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Terhoeven V, Nikendei C, Bärnighausen T, Bountogo M, Friederich H, Ouermi L, Sié A, Harling G. Eating disorders, body image and media exposure among adolescent girls in rural Burkina Faso. Trop Med Int Health 2020; 25:132-141. [PMID: 31710750 PMCID: PMC8609432 DOI: 10.1111/tmi.13340] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Objective Body dissatisfaction and eating disorders (ED) among young females may increase in limited‐resource settings as exposure to media and higher‐resource cultures increases. We examined ED prevalence and its predictors among adolescent girls in rural north‐western Burkina Faso. Methods Fieldworkers interviewed 696 female adolescents aged 12‐20 years in the Nouna Health and Demographic Surveillance System (HDSS). ED were evaluated using the Structured Clinical Interview for DSM‐5 (SCID‐5), self‐perceived appearance and body ideal were measured using Thompson and Gray’s Contour Drawing Rating Scale (CDRS) and eating disorder predictors by the Eating Disorder Examination Questionnaire (EDE‐Q). We assessed media exposure to magazines, radio, television, and the internet. Results 16% of respondents had a BMI below WHO age‐standardised 5th percentile, while 4% were above the 85th percentile; most respondents wanted to be larger. DSM‐5 criteria for anorexia nervosa (AN) were fulfilled by four of 696 respondents (0.6%), those for bulimia nervosa by none, and those for binge eating disorder by two (0.3%). In multivariable regression, more AN symptoms were associated with greater EDE‐Q body dissatisfaction, desiring a thinner body and a history of sexual harassment or assault, but not with media exposure. A thinner desired body was associated with greater media exposure, higher BMI z‐score and greater EDE‐Q disordered eating. Conclusion ED were very rare in rural Burkinabé female adolescents, but factors predictive of ED in higher‐resource settings were also predictive of ED precursor symptoms here. Our findings suggest that increasing media exposure in resource‐limited settings may lead to increased body dissatisfaction, and potentially to increased future ED prevalence.
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Affiliation(s)
- Valentin Terhoeven
- Centre for Psychosocial Medicine University Hospital Heidelberg Heidelberg Germany
| | - Christoph Nikendei
- Centre for Psychosocial Medicine University Hospital Heidelberg Heidelberg Germany
| | - Till Bärnighausen
- Institute for Global Health University College London London UK
- Heidelberg Institute of Global Health (HIGH)University of Heidelberg Heidelberg Germany
- Department of Global Health and Population Harvard T.H. Chan School of Public Health Boston MA USA
- Africa Health Research Institute (AHRI) Somkhele and Durban South Africa
| | | | | | - Lucienne Ouermi
- Centre de Recherche en Santé de Nouna (CRSN) Nouna Burkina Faso
| | - Ali Sié
- Centre de Recherche en Santé de Nouna (CRSN) Nouna Burkina Faso
| | - Guy Harling
- Institute for Global Health University College London London UK
- Africa Health Research Institute (AHRI) Somkhele and Durban South Africa
- Department of Epidemiology & Harvard Center for Population and Development Studies Harvard T.H. Chan School of Public Health Boston MA USA
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102
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Wyssen A, Leins J, Reichenberger J, Blechert J, Munsch S, Steins-Loeber S. Body-related cognitive distortions (thought-shape fusion body) associated with thin-ideal exposure in female students-An ecological momentary assessment study. Clin Psychol Psychother 2020; 27:220-227. [PMID: 31868277 DOI: 10.1002/cpp.2421] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/28/2019] [Accepted: 12/19/2019] [Indexed: 11/07/2022]
Abstract
Etiological models of eating disorders (EDs) describe body dissatisfaction (BD)as one of the major influences fostering dysfunctional body-related behaviour and disordered eating behaviour. BD is influenced by repeated exposure to thin ideals that evoke high self-ideal discrepancy and result in body-related cognitive distortions such as thought-shape fusion body (TSF-B). The aim of this study was to investigate the covariation of daily media exposure and the experience of TSF-B in a naturalistic setting. It was further analysed whether TSF-B is associated with self-ideal discrepancy, dysfunctional body-related behaviour, and disordered eating behaviour. Moreover, person-related predictors of TSF-B were explored. Altogether, 51healthy female students (mean age 21.06years, SD = 1.76) participated in an ecological momentary assessment study with four daily surveys during 10consecutive days. Exposure with thin ideals in contrast to exposure to unspecific media contents went along with the experience of TSF-B. TSF-B was associated with higher self-ideal discrepancy and dysfunctional body-related behaviour as well as more pronounced disordered eating behaviour, suggesting that TSF-B is a common phenomenon in young healthy females' everyday life. A main effect of trait measures (e.g., pre-existing BD) on TSF-B was observable but has no moderating effect. Thus, a specific vulnerability has not been detected.
