How should DSM-V classify eating disorder not otherwise specified (EDNOS) presentations in women with lifetime anorexia or bulimia nervosa?

OBJECTIVE

Anorexia nervosa (AN) and bulimia nervosa (BN) are marked by longitudinal symptom fluctuations. DSM-IV-TR does not address how to classify eating disorder (ED) presentations in individuals who no longer meet full criteria for these disorders. To consider this issue, we examined subthreshold presentations in women with initial diagnoses of AN and BN.

METHOD

A total of 246 women with AN or BN were followed for a median of 9 years; weekly symptom data were collected at frequent intervals using the Longitudinal Interval Follow-up Evaluation of Eating Disorders (LIFE-EAT-II). Outcomes were ED presentations that were subthreshold for 3 months, including those narrowly missing full criteria for AN or BN, along with binge eating disorder (BED) and purging disorder.

RESULTS

During follow-up, most women (77.6%) experienced a subthreshold presentation. Subthreshold presentation was related to intake diagnosis (Wald chi2=8.065, df=2, p=0.018). Individuals with AN most often developed subthreshold presentations resembling AN; those with BN were more likely to develop subthreshold BN. Purging disorder was experienced by half of those with BN and one-quarter of those with AN binge/purge type (ANBP); BED occurred in 20% with BN. Transition from AN or BN to most subthreshold types was associated with improved psychosocial functioning (p<0.001).

CONCLUSIONS

Subthreshold presentations in women with lifetime AN and BN were common, resembled the initial diagnosis, and were associated with modest improvements in psychosocial functioning. For most with lifetime AN and BN, subthreshold presentations seem to represent part of the course of illness and to fit within the original AN or BN diagnosis.

The effects of dose and repeated administration on the longer-term hypophagia produced by amphetamine in rats

Rats are hypophagic approximately 1-3 and 13-27h after receiving amphetamine (2.0mg/kg). This study examined how these short- and longer-term phases of hypophagia were affected by repeated administration of different amphetamine doses. Throughout eight five-day tests, the rats could lever press for food pellets for 1-hour periods beginning every three hours. On test day 1, the rats were treated with saline, and on test day 3, they were treated with a dose of amphetamine. Across tests, for one group, treatment on day 3 alternated between 0.0 (saline) and 0.5mg/kg amphetamine; for a second, group treatment on day 3 alternated between 1.0 and 2.0mg/kg amphetamine; and for a third group, treatment on day 3 was always 1.0mg/kg amphetamine. The patterns of food intake following day 1 saline and day 3 treatment were compared. Short-term food intake was abolished by 0.5, 1.0, and 2.0mg/kg amphetamine, and no tolerance was observed to this effect. Longer-term hypophagia was produced by 1.0 and 2.0 but not by 0.5mg/kg. Tolerance to longer-term hypophagia was seen when 1.0mg/kg alone was used as the day 3 treatment, but not when 1.0 and 2.0mg/kg were alternated across tests as the day 3 treatment. Short- and longer-term hypophagia were dissociated by threshold doses for elicitation and by differential tolerance. Occasional receipt of a higher amphetamine dose may sometimes increase the longer-term hypophagia produced by a lower dose.

Locusts as model organisms in which to study immunogen-induced anorectic behaviour

When injected into adult or nymphal Locusta that have been deprived of food for 2h, immunogens such as laminarin and bacterial LPS can induce an almost immediate dose-dependent state of anorexia for at least 1h. Such anorexia is a component of a medley of physiological and behavioural changes called collectively 'sickness behaviour' that occurs in a wide range of animals in response to infection or immune challenge. Sub-optimal amounts of injected laminarin allow some locusts to feed, but with a longer latency than in controls, although the length of the first meal is unaffected. The feeding behaviour of fifth instar nymphs is more sensitive to laminarin than that of adults, but both stages respond to amounts of immunogen that are lower than those required to activate the phenoloxidase cascade. Injection of adipokinetic hormone (AKH) before the period of food deprivation prevents the anorexigenic action of the laminarin in adults but not in nymphs. It is argued that the effect of the AKH may be indirect, through its lipid-mobilising action. The insecticide pymetrozine increases the latency to feed but also reduces the length of the first meal, and its anorexigenic activity is not affected by injection of AKH. The present data support the concept that laminarin-induced anorexia involves a central lack of motivation to eat, rather than a 'stop eating' signal. Others have shown that the mechanism of action of pymetrozine involves the serotonergic system and can be blocked by mianserin, so it is intriguing that in the present study injection of mianserin prior to that of laminarin modulates the anorexigenic effect of the immunogen. This suggests that biogenic amines are involved in the control of appetitive behaviour in locusts, as they are in vertebrates. The possible usefulness of the locust model in studying sickness-induced anorexia is discussed briefly.

Age-dependence of alpha-MSH-induced anorexia

Long-term regulation of energy balance involves two major trends: first age-related obesity develops in the middle-aged, later it is followed by anorexia of aging (sarcopenia and/or cachexia). A dynamic balance between orexigenic and anorexigenic neuropeptides is essential for the regulation of energy homeostasis. Special imbalances of neuropeptide effects may be assumed corresponding to different age-periods. Anorexia induced by acute alpha-MSH (alpha-melanocyte stimulating hormone; endogenous melanocortin agonist) injections was analyzed in male Wistar rats aged 6-9 weeks (juvenile), 3-4 months (young adult), 6 or 12 months (two middle-aged groups), 18 months (aging) and 24-26 months (old). Alpha-MSH injected through a preimplanted intracerebroventricular (ICV) cannula (compared with saline injection) dose-dependently suppressed spontaneous food intake and also re-feeding following 24-h fasting, but the rate of suppression varied between age-groups. An ICV injection of 5 microg alpha-MSH attenuated the 2-h re-feeding by 21.9+/-3.2% in juvenile rats, strongly (68.7+/-2.5%) suppressed it in young adults, the suppression became progressively weaker in the two middle-aged groups (55.7+/-4.9%, vs. 26.4+/-4.9%, respectively), but it turned extreme in aging (94.7+/-4.2%) and old (74.3+/-4.5%) rats. Body composition also changed with age: unlike the tibialis anterior muscle, the epididymal and retroperitoneal fat pads increased until middle-age and remained large even in old animals, while the measured indicator of muscle mass decreased in the oldest group. The food intake suppressing and body weight decreasing effects of a 7-day-long ICV infusion of 1 microg/h alpha-MSH were weakest in the 12-month-old and most pronounced in the 24 month-old rats. In conclusion, responsiveness to the anorexic effect of alpha-MSH varies with age, with a nadir of the curve in the middle-aged, and a peak in the aging and old animals. This age-related nadir of melanocortin-responsiveness may promote obesity in middle-aged rats, while the tendency for anorexia and incipient sarcopenia of old (still obese) rats may result from age-related melanocortin-hypersensitivity rather than from adiposity.

