Early alterations in the MCH system link aberrant neuronal activity and sleep disturbances in a mouse model of Alzheimer's disease

Early Alzheimer's disease (AD) is associated with hippocampal hyperactivity and decreased sleep quality. Here we show that homeostatic mechanisms transiently counteract the increased excitatory drive to CA1 neurons in App^NL-G-F mice, but that this mechanism fails in older mice. Spatial transcriptomics analysis identifies Pmch as part of the adaptive response in App^NL-G-F mice. Pmch encodes melanin-concentrating hormone (MCH), which is produced in sleep-active lateral hypothalamic neurons that project to CA1 and modulate memory. We show that MCH downregulates synaptic transmission, modulates firing rate homeostasis in hippocampal neurons and reverses the increased excitatory drive to CA1 neurons in App^NL-G-F mice. App^NL-G-F mice spend less time in rapid eye movement (REM) sleep. App^NL-G-F mice and individuals with AD show progressive changes in morphology of CA1-projecting MCH axons. Our findings identify the MCH system as vulnerable in early AD and suggest that impaired MCH-system function contributes to aberrant excitatory drive and sleep defects, which can compromise hippocampus-dependent functions.

MDGAs are fast-diffusing molecules that delay excitatory synapse development by altering neuroligin behavior

MDGA molecules can bind neuroligins and interfere with trans-synaptic interactions to neurexins, thereby impairing synapse development. However, the subcellular localization and dynamics of MDGAs, or their specific action mode in neurons remain unclear. Here, surface immunostaining of endogenous MDGAs and single molecule tracking of recombinant MDGAs in dissociated hippocampal neurons reveal that MDGAs are homogeneously distributed and exhibit fast membrane diffusion, with a small reduction in mobility across neuronal maturation. Knocking-down/out MDGAs using shRNAs and CRISPR/Cas9 strategies increases the density of excitatory synapses, the membrane confinement of neuroligin-1, and the phosphotyrosine level of neuroligins associated with excitatory post-synaptic differentiation. Finally, MDGA silencing reduces the mobility of AMPA receptors, increases the frequency of miniature EPSCs (but not IPSCs), and selectively enhances evoked AMPA-receptor-mediated EPSCs in CA1 pyramidal neurons. Overall, our results support a mechanism by which interactions between MDGAs and neuroligin-1 delays the assembly of functional excitatory synapses containing AMPA receptors.

Effects of physical activity programs on sleep outcomes in older adults: a systematic review

BACKGROUND

One in two older adults report sleep problems, which not only cause fatigue, but also negatively affect general functioning, activities of daily living, and physical and mental health. Although it is known that physical activity is positively associated with sleep in older adults, the effects of physical activity programs on sleep in older adults has not been reviewed. The aim of this systematic review was to systematically review the effects of physical activity programs on sleep in generally healthy older adults aged 60+ years.

METHODS

Searches were performed in PubMed, Embase, Web of Science, SPORTDiscus, PEDro and CINAHL. The methodological quality of the included studies was rated using the 'Quality Assessment Tool for Quantitative Studies'. Only studies of moderate and strong quality were included. This review was registered in PROSPERO (CRD42018094007).

RESULTS

Fourteen studies met the inclusion criteria (six randomised controlled trials and eight pretest-posttest studies). Of these studies, five were moderate and nine were strong quality studies. Mean age of study samples ranged from 64 to 76 years. Exercise programs included various activities aimed at improving mobility, endurance and strength. Intervention duration ranged from 2 weeks to 12 months. Eleven studies used subjective measures of sleep, two used objective measures and one used both. Sixteen different sleep outcomes were reported. All but one study, found at least one significant improvement on sleep outcomes. No significantly detrimental effects were reported. Effect sizes, calculated in ten studies, ranged from 0,34-1,55 and were substantial (≥0,8) in four studies.

CONCLUSIONS

This systematic review suggests that exercise programs positively affect various aspects of sleep in generally healthy older adults. More specifically, moderate intensity exercise programs, with a frequency of three times per week and a duration of 12 weeks up to 6 months, showed the highest number of significant improvements in different sleep outcomes in older adults. Furthermore, programs that offered single exercise types, such as Baduanjin, Tai chi and the silver yoga program, or a combination of exercises showed the highest proportion of significant versus reported effects on sleep outcomes.

