A Group Intervention for Individuals With Obesity and Comorbid Binge Eating Disorder: Results From a Feasibility Study

PurposeA common challenge among a subgroup of individuals with obesity is binge eating, that exists on a continuum from mild binge eating episodes to severe binge eating disorder (BED). BED is common among bariatric patients and the prevalence of disordered eating and ED in bariatric surgery populations is well known. Conventional treatments and assessment of obesity seldom address the underlying psychological mechanisms of binge eating and subsequent obesity. This study, titled PnP (People need People) is a psychoeducational group pilot intervention for individuals with BED and obesity including patients with previous bariatric surgery. Design, feasibility, and a broad description of the study population is reported.Material and MethodsA total of 42 patients were from an obesity clinic referred to assessment and treatment with PnP in a psychoeducational group setting (3-hour weekly meetings for 10 weeks). Of these, 6 (14.3%) patients had a previous history of bariatric surgery. Feasibility was assessed by tracking attendance, potentially adverse effects and outcome measures including body mass index (BMI), eating disorder pathology, overvaluation of shape and weight, impairment, self-reported childhood difficulties, alexithymia, internalized shame as well as health related quality of life (HRQoL).ResultsAll 42 patients completed the intervention, with no adverse effects and a high attendance rate with a median attendance of 10 sessions, 95% CI (8.9,9.6) and 0% attrition. Extent of psychosocial impairment due to eating disorder pathology, body dissatisfaction and severity of ED symptoms were high among the patients at baseline. Additionally, self-reported childhood difficulties, alexithymia, and internalized shame were high among the patients and indicate a need to address underlying psychological mechanisms in individuals with BED and comorbid obesity. Improvement of HRQoL and reduction of binge eating between baseline and the end of the intervention was observed with a medium effectConclusionThis feasibility study supports PnP as a potential group psychoeducational intervention for patients living with BED and comorbid obesity. Assessments of BED and delivery of this intervention may optimize selection of candidates and bariatric outcomes. These preliminary results warrant further investigation via a randomized control trial (RCT) to examine the efficacy and effectiveness of PnP.

DEPRESSION’S WAY OF EXPRESSION IN THE CASE OF A PARANOID-SCHIZOTYPAL PERSONALITY STRUCTURE

Motivation: A psychiatric patient should be looked at in the longitudinal dynamics of their life because it is possible that during youth, mental suffering has a certain tone to it, which is later erased, transformed or moved, through a greater or lesser contact with the ideas or the affect. Objective: We want to present the life history and dynamics of a subject whose first episode of mental illness of a depressive nature was around the age of 20, and to emphasize how over the years, this nature has faded. Currently, there is an absence of connection between the symptoms and the possible causalities. Material and methods: psychiatric and psychoanalytic interviews in dynamics, analysis of the life map, interpretations, the symptom’s evolution under medication, social support, identification of positive and negative prognostic factors, differential diagnoses, performing the diagnostic tree. Results: The patient presented a first depressive episode in youth with a trigger related to an important emotional relationship; the episode overlapping with childhood difficulties (a father with a penal past, absence of parental Superego, attempts to build a shield through divinity). There follows a period of well-being, over which, about ten years ago, a hypochondriac pathology occurs, which associates the significant change of in a bizarre psychotic sense, with homelessness, delusional interpretation and completed with suicide attempt, so that the last episode is predominantly psychotic, but with a mystical and guilt theme and sin, with important changes, which also highlights the paranoid personality background of the person in question. Conclusion: The personality structure along with social functioning are important milestones of clinical evolution, beyond the main diagnosis of axis I, which in this case remained of recurrent depressive disorder, major depressive episode with psychotic phenomena, with the first two differential diagnoses: Bipolar disorder or schizophrenia depressive episode

Forgotten Variables and Incarcerated Males

Religiosity tends to mitigate mental health challenges for incarcerated males. Further, negative life events experienced during childhood tend to exacerbate young adult challenges, resulting in incarceration. The current study, based on Koenig (2015) and the Developmental Adaptation Model (DAM; Martin & Martin, 2002), used self-report data from 261 older male inmates, ages 45-82 (M=57.59; SD =8.41) to test a path analytic model regressing religiosity (public religious attendance and private activities) on to known correlates and antecedents. Nested model testing found that the association between self-reported life events experienced as a child and later life religiosity was mediated by forgiveness of self and social provisions, controlling for age, race, and education (IE = -.014; p=.03, one-tail). Distal and proximal assessments influenced religiosity in this sample. Future research will want to explore assessing religiosity and possible therapeutic interventions relative to childhood difficulties and forgiveness of self for incarcerated males.

Shifting from Village-Based Networks to Locally Generated Networks: Undocumented Mexican Agricultural Workers Who Use/Used Hard Drugs

Hardships that face transmigrants working in agriculture include the potential for drug use. Reliant on village-based networks that facilitate border crossing and developing a plan for a destination within this country, transmigrants who try new drugs/alcohol and/or continue on accustomed drugs/alcohol are facilitated in these endeavors through locally generated networks as alternative forms of access and support. Seven cases of undocumented men from Mexico are reviewed to show how use of illicit drugs is minimally affected by economic success and time in the United States, or village-based networks that first facilitated entry into this country. Prior conditions, especially childhood difficulties and search for socioeconomic autonomy, precipitate new and/or continuing drug use within the United States on this side of the border, where both forms of drug use are facilitated by locally generated networks.

Profiles of Co-Occurring Difficulties Identified Through School-Based Screening

Objective: This study used latent class analysis to identify patterns of co-occurrence among common childhood difficulties (inattention/hyperactivity, internalizing, externalizing, peer problems, and reading difficulties). Method: Parents and teachers of 501 children ages 6 to 9 provided mental health and social ratings, and children completed a reading task. Results: Four latent classes were identified in the analysis of parent ratings and reading: one with inattention/hyperactivity, externalizing, peer problems, and internalizing difficulties; one with inattention/hyperactivity and reading difficulties; one with internalizing and peer problems; and one normative class. The analysis of teacher ratings and reading also identified four latent classes: one with inattention/hyperactivity and externalizing, one with inattention/hyperactivity and reading difficulties, one with internalizing problems, and one normative class. Children in latent classes characterized by one or more difficulties were more impaired than children in the normative latent class 1 year later. Conclusion: The results highlight the need for multifaceted interventions.