Impact of cultural and linguistic factors on symptom reporting by patients with cancer

BACKGROUND

Patient reporting of the severity and impact of symptoms is an essential component of cancer symptom management and cancer treatment clinical trials. In multinational clinical trials, cultural and linguistic variations in patient-reported outcomes instruments could confound the interpretation of study results.

METHODS

The severity and interference of multiple symptoms in 1433 cancer patients with mixed diagnoses and treatment status from the United States, China, Japan, Russia, and Korea were measured with psychometrically validated language versions of the M. D. Anderson Symptom Inventory (MDASI). Mixed-effect ordinal probit regression models were fitted to the pooled data to compare the magnitude of the effect of "country" (nation and linguistic factors) with between-subjects effects on symptom reporting, adjusted for patient and clinical factors (age, sex, performance status, and chemotherapy status).

RESULTS

For the pooled sample, fatigue, disturbed sleep, distress, pain, and lack of appetite were the most severe patient-reported MDASI symptoms. The magnitude of the variance of the country random effects was only one-fourth to one-half of the interpatient variation (sigma(2) = 0.23-0.46) for all symptoms, except nausea and vomiting.

CONCLUSIONS

Cultural and linguistic variations in symptom reporting among the five language versions of the validated MDASI were limited. Ordinal probit modeling provided a simple mechanism for accounting for cultural and linguistic differences in patient populations. The equivalence among MDASI translations in this study suggests that symptom ratings collected from various cultural and language groups using the MDASI can be interpreted in a similar way in oncology practice, clinical trials, and clinical research.

[Perception of social rank and submissive behavior in eating disorders]

OBJECTIVE

The aim of this paper is to study the social behavior in patients with eating disorders, in particular the presence of low social ranking and high submissive behavior. We also considered the relationship between these factors and the presence of some personality traits and pathological eating behaviors.

METHOD

We performed a case-control study on 249 young women (124 controls and 125 eating disorders subjects). Eating disorders were diagnosed as anorexia nervosa, bulimia nervosa and eating disorders non otherwise specified. The patients underwent a routine assessment by means of a diagnostic interview and some self-reported questionnaires. All the subjects (cases and controls) also completed two scales for the assessment of social ranking and submissive behaviors. The two questionnaires were translated from English with the back-translation method.

RESULTS

The two scales were valid and reliable in their Italian version. We observed a significant difference between cases and controls: social ranking was lower in cases, and submissive behavior was lower in controls. Social ranking had an inverse relationship with submissive behavior both in cases and controls, and a significant correlation was found with other interpersonal aspects (ineffectiveness, interpersonal sensitivity) and with some pathological traits and behaviors, like self-injurious behavior.

CONCLUSION

Our study shows that features of low social ranking and submissive behavior are common in eating disorders subjects. These features could represent a risk factor for the development of an eating disorder or, on the contrary, represent a consequence of an eating disorder. A useful therapeutic approach to these disorders could be focused on shifting from submissive to assertive behavior.

Psychological predictors of body image dissatisfaction in women suffering from eating discorders

The objective of the present study was to identify factors influencing body image dissatisfaction in female patients with anorexia and bulimia nervosa. 61 women, aged 16 to 31, (M = 21.69; SD = 3.85) filled questionnaires evaluating dissatisfaction with their body (Body Dissatisfaction Scale by Garner & al., 1984), attitudes about the body (Body Attitude Test by Probst & al., 1995), avoidance with regard to body image (Body Image Avoidance Questionnaire by Rosen & al., 1991), negative mood states (Hospital Anxiety and Depression Scale by Zigmond and Snaith, 1983) as well as self-esteem (Self-Esteem Inventory by Coopersmith, 1984). Negative appreciation of body size, symptoms of depression, grooming and weighting, lack of familiarity with one's own body, as well as low self-esteem in general, could predict the body image dissatisfaction among eating disordered women. The fact of knowing the most important determinants of body image could give indications for the prevention of the cognitive distortions concerning body image.

Consent in cyberspace: Internet-based research involving young people

Social networking sites such as MySpace and virtual communities such as on-line support groups can be a rich source of data for researchers. These sites can be an effective way of reaching and researching young people in order to address their particular health needs. Internet-based research is also potentially risky and exploitative. There is some guidance for conducting research online, but there are no detailed or universally accepted ethics guidelines for research of webspaces such as MySpace or virtual communities in which young people participate. One question that arises is--If MySpace is a public webspace, can research be done without consent? In this paper I investigate ethical issues surrounding young people's consent in cyber research. I identify issues that help determine whether consent is needed, offer suggestions for dealing with consent in cyberspace and add my voice to the call for a resource of case studies--indispensible in the development of guidelines and the education of researchers and research ethics committees.

The contribution of social factors to undereating in older adults with cancer

Inadequate nutrient intake is common in cancer patients and is associated with poor outcomes. Social factors may contribute to inadequate nutrient intake, although they have not been studied. The purpose of this study was to investigate social factors that may contribute to undereating in older adults with cancer. Participants included 30 patients, 17 women and 13 men, aged 70-99 years, who were diagnosed with pancreatic, colon, breast, lymphoma, skin, and head and neck cancers. Both participants and caregivers interpreted weight loss as a positive health outcome of cancer. Furthermore, some patients who had lost weight worked to keep the weight off by going on special diets. Patients and caregivers imbued certain foods with health-promoting qualities without corroborating scientific evidence. Cancer- and treatment-related alterations in self-identity due to changes in their bodies, in taste, and in the manner in which they must eat caused cancer patients to experience frustration and embarrassment, which led to reduced nutritional intake. Despite their compromised nutritional status, patients did not discuss food and eating habits with their physicians. Behaviors and attitudes of patients and caregivers may lead to negative changes in eating behaviors beyond the cancer itself or its treatment or sequelae. Many of these behaviors are potentially modifiable with appropriate education, communication, and intervention.