A Modular Organization of LRR Protein-Mediated Synaptic Adhesion Defines Synapse Identity

Pyramidal neurons express rich repertoires of leucine-rich repeat (LRR)-containing adhesion molecules with similar synaptogenic activity in culture. The in vivo relevance of this molecular diversity is unclear. We show that hippocampal CA1 pyramidal neurons express multiple synaptogenic LRR proteins that differentially distribute to the major excitatory inputs on their apical dendrites. At Schaffer collateral (SC) inputs, FLRT2, LRRTM1, and Slitrk1 are postsynaptically localized and differentially regulate synaptic structure and function. FLRT2 controls spine density, whereas LRRTM1 and Slitrk1 exert opposing effects on synaptic vesicle distribution at the active zone. All LRR proteins differentially affect synaptic transmission, and their combinatorial loss results in a cumulative phenotype. At temporoammonic (TA) inputs, LRRTM1 is absent; FLRT2 similarly controls functional synapse number, whereas Slitrk1 function diverges to regulate postsynaptic AMPA receptor density. Thus, LRR proteins differentially control synaptic architecture and function and act in input-specific combinations and a context-dependent manner to specify synaptic properties.

Severity of traumatic events in patients with eating disorders. A case-control study

Introduction

A high proportion of individuals with eating disorders (EDs) report childhood abuse and neglect. The prevalence of traumatic events in ED patients has been extensively investigated; less is known about their self-perceived–and reported–severity. Objectives/Aims: We aimed to assess in ED patients vs. healthy controls the severity, i.e., duration, perpetrator, and subjective impact, of sexual, physical, and emotional traumas suffered from 0 to 18 years, paying particular attention to emotional neglect.

Methods

Fifty-seven consecutive DSM-V ED patients (91.2% females; age range: 18–42 years) were recruited at the Psychiatric Outpatient Clinic of our University Hospital. Ninety controls (78.9% females; age range: 20–39 years) were also recruited. Among ED patients, 43.9% had restrictive anorexia nervosa (AN), 29.8% binge/purging AN, 26.3% bulimia nervosa. Individuals completed the Eating Disorder Inventory-2 (EDI-2) and the Traumatic Experiences Checklist (TEC).

Results

The severity of all traumatic events, according to the TEC total score, was significantly higher in ED patients than controls (P < 0.001). Moreover, ED patients showed significantly higher scores with regard to emotional neglect (P < 0.001) and emotional abuse (P < 0.001). The same can be said for physical traumas (P < 0.01) and physical abuse (P < 0.01), although with a lower significance, and for sexual abuse (P < 0.05), with an even lower significance. No difference in the severity of sexual harassment was found.

Conclusions

All types of traumas, especially neglect, can occur in ED patients and controls, however they are reported as more severe by ED patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Emotional neglect as the colossus among traumas in patients with eating disorders. A case-control study

Introduction

Individuals with eating disorders (EDs) often report a history of early traumatization. Although a great attention has been paid to sexual and physical trauma, less is known about emotional one, especially neglect.

Objectives/aims

We aimed to estimate the prevalence of sexual, physical, and emotional trauma–occurring under 18 years of age–in ED patients vs. healthy controls, focusing on emotional abuse and neglect.

Methods

We consecutively recruited 57 DSM-V ED outpatients (91.2% females; age range = 18–42 years) at the Psychiatric Outpatient Clinic of our University Hospital and 90 healthy controls (78.9% females; age range = 20–39 years). Among ED patients, 43.9% had restrictive anorexia nervosa (AN), 29.8% binge/purging AN, 26.3% bulimia nervosa. Individuals completed the Eating Disorder Inventory-2 (EDI-2) and the Traumatic Experiences Checklist (TEC). We used Mann-Whitney U test and χ2 test for comparisons.

Results

ED patients scored significantly higher than controls on all EDI-2 subscales (P-values < 0.05). On the TEC, emotional trauma was more frequent than sexual/physical ones in both ED patients and controls. Emotional trauma, and to a lesser extent physical one, were significantly more frequent in ED patients than controls. Distinguishing between emotional abuse and neglect, the latter had a higher prevalence than the former in both groups. Additionally, ED patients reported significantly more neglect, but not emotional abuse, than controls.

