The European Journal of Psychiatry

Stages in the Pathophysiology and Eventual Treatment of Brain Disorders

Eating attitudes and their relation with drug consumption in a university sample

Background and Objectives: Some relations between abnormal eating behaviours and attitudes, and other psychiatric disorders have been found in different populations. This study was carried out to examine the relations between eating attitudes and substance use among university students from Spain. Methods: The EAT and a substance use questionnaire were administered to a sample of 1,089 male and female university students in a cross-sectional design. Results: There were significant differences in drug consumption between students that met cut-off score criteria for the 40 and 26-item versions, and those that did not. Significant differences also emerged between extreme groups (25 vs. 75 percentile) in both EAT versions and in all subscales, especially in the Bulimia and Food Preoccupation subscale. A clearly distinct pattern of differences appeared in male and female students. Conclusions: Outcomes are in consonance with the theories proposed by several authors to explain the etiological relation between eating disorders and substance use.

Pregabalin reduces sleep disturbance in patients with generalized anxiety disorder via both direct and indirect mechanisms

Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD) and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms. Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance. Results: Compared with placebo (n = 128), treatment with pregabalin (n = 121) significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125) had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01) and 47% indirect, mediated through anxiety symptoms (p < 0.05). Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.

Nightmares and bad dreams in patients with borderline personality disorder: Fantasy as a coping skill?

Background and Objectives: Previous studies reported a high prevalence of nightmares and dream anxiety in Borderline Personality Disorder (BPD) and the severity of dream disturbances correlated with daytime symptoms of psychopathology. However, the majority of these results are based on retrospective questionnaire-based study designs, and hence the effect of recall biases (characteristic for BPD), could not be controlled. Therefore our aim was to replicate these findings using dream logs. Moreover, we aimed to examine the level of dream disturbances in connection with measures of emotional instability, and to explore the protective factors against dream disturbances. Methods: 23 subjects diagnosed with BPD, and 23 age and gender matched healthy controls were assessed using the Dream Quality Questionnaire, the Van Dream Anxiety Scale, as well as the Neuroticism, Assertiveness and Fantasy scales of the NEO-PI-R questionnaire. Additionally, subjects were asked to collect 5 dreams in the three-week study period and to rate the emotional and phenomenological qualities of the reported dreams using the categories of the Dream Quality Questionnaire. Results: Dream disturbances (nightmares, bad dreams, night terror-like symptoms, and dream anxiety) were more frequent in patients with BPD than in controls. Dream disturbances correlated positively with Neuroticism, while Fantasy proved to be a negative correlate of dream disturbances. Conclusions: Our study provides further support for the association between dream disturbances and BPD, links the presence of dream disturbances to the levels of emotional instability, and suggests that fantasy is a potential protective factor against dysfunctional dreaming.

Schizoid personality disorder linked to unbearable and inescapable loneliness

Background and Objectives: More insight is needed into the link between loneliness and schizoid personality disorder in order to construct more adequate diagnostic tools and therapeutic programs. Methods: A computer-based search of literature (Medline and PsycInfo) between 1970 and 2009. Results: A combination of intrapsychic, psychosocial, cultural, ethnic, religious, and/or neurobiological factors determine loneliness and associated schizoid etiology. Furthermore, a complex interaction between these influences is prevalent in schizoid etiology. Conclusion: Loneliness appears to be a crucial factor in the etiology of schizoid personality disorder.

The impact a first episode of major depression has on marital dissatisfaction: Is remission associated with improvement in dissatisfaction?

Background and Objectives: Prior research suggests that marital dissatisfaction is associated with Major Depression (MD). The purpose of this study was to investigate whether remission from a first episode of MD is associated with improvement in marital dissatisfaction and whether the degree of marital dissatisfaction at the time of diagnosis has an influence on the outcome of MD. Methods: The Hamilton Rating Scale for Depression, the Dyadic Adjustment Scale and the Areas of Change Questionnaire were administered to 59 married couples in which one member fulfilled DSM-IV criteria for a first Episode of MD, but her husband (or his wife) did not suffer any mental disorder, and to 53 control couples at 6 outpatient clinics, at baseline and after a 6-months follow-up. Results: The level of marital dissatisfaction in couples with a persistent depressed participant decreased in comparison to couples without a depressed subject (p < 0.05 CI: -10.6 and -0.2), but there were no significant differences between couples in which the depressed spouse recovered from MD and comparison couples. Regardless of MD´s severity, high levels of satisfaction were associated with a higher probability to recover. Limitations: The follow-up period was short and we assessed the level of marital dissatisfaction using self-report measures. Conclusion: This study shows that MD has an influence on Marital Satisfaction even at a very early stage of the Depressive Disorder. What is more, changes in any of the two factors (MD or marital dissatisfaction) influenced the other factor´s course; thus an effective intervention on MD may have a positive impact on marital dissatisfaction as well.