[Cognitive aspects of women's body image and eating disorders]

BACKGROUND

The authors presents basics of theoretical knowledge connected with cognitive aspects women's body image in Poland. The authors also presents results of research connected with the same subject.

MATERIAL AND METHODS

The study involved 111 women divided into groups - adolescents and young women and women with eating disorders (anorexia and bulimia nervosa). The study methods included the Contour Drawing Rating Scale (CDRS) by Thompson and Gray.

RESULTS AND CONCLUSIONS

The statistical tests indicate differences in the cognitive dimension of body image (between ideal and real self) among adolescent and young women, and women with eating disorders.

Anorexia-cachexia syndrome: a systematic review of the role of dietary polyunsaturated Fatty acids in the management of symptoms, survival, and quality of life

To provide a systematic review on the clinical utility of anti-inflammatory polyunsaturated fatty acids (PUFAs) in cancer-associated anorexia-cachexia syndrome (ACS), clinical trials involving eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) for the management of ACS were identified in the medical literature using MEDLINE (1966 to October 2006) and EMBASE (1980 to October 2006). Review Manager 4.1 was used to compare trials based on outcome measures of interest, including weight change, lean muscle mass change, survival, and quality of life (QoL). Seven randomized controlled trials (RCTs) were identified. Various outcome measures were used in each study. Variability in study populations, dose of EPA and DHA, and standardized scales did not allow for analysis using Review Manager 4.1. Therefore, trials were summarized based on their individual outcomes. Except for one trial showing a positive effect on weight, none of the trials found a clinically or statistically significant difference in outcome measures reviewed. EPA and DHA alone have not shown significant clinical effect in altering weight, lean muscle mass, survival, or QoL in patients with ACS associated with cancer.

[The influence of stereotypes on obesity perception]

BACKGROUND AND OBJECTIVES

The prejudice biases the categorization processes, which implies assigning particular characteristics beyond the objective data available. The stereotype occupies the categorical content by adding what is lacking to what we little know. From a mere physical datum ("he/she is fat") we categorize the obese individual on the basis of our own believes, intimately fusing the stereotype and categorization. SETTING, POPULATION, AND INTERVENTIONS: We included 138 students and 47 patients with anorexia or bulimia that assigned qualifying adjectives of the personality of obese people by using a list of epithets. This same list was provided to 49 obese patients in order to be used to define their own personality.

RESULTS

We analyzed the most frequently used epithets and the corresponding scales of personality by applying the X2 test to determine the differences between the adjectives and the scales in the samples. We considered a p value<0.05 as being statistically significant, by using the SPSS v.13 software. Obese people define their personality very differently than the control group and the group of patients does. While obese people more frequently use "positive" adjectives, the other groups tend to use adjectives with more "negative" connotations. It seems that the stereotypes introduce a perception bias regarding the personality characteristics. The fear to overweight-obesity or the fact of "weight gaining" of patients would explain some of the findings of this work. Patients attribute obese people some personality characteristics altogether more negative than those attributed by the people in the control group.

CONCLUSIONS

Knowing the influence of the stereotypes on obesity perception is essential to approach the patient with no prejudice regarding his/her treatment. The personality characteristics attributed to obese people are far from how these people really perceive themselves.

Neurobiology of anorexia and bulimia nervosa

Anorexia nervosa (AN) and bulimia nervosa (BN) are related disorders of unknown etiology that most commonly begin during adolescence in women. AN and BN have unique and puzzling symptoms, such as restricted eating or binge-purge behaviors, body image distortions, denial of emaciation, and resistance to treatment. These are often chronic and relapsing disorders, and AN has the highest death rate of any psychiatric disorder. The lack of understanding of the pathogenesis of this illness has hindered the development of effective interventions, particularly for AN. Individuals with AN and BN are consistently characterized by perfectionism, obsessive-compulsiveness, and dysphoric mood. Individuals with AN tend to have high constraint, constriction of affect and emotional expressiveness, ahendonia and asceticism, whereas individuals with BN tend to be more impulsive and sensation seeking. Such symptoms often begin in childhood, before the onset of an eating disorder, and persist after recovery, suggesting they are traits that create a vulnerability for developing an ED. There is growing acknowledgement that neurobiological vulnerabilities make a substantial contribution to the pathogenesis of AN and BN. Considerable evidence suggests that altered brain serotonin (5-HT) function contributes to dysregulation of appetite, mood, and impulse control in AN and BN. Brain imaging studies, using 5-HT specific ligands, show that disturbances of 5-HT function occur when people are ill, and persist after recovery from AN and BN. It is possible that a trait-related disturbance of 5-HT neuronal modulation predates the onset of AN and contributes to premorbid symptoms of anxiety, obsessionality, and inhibition. This dysphoric temperament may involve an inherent dysregulation of emotional and reward pathways which also mediate the hedonic aspects of feeding, thus making these individuals vulnerable to disturbed appetitive behaviors. Restricting food intake may become powerfully reinforcing because it provides a temporary respite from dysphoric mood. Several factors may act on these vulnerabilities to cause AN to start in adolescence. First, puberty-related female gonadal steroids or age-related changes may exacerbate 5-HT dysregulation. Second, stress and/or cultural and societal pressures may contribute by increasing anxious and obsessional temperament. Individuals with AN may discover that reduced dietary intake, by reducing plasma tryptophan availability, is a means by which they can modulate brain 5-HT functional activity and anxious mood. People with AN enter a vicious cycle which accounts for the chronicity of this disorder because caloric restriction results in a brief respite from dysphoric mood. However, malnutrition and weight loss, in turn, produce alterations in many neuropeptides and monoamine function, perhaps in the service of conserving energy, but which also exaggerates dysphoric mood. In summary, this article reviews findings in brain chemistry and neuroimaging that shed new light on understanding the psychopathology of these difficult and frustrating disorders.