Conclusions

Our findings show a high prevalence of emotional trauma in EDs, mainly neglect, i.e., a lack of care and attention potentially contributing to EDs. Thus, it is crucial to investigate emotional neglect in ED patients.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Repeated traumatic experiences in eating disorders and their association with eating symptoms

OBJECTIVE

This study aimed to analyze the association between traumatic experiences (TEs) and eating symptoms and their severity in a healthy group (HG) of students and an eating disorder group (EDG).

METHOD

The HG (N=150) comprised first- and secondyear undergraduate psychology students, the EDG (N=150) day hospital patients. EDG patients were evaluated consecutively when they entered the Day Hospital Eating Disorder Unit. Information on TEs was collected via an ad hoc questionnaire, a semi-structured interview and the first part of The Dissociation Questionnaire (Part I). The Bulimic Investigatory Test Edinburgh was used to evaluate eating symptoms and their severity.

RESULTS

Emotional abuse was the most frequent TE in both groups. In the EDG, TEs occurred more in patients with purging behavior (anorexia nervosa of the binge-eating/purging type, AN-P; and bulimia nervosa of the purging type, BN-P) than in those with AN-R (anorexia nervosa of the restricting type). In patients with purging behavior, TEs often begin in childhood and are repeated. When the severity of eating symptoms in patients with EDs who had suffered repeated TEs was compared with those who had suffered an isolated TE, a tendency towards greater severity of eating symptoms associated with TE repetition was observed.

CONCLUSIONS

The results obtained with respect to the presence and type of TEs in EDs concurred with those of other studies. However, unlike other studies, we found high percentages of childhood TEs in ED subtypes with purging behavior. In these ED subtypes, TEs tended to be more repeated than in ED subtypes with restrictive behavior. Further studies are required to draw conclusions on the effect of the different TEs and their repetition on eating symptoms and their severity.

[The importance of movement-directed interventions in the multidisciplinary treatment of binge eating disorder: an overview]

BACKGROUND

More than three out of four persons with binge eating disorder do not get enough physical exercise.

AIM

To collect scientific evidence of the effects and benefits that movement and physical exercise can have on persons with a binge eating disorder.

METHOD

PubMed, PsychInfo, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Physiotherapy Evidence Database, the Dutch Journal of Psychiatry (Tijdschrift voor Psychiatrie), het Tijdschrift voor Vaktherapie and Actual Themata derived from psychomotor therapy were screened for the period January 1994 to August 2011. The methodological quality of the studies was determined on the basis of a checklist. Evidence for the effectiveness of the interventions was summarised by best-evidence synthesis.

RESULTS

Eight studies met the inclusion and exclusion criteria. Strong evidence was found for: 1) significant weight-loss after movement interventions; 2) fewer symptoms of depression after a combination of both movement and cognitive behavioural therapy (CBT) than after CBT on its own. There was only limited evidence for 1) the fact that the combination of movement and CBT leads to less eating disorder pathology than does CBT alone; 2) the beneficial effects of yoga on weight-loss as well as on the reduction of eating disorder pathology.There are indications that walking can be helpful in reducing of eating disorder pathology.

CONCLUSIONS

Activities involving movement and physical exercise deserve to play an important role in the multidisciplinary treatment of binge eating disorders.

Be kind to your eating disorder patients: the impact of positive and negative feedback on the explicit and implicit self-esteem of female patients with eating disorders

OBJECTIVE

Lack of self-esteem may play an important role in the development of eating disorders (ED). This study investigated the differential impact of positive and negative feedback on implicit and explicit self-esteem in women with an ED (N=25) as compared to women without an ED (N=29).

METHOD

False feedback (positive or negative) was given on participant's performance on a specifically developed intellectual test. Before and after the performance, explicit and implicit self-esteem was measured.

RESULTS

On the explicit measure ED patients reacted congruently with the nature of the feedback. On the implicit measure only ED patients responded to the positive feedback with an improvement of self-esteem, with no effect for negative feedback. The control group was unaffected by either feedback. Furthermore, no correlation was observed between the explicit and implicit measures, a finding suggesting that these measurements tap different constructs.

