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El cambio al subtipo atracón/purga de la anorexia nerviosa con frecuencia se asocia con intentos de suicidio

Published online by Cambridge University Press:  12 May 2020

C. Foulon ,
J. D. Guelfi ,
A. Kipmanc ,
J. Adès ,
L. Romo ,
K. Houdeyer ,
S. Marquez ,
M. C Mouren ,
F. Rouillon  and
P. Gorwood
C. Foulon
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
J. D. Guelfi
Affiliation:
AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
A. Kipmanc
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
J. Adès
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
L. Romo
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
K. Houdeyer
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
S. Marquez
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia
M. C Mouren
Affiliation:
AP-HP, CHU Robert Debré, Departamento de Psiquiatría Infantil, 48 Boulevard Sérurier, 75019París, Francia
F. Rouillon
Affiliation:
CMME-Sainte Anne, Departamento de Psiquiatría del Hospital Universitario, 100 Rue la Santé, 75674París Cedex 14, Francia
P. Gorwood
Affiliation:
AP-HP, CHU Louis Mourier, 178 Rue des Renouillers, 92700Colombes, Francia INSERM Unidad 675, Facultad Xavier Bichat, 16 Rue Henri Huchard, 75018París, Francia INSERM Unidad 677, Facultad Pitié-Salpétrière, 91 bulevar del Hospital, 75634París Cedex 13, Francia
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Resumen

Objetivo.

La anorexia nerviosa tiene la tasa de mortalidad por suicidio más alta de todos los trastornos psiquiátricos, asociándose el suicidio con muchos factores. Evaluamos la primera aparición de estos factores en la vida del paciente, teniendo en cuenta su posible solapamiento.

Método.

Trescientos cuatro pacientes ingresados y ambulatorios con anorexia nerviosa (DSM-IV) fueron seleccionados sistemáticamente en tres hospitales de las afueras de París, entre diciembre de 1999 y enero de 2003. Los pacientes fueron evaluados con una entrevista personal (DIGS). Se midieron las dimensiones del trastorno de la alimentación y los pacientes fueron entrevistados por un clínico entrenado para evaluar el IMC mínimo y determinar, retrospectivamente, la edad en que se produjeron por primera vez la anorexia nerviosa, el trastorno depresivo mayor, los trastornos de ansiedad y el cambio al tipo atracón/purga.

Resultados.

El trastorno depresivo mayor (p < 0,001) y el cambio desde el subtipo restrictivo al tipo atracón/purga (p < 0,001) fueron los dos factores que se produjeron significativamente con más frecuencia antes de los intentos de suicidio y siguieron estando implicados en un análisis multivariante, usando medidas sindrómicas o dimensionales. Teniendo en cuenta la incidencia a lo largo de la vida con un análisis de supervivencia, el cambio de la anorexia al tipo atracón/purga parece ser un factor predictivo fundamental, con un aumento grande de la frecuencia de intentos de suicidio (CP=15) comparados con los pacientes sin trastorno depresivo mayor ni anorexia del tipo atracón/purga.

Conclusiones.

La anorexia nerviosa de tipo atracón/purga se asocia significativamente con intentos de suicidio y podría merecer especial atención. Si se confirma en un estudio con diseño prospectivo, estos resultados abogarían por la necesidad de detección precoz y/o intervención terapéutica más intensiva y específica sobre la conducta de atracones y purgas.

Keywords

SuicidioImpulsividadDepresiónTrastorno alimentarioAdicción
Type
Artículo original
Information
European Psychiatry (Ed. Española) , Volume 15 , Issue 2 , March 2008 , pp. 90 - 97
Copyright
Copyright © European Psychiatric Association 2008

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