Taste intensity and hedonic responses to simple beverages in gastrointestinal cancer patients

Changes in the taste of food have been implicated as a potential cause of reduced dietary intake among cancer patients. However, data on intensity and hedonic responses to the four basic tastes in cancer are scanty and contradictory. The present study aimed at evaluating taste intensity and hedonic responses to simple beverages in 47 anorectic patients affected by gastrointestinal cancer and in 55 healthy subjects. Five suprathreshold concentrations of each of the four test substances (sucrose in black current drinks, citric acid in lemonade, NaCl in unsalted tomato juice, and urea in tonic water) were used. Patients were invited to express a judgment of intensity and pleasantness ranging from 0 to 10. Mean intensity scores directly correlated with concentrations of sour, salty, bitter, and sweet stimuli, in both normals and those with cancer. Intensity judgments were higher in cancer patients with respect to sweet (for median and high concentrations, P<0.05), salty (for all concentrations, P<0.05), and bitter tastes (for median concentration, P<0.01). Hedonic function increased with the increase of the stimuli only for the sweet taste. A negative linear correlation was found between sour, bitter, and salty concentrations and hedonic score. Both in cancer patients and in healthy subjects, hedonic judgments increased with the increase of the stimulus for the sweet taste (r=0.978 and r=0.985, P=0.004 and P=0.002, respectively), and decreased for the salty (r=-0.827 and r=-0.884, P=0.084 and P=0.047, respectively) and bitter tastes (r=-0.990 and r=-0.962, P=0.009 and P=0.001, respectively). For the sour taste, the hedonic scores remained stable with the increase of the stimulus in noncancer controls (r=-0.785, P=0.115) and decreased in cancer patients (r=-0.996, P=0.0001). The hedonic scores for the sweet taste and the bitter taste were similar in cancer patients and healthy subjects, and these scores were significantly higher in cancer patients than in healthy subjects for most of the concentrations of the salty taste and all the concentrations of the sour taste. The present study suggests that cancer patients, compared to healthy individuals, have a normal sensitivity, a normal liking for pleasant stimuli, and a decreased dislike for unpleasant stimuli. Moreover, when compared to controls, they show higher hedonic scores for middle and high concentrations of the salty taste and for all concentrations of the sour taste. Further studies are needed to evaluate whether these changes observed in cancer patients translate into any alteration in dietary behavior and/or food preferences.

Grooming, scratching and feeding: role of response competition in acute anorectic response to rimonabant in male rats

RATIONALE

Although the CB1 receptor antagonist/inverse agonist rimonabant acutely suppresses food intake in rodents, the behavioural specificity of this effect remains unclear.

OBJECTIVES

To profile the behavioural effects of rimonabant in a free-feeding context.

MATERIALS AND METHODS

Videoanalysis was employed to characterise the effects of acute rimonabant (1.5 and 3.0 mg/kg, IP) on the behaviour of non-deprived male rats exposed to palatable mash. Data were also collected on post-treatment weight gain, and, as prolonged appetite suppression has been found after single dosing with compounds of this series, rats were reassessed (drug-free) for food intake 7 days after initial testing.

RESULTS

Both doses of rimonabant not only decreased mash consumption (44-55%) but also reduced 24-h weight gain. Although videoanalysis confirmed the inhibitory effects of rimonabant on feeding behaviour, it also revealed concurrent reductions in locomotion, rearing and sniffing as well as substantial (up to tenfold) and dose-dependent increases in grooming and scratching. Timecourse analyses further revealed that rimonabant dose-dependently induced frequent episodes of atypical scratching that waned over the test but which were succeeded by prolonged and behaviourally disruptive grooming. Finally, as groups did not differ in mash consumption on retest, any prolonged anorectic effect of acute rimonabant dissipates within 7 days of treatment.

CONCLUSIONS

The anorectic response to rimonabant in male rats would appear to be due largely to response competition. This parsimonious conclusion is supported by the less profound (although still significant) increases in scratching and grooming observed in rats treated with a sub-anorectic dose (0.5 mg/kg) of the compound.

Insufficient voluntary intake of nutrients and energy in hospitalized patients

AIM

The aim of our study was to evaluate the inadequacy of voluntary energy and nutrient intake on the first day of hospital admission.

PATIENTS AND METHODS

A cross-sectional study was carried out in two terciary care hospitals, with a probabilistic sample of 50% of in-patients. Dietary intake was evaluated by a 24-hour dietary recall, and undernutrition was screened through the Nutritional Risk Screening 2002 tool. The overall frequency of inadequate energy and nutrient intake was estimated using Dietary Reference Intakes.

RESULTS

Energy and nutrient intakes from 258 patients showed very low values for both men and women. No significant differences were found for energy and nutrient intakes across age groups (< 65 years and > or = 65 years). When the proportion of study subjects with inadequate nutrient intakes was analysed, a high degree of inadequacy was found. The degree of inadequacy was higher for fibre, niacin, folate, vitamin B12, magnesium and zinc. No significant differences were found for energy and nutrients studied and for intakes below 1/3 of dietary recommendations from nutritionally-at-risk (n = 89) and well nourished (n = 169) patients.

CONCLUSION

Voluntary nutrient and energy intakes in the first 24 hour of hospital admission are highly inadequate. No differences were found between undernourished and well-nourished patients or patients < 65 years and > or = 65 years.

Symptoms in the palliative phase of children with cancer

BACKGROUND

The aim of the study was to make a comprehensive inventory of the physical, psychological, and social symptoms of children with cancer and their parents during the palliative phase and the extent to which health professionals address those symptoms.

PROCEDURE

Forty parents of children who died 1-3 years prior to data collection (structured questionnaire) were invited to participate in the study.

RESULTS

The response rate was 32 out of 40 parents (80%). Most frequently mentioned physical symptoms were pain, poor appetite, and fatigue. The children's most mentioned psychological symptoms were sadness, difficulty in talking to their parents about their feelings regarding illness and death and fear of being alone. The symptoms of fear of death of the child and fear of physical symptoms were most frequently mentioned parents' psychological symptoms. Health professionals addressed 82% of the children's physical symptoms, 43% of the children's psychological symptoms, and 56% of the parents' psychological symptoms. Parents indicated that after professional attention the proportion of children's physical symptoms that were completely or partially resolved was 18 and 26%, respectively. For children's psychological symptoms the figures were 9 and 25%, respectively, and for parents' psychological symptoms 2 and 23%, respectively.