CONCLUSION

Positive feedback affects implicit self-esteem of female patients with eating disorders. The results underline the importance of positively approaching women with ED.

Alexithymia in patients with alopecia areata: educational background much more important than traumatic events

BACKGROUND

Recent studies suggest a higher prevalence of alexithymia in patients with alopecia areata (AA). Some authors link alexithymia with the presence of early traumatic events, such as dysfunctional parent-child relationships. However, until today, no studies have been carried out on the association of alexithymia and early traumatic events in AA patients.

OBJECTIVE

The primary aim of this study was to explore if an association exists between the presence of traumatic childhood experiences and alexithymia in AA patients. A secondary aim was to confirm earlier observations indicating that the occurrence and/or degree of alexithymia is higher in patients with AA compared with individuals from the general population.

METHODS

We enrolled 90 patients with AA. Data on alexithymia and traumatic events were collected with two self-report questionnaires: the Toronto Alexithymia Scale-20 and the Traumatic Experiences Checklist. These data were compared with data obtained from control patients without AA randomly selected from patients presenting for dermatological surgery.

RESULTS

In adult AA patients, we found no evidence for a significant association between Toronto Alexithymia Scale (TAS) scores and emotional neglect or childhood traumatic experiences. We found a significant association with educational level, higher levels of education being associated with lower TAS-20 scores (P = 0.002). The mean TAS-20 score of 51.22 (SD 11.90) in our adult AA patient group was significantly higher compared with control patients from the same setting (44.00, SD 10.33, P < 0.001).

CONCLUSION

In adult AA patients, higher levels of education are significantly associated with lower alexithymia scores. Somewhat unexpectedly, we found no association between alexithymia score and emotional neglect or childhood traumatic experiences. Our results also confirm that alexithymia scores are significantly higher in adult patient with AA compared with control patients.

[Dissociative phenomena: relationship to present and past stress]

BACKGROUND

Up till now research into dissociation has paid little attention to the relationship between current stress and family variables on the one hand and dissociative phenomena on the other hand. By contrast, however, many studies have investigated the link between traumatic experiences in the past and dissociative phenomena.

AIM

To investigate, in a clinical population, whether dissociation is linked to current stress (within and outside the family) and to traumatic experiences in the past.

METHOD

Dissociation was predicted on the basis of current stress (within and outside the family) and trauma by means of a multiple regression conducted on a population of patients with an eating disorder.

RESULTS

Results indicated a clear link between current stress and dissociation. Patients with particularly high dissociation scores reported significantly more stress both on the measures of current stress and on the list of trauma.

CONCLUSION

Dissociation is associated with stressful experiences, but not only with sexual trauma. Dissociation is also linked to stress experienced in current living conditions. Therefore the simple model that links dissociative experiences directly with trauma needs to be revised. This finding demonstrates that more attention should be given to stress factors in the treatment of dissociative phenomena.

Which elements in the treatment of eating disorders are necessary ‘ingredients’ in the recovery process?—A comparison between the patient's and therapist's view

BACKGROUND

Little is known about which therapeutic 'ingredients' in the treatment of eating disorders (anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED)) are needed for recovery. Remarkably, most studies on this topic have neglected the patient's view.

METHOD

In this study, a large sample of eating disorder patients (n = 132) was invited to evaluate which elements in the treatment they consider to be helpful and effective in their recovery process. These results were compared to the view of 49 eating disorder experts.

RESULTS

Following the patient's view, 'improving self-esteem', 'improving body experience' and 'learning problem solving skills', were considered as core elements in their treatment. No major differences were found between the different patient samples when comparing the patient's and therapist's view.

DISCUSSION

The findings suggest that therapists and patients share more or less the same view about the basic and effective elements in the treatment.

Which factors do provoke binge eating? An exploratory study in eating disorder patients

OBJECTIVE

To study the different factors (external, emotional, cognitive, and physiological) which may trigger binge eating in eating disorder patients and to make a comparison of binge eating triggers in different eating disorder samples, i.e. anorexia nervosa bingeing-purging type and bulimia nervosa (BN).

