Trastorno de ensoñación excesiva:: características clínicas y neuropsicológicas del primer caso descrito en España

Maladaptive Daydreaming (MD) is a little known and recently described psychopathological condition, characterized by complex and recurrent daytime fantasies in a disfunctional way. Worldwide prevalence of MD is unknown. In previously reported cases a high comorbidity of MD with other mental disorders was highlighted, especially with ADHD. This paper presents the first case of MD reported in Spain, detected in a young female patient that seeks assistance in Mental Health Services for other symtoms. Clinical evaluation indicates the presence of MD and several comorbid mental disorders, but we do not detect ADHD or significant neurospychological deficit. The case is discussed in relation to the research on cognitive effects of mind wandering and daydreaming. Different subtypes of MD depending on attentional- executive involvement is suggested as hipothesis. Psychological treatment of MD is also discussed. This first case of MD reported in Spain highlights the desirability of exploring symptoms in clinical settings and adds evidence on MD, but its necessary to adapt measuring instruments to different populations and to refine syndromic characterization before considering MD as a new disorder whithin normative classification systems.El trastorno de Ensoñación Excesiva (TEE) constituye una condición psicopatológica recientemente definida y poco conocida, caracterizada por la presencia de fantasías diurnas complejas y recurrentes hasta extremos disfuncionales. Se desconoce la prevalencia del TEE a nivel mundial, destacando algunos autores su alta comorbilidad con otros trastornos mentales, especialmente con el Trastorno por Déficit de Atención/Hiperactividad (TDAH). En este trabajo presentamos el primer caso de TEE descrito en España, en una paciente joven que acude a los Servicios de Salud Mental por otros motivos. La evaluación clínica constata varios trastornos mentales comórbidos, entre ellos TEE, pero no TDAH ni alteraciones neuropsicológicas llamativas. Se discute el caso en el contexto de la investigación sobre efectos cognitivos de la ensoñación y la divagación mental, sugiriéndose la hipótesis de distintas variantes del TEE dependiendo de la afectación (o no) atencional-ejecutiva. Se discuten también algunas cuestiones relativas al tratamiento psicológico del TEE. La detección de este primer caso en España subraya la conveniencia de explorar síntomas compatibles con TEE en entornos clínicos y contribuye a sumar evidencia sobre esta patología, siendo necesario adaptar a diversas poblaciones los instrumentos de medida existentes y depurar su caracterización sindrómica antes de que pueda plantearse como un nuevo trastorno dentro de los sistemas clasificatorios

Inflammatory activation and cholinergic anti-inflammatory system in eating disorders

Dysfunctional serotoninergic regulation and hypothalamic-pituitary-adrenal (HPA) axis overreactivity have been consistently reported in research studies with eating disorders (ED). In addition, the links between stress response, serotonin function, HPA axis and inflammatory mechanisms in ED have also been suggested in a number of studies. In our study, inflammatory parameters in white blood cells were investigated in 26 female patients with ED and 25 healthy control subjects matched for sex, age and ethnicity. Patients were free of medication for at least two weeks at the time of the study. Results showed a significant increase in plasma levels of the proinflammatory cytokine IL1β and the protein expression of cyclooxygenase 2 (COX2) in peripheral mononuclear blood cells (PMBCs) in ED patients compared with controls. As well as a significant increase of the oxidative-nitrosative marker TBARS (Thiobarbituric Acid Reactive Substances) in plasma. These findings were associated with increased expression of the alpha7 subunit of the nicotinic receptor (α7nAChR) in PMBC in ED patients independent of plasma cotinine levels. These results suggest that a pro-inflammatory and oxidant phenotype might be present in ED patients. Further research on cellular inflammatory and anti-inflammatory pathways might be oriented to investigate differences between ED subtypes and to search for new potential targets for pharmacological treatment.Instituto de Salud Carlos IIICIBERSAMDepto. de Farmacología y ToxicologíaDepto. de Medicina Legal, Psiquiatría y PatologíaFac. de MedicinaTRUEpu

Personality in patients with eating disorders depending on the presence/absence of comorbidity with borderline personality disorder / Personalidad en pacientes con trastorno alimentario en función de la presencia/ausencia de comorbilidad con trastorno límite de la personalidad