CONCLUSIONS

The burden of symptoms of the child with cancer during the palliative phase and their parents is high. Health professionals focus mainly on the physical symptoms of the child. Relief of symptoms could not be achieved for a large proportion of symptoms. Further prospective research is necessary to investigate the kind, frequency and intensity of symptoms in order to tailor optimal palliative care to the needs of both child and parent.

Shifting to conscious control: psychosocial and dietary management of anorexia by patients with advanced cancer

The psychosocial strategies used by advanced cancer patients to manage anorexia are poorly described. A greater understanding of them may guide clinicians to provide appropriate interventions to patients and caregivers.

METHODS

Glaserian Grounded Theory was used to recruit and analyse data from two women and seven men with advanced cancer suffering from anorexia. They were interviewed about the emotional and social impact of appetite loss and the strategies that they used to compensate for reduced food intake.

RESULTS

Shifting to conscious control (overeating) was the basic social psychological process employed by participants to manage the emotional and social consequences of declining intake. Although a number of symptoms were found to contribute, nausea or the anticipation of emesis provoked by food was most commonly named as the ultimate barrier to eating.

DISCUSSION

Participants retained the motivation and ability to eat without appetite, providing the intake of food did not provoke nausea or the anticipation of emesis. Nutritional interventions must be tailored around patients' eating capabilities. Counselling and education programmes that assist family members in understanding the shift to conscious control over eating are required.

Körperbilder männlicher Patienten mit Essstörungen

Ideals of male attractiveness have changed considerably. The ideal male body at present is characterized by low body fat and pronounced muscles. Similar to what has been found for women, these normative societal conceptions should influence the pathology of men with eating disorders. In the present study, men with and without eating disorders are compared regarding body satisfaction and body perception. Both questionnaire data and a computer assisted approach are applied. Men with bulimia nervosa wish to have a body with less fat whereas men with anorexia do not wish for a bigger body although they are seriously underweight. Men in all groups wish to have more muscles. Men with and without an eating disorder do not differ in this respect. The wish for less body fat and more muscles is associated with body dissatisfaction in men. Treatment of men with eating disorders should focus on men's body images similar to how it is conceptualized in treatments for women with eating disorders. Different from women, a body image focused approach for men should emphasize the meaning of muscularity.

Personality and repeated suicide attempts in dependent adolescents and young adults

This study compared personality characteristics of subjects with dependence disorders who had previously made a suicide attempt. The population, recruited in France, Belgium, and Switzerland, was composed of 570 subjects (225 females, 345 males, mean age = 27.3, SD = 8.5). The subjects' psychological dimensions were investigated by means of several self-report questionnaires including: BDI-13 (Beck), Sensation-Seeking Scale (Zuckerman), Toronto Alexithymia Scale (Taylor), Interpersonal Dependency Inventory (Hirschfeld), MMPI-2, and some additional scales. For most dimensions, repeat attempters, both past and recent, but more specifically the recent repeaters, had a more severe psychological profile compared to the other suicide attempters.

Difference in susceptibility to activity-based anorexia in two inbred strains of mice

Food restricted rodents develop activity-based anorexia in the presence of a running wheel, characterised by increased physical activity, weight loss and decreased leptin levels. Here, we determined trait differences in the development of activity-based anorexia between C57BL/6J and DBA/2J inbred mouse lines previously reported as having low and high anxiety, respectively. C57BL/6J mice housed with running wheels and exposed to scheduled feeding reduced their wheel activity, in contrast to DBA/2J mice which exhibited increased behavioural activity under these conditions. Food restriction induced hypoleptinemia in both strains, but the decline in plasma leptin was stronger in DBA/2J mice and correlated with increased activity only in that strain. These data suggest that plasma leptin level dynamics rather than hypoleptinemia alone influences the development of activity-based anorexia and that recombinant inbred panels based on these progenitor lines offer opportunities for the identification of molecular determinants for anorexia nervosa related behavioural traits.

Psychological traits and platelet monoamine oxidase activity in eating disorder patients: their relationship and stability

Self-reported behavior and attitudes towards eating [Eating Disorder Inventory-2; Garner DM (1991). Eating Disorder Inventory-2: Professional Manual. Odessa, Fl.: Psychological Assessment Resources; Estonian version Podar I, Hannus A, Allik J (1999). Personality and Affectivity Characteristics Associated With Eating Disorders: a Comparison of Eating Disordered, Weight-Preoccupied, and Normal Samples. J Pers Assess; 73(1), 133-147] and the activity of platelet monoamine oxidase (MAO) was studied in 11 patients with anorexia nervosa (AN), 43 patients with bulimia nervosa (BN) and a healthy control group (n=138). Nineteen patients filled in the EDI-2 questionnaire and donated blood samples three times with three month intervals in order to determine platelet MAO activity. Eating disordered (ED) patients scored higher on all EDI-2 subscales and had lower MAO activity compared to the control group. They also scored higher than the control group on the Neuroticism domain but lower on the Extraversion, Openness, and Conscientiousness domains of the NEO-PI-R questionnaire. The average stability of MAO on different occasions (r=.56) was slightly smaller than the stability of the EDI-2 scores (r=.70). The lack of correlations between personality dispositions and MAO activity indicates that they have independent influence on eating disorders. A possible relationship between neurochemical mechanisms and psychological symptoms of eating disordered behavior is discussed.

Pharmacological, but not genetic, disruptions in 5-HT(2C) receptor function attenuate LPS anorexia in mice

Peripheral administration of bacterial lipopolysaccharide (LPS) elicits anorexia in several species, including rats and mice. There is strong evidence that antagonism of serotonergic activity at 2C receptors (5-HT(2C)R) attenuates LPS anorexia in rats. Here we used pharmacological and genetic approaches to examine the role of the 5-HT(2C)R in LPS anorexia in mice. In Experiment 1, SB 242084, a potent and selective 5-HT(2C) antagonist (0.3 mg/kg) was injected intraperitoneally 15 min before intraperitoneal LPS (2 microg/kg) injections just prior to dark onset in c57BL/6 mice. Food intake was recorded 1, 2 and 4 h after LPS administration. In Experiment 2, we recorded 2, 4 and 24 h food intake following dark onset intraperitoneal LPS (0.125, 0.25, 0.5, 1 and 2 microg/kg) injections in mice with a genetic deletion of 5-HT(2C)R and their WT controls. Our pharmacological results suggest that at least part of the anorexia following peripheral LPS administration is mediated by an increase in 5-HT-ergic activity at the 5-HT(2C)R. Our genetic data, in contrast, suggest that 5-HT(2C)R is not a necessary part of LPS anorexia.

