Although adult sexual assault has been suggested to be a risk factor for disordered eating, little is known about the pathways leading to this disorder. This study aimed to examine the mediating effect of depressive symptoms and symptoms of posttraumatic stress disorder (PTSD), in the relationship between sexual assault and disordered eating among female students. A sample of 296 French female students completed a questionnaire assessing experiences of sexual assault from age 15, PTSD symptoms, depressive symptoms, and disordered eating. Results revealed that PTSD symptoms fully mediated the effect of early adult sexual assault on disordered eating (B = 1.10, SE = 1.64), and depressive symptoms were a partial mediator of this relationship (B = 2.64, SE = 1.28). When examining both mediators simultaneously the relationship was fully mediated and neither variable emerged as a significantly stronger mediator. Our findings highlight the complex relationship between PTSD symptoms, depressive symptoms, and disordered eating following sexual assault. Further investigation into the temporal relationships between these variables would contribute to inform prevention interventions for disordered eating.
To the Editor: On March 11, 2011, a 9.0 magnitude earthquake and tsunami struck Japan, killing 14,000 people and damaging nuclear and petrochemical plants. The immediate and intense media coverage exposed viewers across the world to disturbing images. While television coverage of a nearby disaster has been found to increase the risk for subsequent psychological distress (1), little is known about the effects of Internet coverage of a distant disaster.
Abstract: The present study aimed to explore exposure to stressful events during a psychiatric admission and the predictive power of peritraumatic distress and dissociation in the development of posttraumatic stress disorder (PTSD) symptoms after exposure to such events. Psychiatric inpatients (N = 239) were asked to report exposure to stressful events during their admission within 48 hours of being admitted. Individuals reporting at least one stressful event during admission (n = 70, 29%) were assessed for peritraumatic dissociation and distress in relation to this event and, 5 weeks later, were reassessed for PTSD symptoms. Eight participants (12.3%) scored above the cutoff for probable PTSD. Multiple regression analyses revealed that peritraumatic distress was a significant predictor of 5-week PTSD symptoms. Our findings suggest that individuals experiencing increased peritraumatic distress in relation to a stressful event experienced during a psychiatric admission might be at risk of PTSD symptoms and might benefit from increased attention.
RésuméLe trouble de personnalité limite (TPL) représente 10 % de l’activité psychiatrique ambulatoire. Le risque de suicide est important, ainsi que l’altération du fonctionnement psychosocial. L’objectif de notre revue de littérature est de déterminer l’efficacité des psychothérapies adaptées aux sujets présentant un TPL sur la sphère affective, comportementale, le fonctionnement interpersonnel et global ainsi que sur la personnalité. Pour cela, nous avons réalisé une revue de littérature de 1990 à 2008 sur Medline recoupant les mots clefs, « borderline personality disorder » et « psychotherapy » avec les limites « randomised control trial » ou « meta analysis ». Nous avons retenu 39 résumés, dont 17 (44 %) ont été sélectionnés, après application des critères d’exclusion (méthode non contrôlée, étude centrée sur un psychotrope, étude ne correspondant pas à notre objectif). Les psychothérapies apparaissent efficaces dans la prise en charge de plusieurs aspects touchant au TPL. La thérapie comportementale et dialectique possède le plus haut niveau de preuve, notamment concernant son action sur les comportements autoagressifs. La thérapie basée sur la mentalisation possède le plus large spectre d’action. La thérapie cognitive manualisée et la formation d’inspiration systémique à la prédiction émotionnelle et à la résolution de problème offrent la faisabilité la plus importante. En l’état actuel, il existe des différences d’indication probable en fonction des symptômes cibles et des ressources sanitaires disponibles.
Borderline personality disorder (BPD) accounts for 10% of outpatient psychiatric practice. The risk of suicide attempts is high and the psychosocial impairment significant. Different theoretical streams have suggested psychotherapeutical approaches for BPD.
to examine the efficacy of psychotherapy for BPD patients on affective symptoms, behavioural outcomes, interpersonal and social functioning, as well as BPD criteria.