METHOD

A total of 242 eating disorder patients filled out the Binge Eating Trigger Checklist (BETCH), a new screening device to evaluate the type of situations (and their experienced discomfort) which subjects identify as antecedents of a binge eating episode.

RESULTS

Eating disorder patients report a combination of negative emotions, physiological states (urge for sweets) and negative cognitions as most important antecedents for their bingeing episodes. External stimuli were only reported by a small number of patients and provoked significantly lower levels of discomfort. A comparison of binge eating triggers in bingeing anorexia nervosa patients and bulimic patients showed only a few significant differences.

CONCLUSIONS

Binge eating, as perceived and reported by eating disorder patients, seems to be provoked by a combination of different antecedents, both emotional, cognitive and physiological. Remarkably enough, binge eating triggers did not differ between bingeing anorectic patients and patients suffering from BN.

Which factors do provoke binge-eating? An exploratory study in female students

To study the different factors (external, emotional, cognitive, and physiological) which may trigger binge-eating in young females. A total of 110 female students (between 14 and 25 years of age) filled out the Eating Disorder Inventory (EDI) and the Binge Eating Trigger Checklist (BETCH), a new screening device to evaluate the type of situations (and their experienced discomfort) which subjects identify as antecedents of a binge-eating episode. Approximately 41% of the female students reported binge-eating and 15% admitted they have daily binges. The binge-eating triggers most frequently reported and at the same time having the highest level of discomfort were emotional triggers (feeling bored, depressed, anxious, tense, and sad) and physiological triggers (being hungry and feeling an urge to eat sweets). Fewer food-related cues have been reported whereas dysfunctional cognitions were rarely mentioned as antecedents of binge-eating. Binge-eating, as perceived and reported by female students, seems to be provoked by a combination of different antecedents, both emotional and physiological.

Psychometric characteristics of the somatoform dissociation questionnaire: a replication study

BACKGROUND

The present study aimed to replicate the results of previous studies concerning the development of two versions of the Somatoform Dissociation Questionnaire. The SDQ-20 evaluates the severity of somatoform dissociative phenomena, and the SDQ-5 is a dissociative disorders screening instrument.

METHODS

Thirty-one patients with dissociative disorders and 45 consecutive psychiatric outpatients with other DSM-IV diagnoses completed the SDQ-20 and SDQ-5 as well as the Dissociation Questionnaire which measures psychological dissociation.

RESULTS

Mokken scale analysis showed that the items of the SDQ-20 are strongly scalable on a latent unidimensional scale. Internal consistency was high. The SDQ-20 convergent validity was supported by high intercorrelations with the DIS-Q. Dissociative patients obtained significantly higher scores than comparison patients. Patients with dissociative identity disorder scored significantly higher compared to patients with dissociative disorder nos. Sensitivity (94%) and specificity (98%) of the SDQ-5 were very satisfactory, as were, at an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients, positive predictive value (84%) and negative predictive value (99%).

CONCLUSIONS

All results replicated the first findings, and therefore corroborate the conclusion that the SDQ-20 and SDQ-5 are instruments of sound psychometric quality, and that somatoform dissociative phenomena are core symptoms of complex dissociative disorders.

Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology

OBJECTIVE

The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology.

METHOD

The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder.

RESULTS

The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders.

CONCLUSIONS

Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.

Somatoform dissociation discriminates among diagnostic categories over and above general psychopathology

OBJECTIVE

The primary aim of this study was to investigate the hypothesis that somatoform dissociation would differentiate among specific diagnostic categories after controlling for general psychopathology.

METHOD

The Somatoform Dissociation Questionnaire (SDQ-20), the Dissociative Experiences Scale, and the Symptom Checklist-90-R were completed by patients with DSM-IV diagnoses of dissociative disorders (n = 44), somatoform disorders (n = 47), eating disorders (n = 50), bipolar mood disorder (n = 23), and a group of consecutive psychiatric outpatients with other psychiatric disorders (n = 45), mainly including anxiety disorders, depression, and adjustment disorder.