Do anorectic men share personality traits with opiate dependent men? A case-control study

BACKGROUND

Eating disorders (ED) and substance use disorders (SUD) display clinical and psychodynamic analogies. The co-diagnosis of a substance use disorder in male ED patients is frequent. Nevertheless, knowledge about the mutual predisposing factors or personality analogies is currently scarce and hypotheses are controversial.

METHODS

The Temperament and Character Inventory (TCI) was used to assess 21 anorectic men, 79 heroin-dependent men, and 75 control men matched for age and education.

RESULTS

Anorectic and opiate-addicted patients displayed higher Harm Avoidance and lower Self-directedness and Cooperativeness. Anorectic men displayed lower Reward Dependence and higher Persistence. Opiate addicts had higher Novelty Seeking and Self-transcendence.

DISCUSSION

Anorectic and heroine-dependent subjects share personality traits related to anxiety, fearfulness and antisocial features. Nevertheless, the personality profile does not completely overlap and this could influence the choice of the "substance" of abuse and the related clinical differences between anorexia and heroin dependence.

[Differences among chronic restrained eaters: the influence of motivational systems]

BACKGROUND

Restrained eaters (RE) are individuals who restrain their food intake on a regular basis as they are frightened to gain weight. However, they tend to overeat under conditions of anxiety. It has been shown that RE possess a behavioral inhibition system that is more active in tonic terms, which would partially explain their affective vulnerability. Even so, the influence of variations in the activation levels of the emotional systems on the eating behavior of a RE is still unknown. Our hypothesis is that variations of such systems will give place to two types of RE: a successful or a non-successful one.

AIM

To assess the influence of variations on the activation of motivational systems in food intake of RE.

MATERIALS AND METHODS

As part of a factorial experimental design, 105 undergraduate university students were part of an experimental test for inducting food intake. Then they reported their levels of dietary restraint and their emotional behavioral preferences.

RESULTS

Differences in the activation of motivational systems were significantly related to differences in food intake (F= 7.210; p= 0.001). Additionally, food intake for those RE with a predominant inhibition system tended to be higher than for those with a more active approach system, though the latter did not reach a significant difference (F=0.718; p=0.399).

CONCLUSIONS

Although more investigations are required, our data suggest that the success of retaining the diet among the RE would depend on their profile of affective reactivity (affective style). There are putative implications for research on anorexia and obesity.

Prolactin-releasing Peptide mediates cholecystokinin-induced satiety in mice

We have shown previously that prolactin-releasing peptide (PrRP) plays a role in the regulation of feeding and energy expenditure in rats. We hypothesize that PrRP may have a physiological action through its putative receptor, GPR10, to mediate the central anorexigenic effects of peripheral satiety factors. Here we examine the effects of PrRP and cholecystokinin (CCK) on feeding in mice, including PrRP receptor gene knockout animals (GPR10(-/-)). Intracerebroventricular administration of PrRP (1-4 nmol) inhibited feeding in C57B6/J mice under both fast-induced and nocturnal feeding conditions. In contrast to the observations made in wild-type mice, neither PrRP nor CCK reduced food intake in GRP10(-/-) mice. The reduction in feeding and the release of corticosterone induced by systemic injection of the stressor lipopolysaccharide was similar in both GPR10(+/+) and GPR10(-/-) mice. These findings suggest that PrRP, acting through GPR10, is involved in regulating food intake and may be a key intermediary in the central satiating actions of CCK.

[Feeding-related disorders in medicine, with special reference to cancer anorexia-cachexia syndrome]

Cachexia is among the most debilitating and life-threatening aspects of cancer. Associated with anorexia, fat and muscle tissue wasting, psychological distress, and a lower quality of life, cachexia arises from a complex interaction between the cancer and the host. This process results from a failure of the adaptive feeding response seen in simple starvation and includes cytokine production, release of lipid-mobilizing and proteolysis-inducing factors, and alterations in intermediary metabolism. Cytokines play a pivotal role in long-term inhibition of feeding by mimicking the hypothalamic effect of excessive negative feedback signaling from leptin, a hormone secreted by adipose tissue, which is an integral component of the homeostatic loop of body weight regulation. The two major options for pharmacological therapy have been either progestational agents or corticosteroids. However, knowledge of the mechanisms of cancer anorexia-cachexia syndrome continues to lead to effective therapeutic interventions for several aspects of the syndrome. These include antiserotonergic drugs, gastroprokinetic agents, branched-chain amino acids, eicosapentanoic acid, cannabinoids, melatonin, and thalidomide, all of which act on the feeding-regulatory circuitry to increase appetite and inhibit tumor-derived catabolic factors to antagonize tissue wasting and/or host cytokine release. The outcomes of drug studies in cancer cachexia should focus on the symptomatic and quality-of-life advantages rather than simply on nutritional end points, since the survival of cachexia cancer patients may be limited to weeks or months due to the incurable nature of the underlying malignancy. As weight loss shortens the survival time of cancer patients and decreases their performance status, effective therapy would extend patient survival and improve quality of life.

The anorexia of aging in humans

Energy intake is reduced in older individuals, with several lines of evidence suggesting that both physiological impairment of food intake regulation and non-physiological mechanisms are important. Non-physiological causes of the anorexia of aging include social (e.g. poverty, isolation), psychological (e.g. depression, dementia), medical (e.g. edentulism, dysphagia), and pharmacological factors. Physiological factors include changes in taste and smell, diminished sensory-specific satiety, delayed gastric emptying, altered digestion-related hormone secretion and hormonal responsiveness, as well as food intake-related regulatory impairments for which specific mechanisms remain largely unknown. Studies in healthy elderly individuals have shown that men who consume diets over several weeks providing either too few or too many calories relative to dietary energy needs subsequently do not compensate for the resulting energy deficit or surplus when provided an ad libitum diet. Healthy elders have also been shown to be less hungry at meal initiation and to become more rapidly satiated during a standard meal compared to younger adults. Studies in animal models are required to investigate potential mechanisms underlying these observations, while human studies should focus on examining the potential consequences of this phenomenon and practical therapeutic strategies for the maintenance of appropriate energy intake with increasing age. In light of this need, we have recently demonstrated that low reported hunger assessed using a simple questionnaire predicts unintentional weight loss in a sample of healthy older women, and thus may provide a clinically useful tool for identifying older individuals at risk for undesirable weight change and therefore at high priority for intervention.