We reviewed the medical literature from 1990 to 2008 on Medline by combining the following keywords “borderline personality disorder” and “psychotherapy” (inclusion criteria). We restricted the analysis to “randomised control trial” or “meta analysis”.
Of the 39 abstracts that came out from the search, we selected 17 (44%) after applying the exclusion criteria. According to our review, different types of psychotherapies have shown some efficacy on reducing affective symptoms and BPD criteria, as well as improving behavioural outcomes and psychosocial functioning. Dialectical behavioural therapy presents the best-documented efficacy, notably on reducing self-mutilating and suicidal behaviours (five randomized controlled trials [RCT]). Mentalization based treatment seems to be efficient on the four types of outcomes, but has been the object of only one RCT. Finally, some evidence suggests that Manual Assisted Cognitive Treatment and Systems Training for Emotional Predictability and Problem Solving are the most cost-effective and easiest to be implemented.
According to our review, some evidence supports an efficiency of psychotherapies in the management of several features of BPD. It is likely that, depending on the target symptoms, one type of therapy might be more efficient than another. The acceptability of these long-term treatments is however unknown.
Background: To date, only a few cases of improvement of Parkinsonism in depressed patients treated with electroconvulsive therapy (ECT) have been reported. However, no functional imaging data are available to support this finding.Objective: To describe the first observation of increase in dopamine transporter uptake after ECT.
Methods: Iodine-123 fluoropropyl-carbomethoxy-3-β-(4-iodophenyltropane) single-photon emission computed tomographic imaging was conducted in a 77-year-old depressed patient displaying symptoms of Parkinson disease (PD) before and after a series of 12 bilateral ECTs.
Results: The patient displayed improvement in PD symptoms and increase in dopamine transporter uptake after ECT.
Conclusions: Our observation suggests that the PD symptoms and decrease in striatal uptake appearing in the context of a depressive episode might warrant further attention, as they might be reversible.
The Clinical Global Impression scale (CGI) is frequently used in clinical research because of its face validity and ease of use but data on its reliability are scarce. Our goal was to estimate the reliability of the scale and compare reliability between face-to-face and video scoring. We analyzed 50 different video interviews recorded during 5 visits of a crossover trial to study the effect of subthalamic nucleus stimulation. Six specialized clinicians rated the CGI using these videos, providing 300 different ratings. The intraclass correlation was lower at inclusion (0.30 [0.13–0.50]) than at later visits (0.68 [0.61–0.80]). Reliability was not influenced by the patients' stimulation status. The mean of at least two independent evaluations of the video is needed to achieve an ICC greater than 0.8. The video CGI is a valid clinical outcome measure suitable for clinical trials (ClinicalTrials.gov number, NCT00169377).
ABSTRACT ABSTRACTBackground: Psychotropic medication is widely prescribed in clinical practice for the management of behavioral and psychological symptoms of dementia (BPSD) in Alzheimer's disease (AD). However, there have been few pharmaco-epidemiological studies or studies conducted in a natural setting on the real use of antidepressants in AD. The aim of this survey was to assess the prevalence of antidepressant use in AD and to identify the clinical factors associated with antidepressant prescription.Methods: REAL.FR is a four-year, prospective, multi-center study. Baseline data including demographic characteristics, clinical variables and drug intake were obtained. Depressive symptoms were determined using the Neuropsychiatric Inventory (NPI).Results: A total of 686 AD patients were included. Antidepressant treatment was prescribed for 34.8% of patients. Clinically significant depressive symptoms (NPI ≥ 4) were observed in 20.5% of the total population. Although depressed subjects were significantly more likely to be treated with antidepressants than non-depressed subjects (p<0.0001), only 60% of depressed subjects overall were prescribed an antidepressant. In multivariate analysis, clinically significant depressive symptoms were associated with antidepressant prescription although this result was only observed in subjects without a previous history of depression.Conclusions: The available data on antidepressant efficacy in BPSD other than depression (in particular, agitation, aggression and, occasionally, psychotic symptoms) do not influence prescription choices. Depressive symptoms may be taken more seriously in the absence of a previous history of depression, leading to increased antidepressant prescription rates in individuals presenting with depression for the first time.