RESULTS

The SDQ-20 significantly differentiated among diagnostic groups in the hypothesised order of increasing somatoform dissociation, both before and after statistically controlling for general psychopathology. Somatoform dissociation was extreme in dissociative identity disorder, high in dissociative disorder, not otherwise specified, and increased in somatoform disorders, as well as in a subgroup of patients with eating disorders. In contrast with somatoform dissociation, psychological dissociation did not discriminate between bipolar mood disorder and somatoform disorders.

CONCLUSIONS

Somatoform dissociation is a unique construct that discriminates among diagnostic categories. It is highly characteristic of dissociative disorder patients, a core feature in many patients with somatoform disorders, and an important symptom cluster in a subgroup of patients with eating disorders.

Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma

In this study, the prevalence and severity of traumatic experiences as reported by patients with dissociative disorders and with other DSM-IV psychiatric diagnoses were compared. Furthermore, the predictive value of emotional, physical, and sexual trauma with respect to somatoform and psychological dissociation was analyzed. In contrast with comparison patients, dissociative disorder patients reported severe and multifaceted traumatization. Physical and sexual trauma predicted somatoform dissociation, sexual trauma predicted psychological dissociation as well. According to the memories of the dissociative disorder patients, this abuse occurred in an emotionally neglectful and abusive social context. Pathological dissociation was best predicted by early onset of reported intense, chronic and multiple traumatization. Methodological limitations restricting causal inferences between reported trauma and dissociation are discussed.

The significance of body size estimation in eating disorders: its relationship with clinical and psychological variables

OBJECTIVE

To assess the relationship between body size estimation on the one hand and clinical and psychological variables on the other.

METHOD

Body size estimation was tested with the video distortion method on a life-size screen in normal women (n = 45) and compared to a total of 189 female eating disorder patients (100 with restricting anorexia nervosa, 41 with binging/purging anorexia nervosa, 48 with bulimia nervosa). The subjects' cognitive responses (what they think they really look like), affective responses (what they feel they look like), and optative responses (what they want to look like) were correlated with clinical parameters (including body composition) and with the scores on a series of self-report questionnaires assessing general psychological well-being and body experience.

RESULTS

No significant relationship was found between the body size estimations and the clinical variables. The cognitive and affective responses showed a moderate relationship with self-reported body attitude. Body dissatisfaction was negatively correlated with the optative response (desired body size).

DISCUSSION

This study contributes to the construct validity of the video distortion method. Body size estimation includes more than just a perceptual task. Hence, the narrow notion of body image should be replaced by the more complex construct of "body experience," the multidimensionality of which should be addressed in both research and treatment of eating-disordered patients.

[The Dissociation Questionnaire DIS-Q: preliminary results with a French-speaking Swiss population]

Vanderlinden and his collegues (1993) proposed a first european clinical scale to assess dissociative symptoms, the DIS-Q. The DIS-Q was studied in a psychiatric (n = 154) and a control (n = 65). Swiss French speaking sample. Our results reflected that The Dissociation Questionnaire (DIS-Q) has a good criterion-related validity since it discriminates between patients (Axes I and II of the DSM IV classification) and controls. Statistical comparisons indicated significant differences between three subgroups (axis I only, n = 60; axis II only, n = 24; axes I et II together, n = 70), and controls (n = 65). The total DIS-Q score was the highest for the patients with axes I and II together. About 12% of the psychiatric sample studied obtained DIS-Q score > or = 2.5, suggesting the presence of pathological dissociative symptoms. Our results seem not to be influenced by cultural factors.

Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury

The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.

Animal defensive reactions as a model for trauma-induced dissociative reactions

Patients with complex dissociative disorders remain in alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies. In this contribution, a parallel is drawn between animal defensive and recuperative states that are evoked in the face of severe threat and the characteristic responses of dissociative disorder patients as displayed in major dissociative states. Empirical data and clinical observations seem to be supportive of the idea that there are similarities between freezing, concomitant development of analgesia and anesthesia, and acute pain in threatened animals and severely traumatized human beings.

Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury

The authors hypothesized that there would be a similarity between animal defensive responses to variable predatory imminence and injury and certain somatoform dissociative symptoms of trauma-reporting patients who have dissociative disorder. As a first test of this hypothesis, 12 somatoform symptom clusters consisting of clinically observed somatoform dissociative phenomena were constructed. All clusters discriminated between patients with dissociative disorders (n = 50) and patients with other psychiatric diagnoses (n = 50). Those expressive of the hypothesized similarity--freezing, anesthesia-analgesia, and disturbed eating--belonged to the 5 most characteristic symptoms of dissociative disorder patients. Anesthesia-analgesia, urogenital pain, and freezing symptom clusters independently contributed to predicted presence of dissociative disorder. Using an independent sample, it appeared that anesthesia-analgesia best predicted presence of dissociative disorder after controlling for symptom severity. The results were largely consistent with the hypothesized similarity.

The development of the somatoform dissociation questionnaire (SDQ-5) as a screening instrument for dissociative disorders

Using cases of dissociative disorder (n=50) and other DSM-IV diagnoses (n=50), a somatoform dissociation self-report questionnaire was developed and its capacity to function as a screening device for dissociative disorders was analysed. A list of 75 items was constructed which, according to clinical experience and expert judgement, could reflect instances of somatoform dissociation. Statistical analyses revealed the 20 best discriminating items. Stepwise forward logistic analysis detected five items which, as a group, provided optimal discrimination between the two groups. At an estimated prevalence rate of dissociative disorders of 10% among psychiatric patients the sensitivity would be 94%, the specificity would be 96%, the positive predictive value would be 72%, and the negative predictive value would be 99%. Cross-validation in an independent sample (n=33/42) largely corroborated the initial findings. The SDQ-5 can be used as a brief screening device for dissociative disorders.

The development and psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20)

According to 19th century French psychiatry and contemporary clinical observations, dissociation pertains to both psychological and somatoform components of experience, reactions, and functions. Because such an instrument was lacking, we aimed to develop a self-reporting questionnaire measuring what we propose to call somatoform dissociation. Patients with dissociate disorder and with other DSM-IV psychiatric diagnoses completed a list of 75 items that, according to clinical experience and expert judgment, could reflect instances of somatoform dissociation. Separate logistic analyses and determination of discriminant indices per item revealed 20 items that best discriminated between those with and without dissociative disorders. Mokken analysis showed that these items are strongly scalable on a dimensional latent scale interpreted to measure somatoform dissociation. Reliability of the scale was high. Construct validity was supported by high intercorrelations with the Dissociation Questionnaire, which measures psychological dissociation, and higher scores of patients with dissociative identity disorder compared with patients with dissociative disorders not otherwise specified. In conclusion, the Somatoform Dissociation Questionnaire (SDQ-20) is a scale of good psychometric quality, which measures somatoform dissociation. The symptoms pertain to negative and positive dissociative phenomena, which were well known in 19th century French psychiatry as the mental stigmata and mental accidents of hysteria.

Laparoscopic cholecystectomy in the third trimester of pregnancy

Laparoscopic cholecystectomy has become the method of choice for symptomatic cholelithiasis. Laparoscopic cholecystectomy during pregnancy is also becoming more accepted, as illustrated by several recent publications on this subject. In the third trimester, however, laparoscopic cholecystectomy has been less commonly attempted, with only a few case reports. We present a series of four patients who underwent laparoscopic cholecystectomy during the third trimester of pregnancy without complication. We describe a safe and effective technique for this procedure, and review the literature on this topic.

Dissociative and hypnotic experiences in eating disorder patients: an exploratory study

Hypnotizability, subjective experiences during hypnotizability assessment, and dissociation were studied in 53 eating disorder patients in order to explore the relationship between these phenomena. Dissociation was measured with a newly developed self-reporting Dissociation-Questionnaire (DIS-Q), level of hypnotizability was assessed with the Stanford Hypnotic Clinical Scale (SHCS), subjective experiences during hypnosis with the Dutch Phenomenology of Consciousness Inventory (DPCI), and the Dutch Resistance to Hypnosis Scale (DRHS). Compared with normals, eating disorder patients scored significantly higher on the DIS-Q and SHCS. Compared with restricting anorexics, anorexics of the mixed type as well as bulimics report higher scores on both the DIS-Q and SHCS, but a significant difference was found only for the DIS-Q subscale loss of control. Although positive correlations between the DIS-Q and SHCS were found, the magnitude of the correlations shows that both instruments probably are measuring different constructs. Some implications of these findings are discussed.

