccentric LVH. RESULTS: A LVH was present in 17.3% of patients, and these patients had higher LFS (P < 0.001), FLI (P = 0.008), NAÏVE (P = 0.004) and NFS (P = 0.011) scores than patients without LVH. LVH was independently associated with the FLI score but not with fibrosis scores. The steatosis scores (LFS, NAÏVE, FLI) linearly increased across the four LV geometric patterns (P = 0.007, P = 0.001, P = 0.003, respectively). The fibrosis score NFS was significantly higher in subjects with concentric LVH (P = 0.041). The LFS was independently associated with BMI, GAUC, G120, and triglycerides levels. The NFS was independently associated with waist circumference, GFR and weakly with fasting glucose level. Ultrasound steatosis was not different among the four LV geometric patterns. CONCLUSIONS: In naïve EH patients the biochemical steatosis scores show a relationship with LVH and LV geometric changes, while fibrosis is associated with concentric LVH. An accurate investigation to reveal a NAFLD should be done in EH patients with altered LV geometry and to better understanding of mechanisms linking the two conditions