Personality traits after recovery from eating disorders: do subtypes differ?

OBJECTIVE

We compared individuals recovered from anorexia (AN) and bulimia nervosa (BN) to determine characteristics that are shared by or distinguish eating disorder (ED) subtypes.

METHOD

Sixty women recovered for > or = 1 year from AN or BN were compared with 47 control women (CW). Assessments included the Yale-Brown-Cornell Eating Disorder Scale, the Spielberger State-Trait Anxiety Inventory, the Beck Depression Inventory, the Yale-Brown Obsessive Compulsive Scale, the Temperament and Character Inventory, and Structured Clinical Interviews for DSM-IV.

RESULTS

Individuals recovered from an ED had similar scores for mood and personality variables that were significantly higher than the scores for CW. Few recovered subjects had Cluster B personality disorder. Most individuals recovered within 6 years of their ED onset. A latent profile analysis identified an "inhibited" and "disinhibited" cluster based on personality traits.

CONCLUSION

A wide range of symptoms persist after recovery and do not differ between subtypes of ED. These findings may aid in identifying traits that create vulnerabilities for developing an ED.

Early satiety in cancer patients: a common and important but underrecognized symptom

INTRODUCTION

The severity of anorexia correlates with the presence of early satiety. The sense of fullness limits nutritional intake. The symptom is poorly understood because most assessment questionnaires do not include early satiety.

METHODS

Patients rarely volunteer early satiety. Central and peripheral mechanisms may be involved in the genesis of early satiety. These would include central sensory specific satiety, food aversions, diurnal changes in intake, gastric motility and accommodation and as gastrointestinal hormones.

CONCLUSIONS

Prokinetic medications, such as metoclopramide are used to treat early satiety. However, other medications which influence gastric accommodation such as clonidine, sumatriptan, or sildenafil, or diminish enteric afferent output such as kappa opioid receptor agonists, may favorably influence early satiety and should be subject to future research. Translational research is needed to understand the relationship of early satiety to gastric motility and accommodation.

The psychobiology and diagnostic significance of amenorrhea in patients with anorexia nervosa

Amenorrhea is a diagnostic criterion for anorexia nervosa (AN), although menstrual cycles have been found to persist in some women with all the other features of AN. This study sought to determine factors that are associated with amenorrhea in 39 women with current primary spectrum AN. The use of exercise to control weight (odds ratio (OR) = 3.5; 95% confidence interval (CI) = 1.3-9.9; P = .02), low novelty seeking scores (OR = 0.7; 95% CI = 0.58-0.94; P = .02), and low systolic blood pressure (OR = 0.9; 95% CI = 0.84-0.99; P = .046) were predictors of amenorrhea independent of body mass index.

[Animal model of eating disorders]

Patients with eating disorders are increasing in number. Some neurocircuits concerned with feeding behavior might be dysfunctional in these patients with repeated expression of disorganized eating behavior like long-lasting dieting. These neuronal, or endocrinological dysfunctions might even be enhanced by psychological stress. To understand the biological bases of eating disorders is necessary to establish effective treatment. According to the clinical features of the patients, we have conducted some rat studies. We have found that space restriction stress enhances rebound hyperphagia induced by time-restricted scheduled feeding, and propose the phenomenon as a possible rat model of binge eating. We can speculate some part of the biological bases of human eating disorders, and effective prevention and treatment through such animal models.

How Anorexic-like Are the Symptom and Personality Profiles of Aesthetic Athletes?

PURPOSE

We tested the hypothesis that aesthetic athletes (AA) have anorexic-like eating attitudes and behaviors, share personality characteristics such as perfectionism and obsessiveness, and are at high risk of eating disorders.

METHODS

We compared symptomatology, personality variables typical of anorexia nervosa, and lifetime eating disorder prevalence across four groups of Israeli women: 31 anorexics, 111 AA (mostly dancers), 68 nonaesthetic athletes (NAA), and 248 controls. All participants completed self-report measures of symptomatology, harm avoidance, perfectionism, obsessiveness, self-esteem, and self-rated facial attractiveness and were screened for eating disorders. Those screening positively were interviewed and diagnosed using the structured clinical interview for DSM-IV.

RESULTS

Scores of the anorexic women differed from those of the three other groups in the expected direction on all variables. NAA scored similarly to controls, but had greater body satisfaction and less drive for thinness. Surprisingly, the AA did not differ from control women on any self-report measure. However, significantly more AA (11.7%) than NAA (5.8%) and controls (4.4%) had a lifetime diagnosis of eating disorder not otherwise specified (EDNOS). The eating attitudes and behavior of the 13 AA with a lifetime history of EDNOS fell intermediately between the anorexic women and the controls, whereas their personality profile resembled that of controls.

CONCLUSIONS

Being a nonaesthetic female athlete in Israel appears to promote body esteem and offer some protection from a preoccupation with dieting. AA also appear to enjoy excellent psychological health; however, a subgroup has EDNOS and appears not to receive appropriate treatment for it. These results lend credibility to the existence of the diagnostic entity of anorexia athletica, proposed to be a subclinical, environmentally influenced eating disorder with a favorable prognosis.