The (limited) possibilities of hypnotherapy in the treatment of obesity

In this paper we review the possibilities and limitations of hypnotherapeutic techniques in the treatment of obesity. In spite of some promising reports, the findings and opinions about the effectiveness of hypnosis in the treatment of obesity vary greatly. We provide a brief overview of specific hypnotherapeutic techniques--such as teaching relaxation, increasing self-control, encouraging physical exercise, altering self-esteem and body image, strengthening motivation, and exploring ambivalence for change--that can be involved in a multidimensional approach to obesity. Case reports illustrate the use of these techniques.

Assessment of hypnotic processes and responsiveness in a clinical context

The present study was designed to investigate in a clinical situation whether differences in measured hypnotizability validly reflect differences in hypnotic processes and to what extent factors deemed extraneous to hypnosis--such as resistance--influence hypnotic responding. To answer this question, Dutch versions of relevant scales had to first be developed. The factorial validity and reliability of a Dutch translation of the Resistance Toward Hypnosis Scale (DRHS) and a shortened Dutch version of the Phenomenology of Consciousness Inventory (DPCI) were investigated in a sample of 205 psychiatric patients. The DRHS proved to be factorially valid and reliable, and two subscales, Trance and Reality Orientation, derived empirically from the DPCI showed good to satisfactory reliability. In a second study with a subsample of 99 psychiatric patients, hypnotizability as measured by the Stanford Hypnotic Clinical Scale for Adults was strongly and positively related to DPCI Trance scores and moderately and negatively related to DPCI Reality Orientation and DRHS Resistance scores. It is concluded that hypnotizability as measured in a clinical context under standard conditions is strongly related to hypnotic experiences over and above the moderate effects of resistance toward hypnosis and hypnotic suggestions. Standard hypnotizability assessments appear to be similar in their meaning in an experimental and clinical context.

Dissociative experiences and trauma in eating disorders

This study explores the relationship between traumatic experiences and dissociative phenomena in a large group of eating disorder patients (N = 98). Traumatic experiences were assessed by means of a self-report questionnaire and a clinical interview; dissociative experiences were assessed with the newly developed self-reporting Dissociation Questionnaire (DIS-Q). About 25% of the patients reported to have experienced traumatic events in their personal life and this subgroup had significantly higher scores on the DIS-Q, compared with normal control subjects. About 12% of our patient sample mentioned dissociative experiences to a degree as high as in a group of patients with dissociative disorders. Amnesia turned out to be the most specific characteristic in trauma-induced dissociation. These data suggest that trauma-induced dissociative experiences may play an important role in the development of a subgroup of patients with an eating disorder.

Guidelines for the family therapeutic approach to eating disorders

After a brief historical overview of the literature on family therapy in eating disorders, the authors' own clinical experience is summarized in some practical guidelines: give the family therapist a central position within the team, engage the family and/or spouse as co-therapist, explore the message of the eating disorder on different levels, neutralize the symptoms outside of the family interaction, promote direct communication, facilitate the separation-individuation process, and be available for a long time. Finally some special issues are discussed: sexual and/or physical abuse in the family, broken-home situations and single-parent families, married and chronic patients.

The use of hypnosis in the treatment of bulimia nervosa

Promising research data, relating hypnotizability and the possible presence of a dissociative mechanism in bulimic individuals, stimulated the present authors to incorporate hypnosis in their directive and multidimensional treatment of bulimic patients. Important strategies and how and when they can be applied in the different phases of treatment are described. In many cases, hypnotherapeutic techniques may enhance the effectiveness of cognitive behavioral and interactional strategies in the treatment of bulimic patients. In other instances, the incorporation of hypnosis may help both the therapist and patient to discover new pathways to facilitate the therapeutic process.

Perception of changes in eating disorder patients during group treatment

The evolution of 53 eating disorder patients during inpatient group treatment has been studied by comparing the perception of changes by the patients themselves, the group members, and the therapeutic team. Remarkable differences were found between the judgments of these three groups. Patients tend to deny problems or to evaluate their progress rather optimistically, whereas fellow patients and staff members are much alike in their sceptical evaluations. It is concluded that the evaluation procedure may have more value as a therapeutic tool than as an assessment method.