Studies on comorbidity between eating disorders (ED) and personality disorders yield rates of 20-80%, a condition that makes difficult the diagnosis and complicates prognosis, especially regarding their comorbidity with borderline personality disorder (BPD). The objective of this study was to assess whether pathological personality alterations make it possible to distinguish not only between different types of ED, but also in terms of their comorbidity with BPD. Participants included 29 patients with ED, 10 with comorbid ED with BPD (EDc), 27 with BPD and 22 healthy controls, who completed the Millon Multiaxial Clinical Inventory (MCMI-II), and two other measures, one on impulsivity and other aimed at assess symptoms of bulimia nervosa (BN). The ED group was characterized by greater compulsivity, mainly in the subgroup with anorexia nervosa vs. BPD and EDc groups; however, these last two groups shared many features that show emotional instability, although less that the subgroup with BN. These findings support a continuum of severity in terms of compulsivity-impulsivity, with important etiopathogenic, diagnostic and psychotherapeutic implications.Los estudios sobre comorbilidad entre los trastornos de la conducta alimentaria (TCA) y los trastornos de la personalidad reportan tasas del 20-80%, condición que dificulta el diagnóstico y ensombrece el pronóstico, especialmente respecto a su comorbilidad con el trastorno límite de la personalidad (TLP). El objetivo de este estudio fue valorar si las alteraciones patológicas de la personalidad permiten distinguir no solo entre distintos tipos de TCA, sino además en función de su comorbilidad con el TLP. Participaron 29 pacientes con TCA, 10 con TCA comórbido con TLP [TCAc], 27 con TLP y 22 controles sanas, quienes completaron el Inventario Clínico Multiaxial de Millon (MCMI-II) y otras dos medidas, una sobre impulsividad y otra dirigida a evaluar síntomas de bulimia nerviosa (BN). El grupo TCA se caracterizó por mayor compulsividad, principalmente en el caso del subgrupo con anorexia nerviosa vs. los grupos TLP y TCAc; no obstante, estos dos últimos compartieron un amplio número de rasgos indicativos de inestabilidad emocional, y también –aunque en menor medida− con el subgrupo con BN. Los hallazgos apoyan un continuum de gravedad en función de la compulsividad-impulsividad, con importantes implicaciones etiopatogénicas, diagnósticas y psicoterapéuticas

Transdiagnostic study of impulsivity and self-injurious behaviour in unstable and impulsive disorders

Introduction. High comorbidity between borderline personality disorder (BPD) and eating disorders (ED) shows the necessity of developing transdiagnostic models, where impulsivity could play a relevant role in the manifestations of self-injurious behaviour. Objectives: 1) To compare the levels of impulsivity and self-injurious behaviour among people with BPD, people with ED and controls. 2) To predict the presence of self-injurious behaviour based on impulsivity and other relevant clinical variables, such as the experience of traumatic events and sensitivity to rejection. Methods. 108 women (23 controls; 29 with a diagnosis of restrictive ACT (rED); 21 with a diagnosis of purgative ACT (pED); and 35 with a diagnosis of BPD) were assessed using the Barratt Impulsivity Scale, the Traumatic Experiences Questionnaire and the Sensitivity to Rejection Questionnaire. Information about self-injurious behaviour was collected through interview and clinical history. Results. Differences in impulsivity and self-injurious behaviour scores were found between the groups, with higher impulsivity in the BPD and pED groups, and higher rates of self-injurious behaviour in the BPD group followed by both ED groups. On the other hand, impulsivity predicted suicide attempts, and together with sensitivity to interpersonal rejection predicted nonsuicidal self-harm (NSSH). Conclusion. Impulsivity is a dimensional variable in BPD and ED, which in turn plays a relevant role in the prediction of self-injurious behaviour.Acknowledgements and conflicts of interest. This work has been supported by the project PI16/01949, integrated in the Plan Nacional de I+D+I, AES 2013-2016; funded by the ISCIII and co-financed by the Fondo Europeo de Desarrollo Regional (FEDER). “Una forma de hacer Europa

The interplay between functioning problems and symptoms in first episode of psychosis: An approach from network analysis

The relationship between psychotic symptoms and global measures of functioning has been widely studied. No previous study has assessed so far the interplay between specific clinical symptoms and particular areas of functioning in first-episode psychosis (FEP) using network analysis methods. A total of 191 patients with FEP (age 24.45 ± 6.28 years, 64.9% male) participating in an observational and longitudinal study (AGES-CM) comprised the study sample. Functioning problems were assessed with the WHO Disability Assessment Schedule (WHODAS), whereas the Positive and Negative Syndrome Scale (PANSS) was used to assess symptom severity. Network analysis were conducted with the aim of analysing the patterns of relationships between the different dimensions of functioning and PANSS symptoms and factors at baseline. According to our results, the most important nodes were “conceptual disorganization”, “emotional withdrawal”, “lack of spontaneity and flow of conversation”, “delusions”, “unusual thought content”, “dealing with strangers” and “poor rapport”. Our findings suggest that these symptoms and functioning dimensions should be prioritized in the clinical assessment and management of patients with FEP. These areas may also become targets of future early intervention strategies, so as to improve quality of life in this population.Depto. de Psicobiología y Metodología en Ciencias del ComportamientoFac. de PsicologíaTRUEpu