[Infantile anorexia: from birth to childhood]

Young child's anorexia (0-4 years) may have organic or psychological origin, when parents-child relationships are concerned. The most complex and earliest forms often have unspecified aetiology. Psychopathological classifications, which emphasize the mother-child relationships, are essential reference marks. But there is now a consensus in the definitions: the diagnosis of infantile anorexia requires criteria of acute or chronic malnutrition. We mainly distinguish anorexia by early disorder of homeostasis, anorexia resulting from serious disorder of attachment, anorexia by disorder of mother-child interactions, and finally early and complex anorexia, mixing an organic vulnerability and a bonding trouble, which can be secondary. Treatments differ according to the selected aetiology. Even if the origin is not mainly the fact of a relational mother-child dysfunction, parents-child's relations require a support to avoid aggravation by interactive vicious circles (force feeding). More than other diseases of early childhood, feeding disorders require a good knowledge of the working hypotheses both in the field of the paediatrics and the child psychiatry.

Disorders of eating behavior: correlation between hypothalamo-pituitary-thyroid function and psychopathological aspects

Altered pituitary-thyroid (PT) function (TSH, FT4, FT3 plasma levels) was correlated with symptoms of Eating Disorders (ED) in 137 patients (65 ANR, 12 ANP, 19 ANBP, 26 BN, 8 EDNOS-AN, 7 EDNOS-BN) and 30 controls. PT hormone concentrations were assessed by immunofluorimetry and psychopathology by EDI-2 and HSCL-90. Values of TSH were decreased in ANP, BN, EDNOS-AN, of T4 in ANR, ANP, AN-BP, of T3 in ANR, ANP, ANBP, BN, EDNOS-AN, EDNOS-BN. TSH values correlated negatively with ineffectiveness in BN and EDNOS-AN, and with depression in EDNOS-AN. FT4 values correlated positively with perfectionism in ANR, ANP and ANBP, with interoceptive awareness in EDNOS-AN, and negatively with depression in EDNOS-AN and with body dissatisfaction in EDNOS-BN. FT3 values correlated positively with perfectionism in ANBP and BN, with ineffectiveness in ANR and ANP, with depression in EDNOS-AN, with hostility in ANR and EDNOS-BN, with interpersonal sensibility in ANP, with somatization in EDNOS-BN, and negatively with interpersonal distrust in EDNOS-AN. Prospective studies are needed to confirm whether or not altered PT parameters correlate with ED symptoms during the course of the diseases.

Early handling reduces vulnerability of rats to activity-based anorexia

Resistance to restricted feeding with and without wheel access was tested in rats handled (H) for 20 days since birth. Weight loss produced by 1.5-hr restricted food access was less in H than in non-handled (NH) males when tested aged 41 days. At this age combining food restriction with access to a running wheel (a procedure commonly known as activity-based anorexia, ABA) produced very rapid weight loss and no effect of handling was detected. When 75-day females were tested in the same way, under the ABA procedure H rats took longer than NH controls to reach the removal criterion. Simply restricting food access in these females produced variable weight loss, without detection of any handling effect. No differences in food intake or running were detected between H and NH rats in either males or females. In conclusion, handling seems to have a direct effect on rats' later response to either food deprivation alone or to an ABA procedure.

Anorexia/cachexia-related quality of life for children with cancer

BACKGROUND

Anorexia is a common symptom in patients with cancer, which can lead to poor tolerance of treatment and can contribute to cachexia in extreme cases. Children with advanced-stage cancer are especially vulnerable to malnutrition resulting from anorexia and cachexia. Currently, there are no instruments that measure common concerns specifically associated with anorexia and cachexia in children with cancer. The purpose of the current article was to test the psychometric properties of a newly developed pediatric Functional Assessment of Anorexia and Cachexia Therapy (peds-FAACT) for children with cancer.

METHODS

Ninety-six patients (ages 7-17 yrs) receiving cancer treatment and their parents were asked to complete the 12-item peds-FAACT. The authors implemented both classical test theory and item response theory to evaluate the agreement between parents and patients, internal consistency and unidimensionality of the scale, and stability of items across subgroups.

RESULTS

As a result, a patient-reported six-item scale was recommended as the core measure for all pediatric patients with cancer and four additional peripheral items were recommended for adolescent patients.

CONCLUSIONS

The peds-FAACT demonstrated good psychometric properties, differentiated patients with different functional performance status, and was determined to be a useful tool for future clinical trials.

Increased dopamine D2/D3 receptor binding after recovery from anorexia nervosa measured by positron emission tomography and [11c]raclopride

BACKGROUND

Several lines of evidence support the possibility that disturbances of dopamine (DA) function could contribute to alterations of weight, feeding, motor activity, and reward in anorexia nervosa (AN).

METHODS

To assess possibly trait-related disturbances but avoid confounding effects of malnutrition, 10 women who were recovered from AN (REC AN) were compared with 12 healthy control women (CW). Positron emission tomography with [(11)C]raclopride was used to assess DA D2/D3 receptor binding.

RESULTS

The women who were recovered from AN had significantly higher [(11)C]raclopride binding potential in the antero-ventral striatum than CW. For REC AN, [(11)C]raclopride binding potential was positively related to harm avoidance in the dorsal caudate and dorsal putamen.

CONCLUSIONS

These data lend support for the possibility that decreased intrasynaptic DA concentration or increased D2/D3 receptor density or affinity is associated with AN and might contribute to the characteristic harm avoidance or increased physical activity found in AN. Most intriguing is the possibility that individuals with AN might have a DA related disturbance of reward mechanisms contributing to altered hedonics of feeding behavior and their ascetic, anhedonic temperament.

Pro-anorexia, weight-loss drugs and the internet: an "anti-recovery" explanatory model of anorexia

This paper explores the online "pro-anorexia" underground, a movement that supports those with anorexia and adopts an "anti-recovery" perspective on the disease. While encouraging a "healthy" diet to sustain an anorexic way-of-life, the movement also recommends the radical use of weight-loss pharmaceuticals to pursue and maintain low body weight, in contrast to their conventional use to treat obesity. Using ethnographic and interview data collected from participants in the "Anagrrl" website and online forum, we analyse the pro-anorexia (or "pro-ana") movement in terms of its underlying "explanatory model" of the disease, and contrast it with medical, psychosocial, sociocultural and feminist models that encourage a "normalisation" of body shape and weight. We suggest that for participants in pro-ana, anorexia represents stability and control, and Anagrrl offers support and guidance for those who wish to remain in this "sanctuary". We discuss the pro-anorexia movement's use of the internet to facilitate resistance to medical and social theories of disease, and its subversion of pharmaceutical technologies.