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Affiliation(s)
- Andrea Wyssen
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland.,Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Judith Leins
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University of Bamberg, Bamberg, Germany
| | - Julia Reichenberger
- Department of Psychology, Centre for Cognitive Neuroscience, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Jens Blechert
- Department of Psychology, Centre for Cognitive Neuroscience, Paris Lodron University of Salzburg, Salzburg, Austria
| | - Simone Munsch
- Department of Psychology, Clinical Psychology and Psychotherapy, University of Fribourg, Fribourg, Switzerland
| | - Sabine Steins-Loeber
- Department of Clinical Psychology and Psychotherapy, Otto-Friedrich University of Bamberg, Bamberg, Germany
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103
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Tith RM, Paradis G, Potter BJ, Low N, Healy-Profitós J, He S, Auger N. Association of Bulimia Nervosa With Long-term Risk of Cardiovascular Disease and Mortality Among Women. JAMA Psychiatry 2020; 77:44-51. [PMID: 31617882 PMCID: PMC6802370 DOI: 10.1001/jamapsychiatry.2019.2914] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
IMPORTANCE Bulimia nervosa is associated with short-term cardiovascular complications in women, but its long-term consequences on cardiovascular health are unknown. OBJECTIVE To study the association of bulimia nervosa with the long-term risk of cardiovascular disease and mortality in women. DESIGN, SETTING, AND PARTICIPANTS In this longitudinal cohort study, 416 709 women hospitalized in Quebec, Canada, including women hospitalized for bulimia nervosa and those for pregnancy-related events as a comparison group, were followed up for 12 years from 2006 to 2018 to identify incidences of cardiovascular disease and death. EXPOSURES At least 1 hospitalization for bulimia nervosa. MAIN OUTCOMES AND MEASURES The study participants were followed up to identify future incidences of cardiovascular disease and deaths. Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs to assess the association of bulimia nervosa with future outcomes after adjustment for patient characteristics. RESULTS The study population comprised 818 women who were hospitalized for bulimia nervosa (mean [SD] age, 28.3 [13.4] years) and 415 891 hospitalized for pregnancy-related events (mean [SD] age, 28.3 [5.4] years). Patients were followed up for a total of 2 957 677 person-years. The women hospitalized for bulimia nervosa had a greater incidence of cardiovascular disease compared with those hospitalized for pregnancy-related events (10.34 [95% CI, 7.77-13.76] vs 1.02 [95% CI, 0.99-1.06] per 1000 person-years). Incidence of future cardiovascular disease was even higher for women with 3 or more bulimia admissions (25.13 [95% CI, 13.52-46.70] per 1000 person-years). Women hospitalized for bulimia nervosa had 4.25 (95% CI, 2.98-6.07) times the risk of any cardiovascular disease and 4.72 (95% CI, 2.05-10.84) times the risk of death compared with women hospitalized for pregnancy-related events. Bulimia nervosa was found to be associated with ischemic heart disease (HR, 6.63; 95% CI, 3.34-13.13), atherosclerosis (HR, 6.94; 95% CI, 3.08-15.66), and cardiac conduction defects (HR, 2.99; 95% CI, 1.57-5.71). Bulimia was also associated with 21.93 (95% CI, 9.29-51.74) times the risk of myocardial infarction at 2 years of follow-up and 14.13 (95% CI, 6.02-33.18) times the risk at 5 years of follow-up. CONCLUSIONS AND RELEVANCE This study's findings suggest that bulimia nervosa may be associated with the long-term risk of any cardiovascular disease, such as ischemic cardiac events and conduction disorders, as well as with death among women. The findings also suggest that women with a history of bulimia nervosa should be screened regularly for ischemic cardiovascular disease and may benefit from prevention of and treatment for cardiovascular risk factors.
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Affiliation(s)
- Rasmi M. Tith
- School of Public Health and Health Systems, Faculty of Applied Health Sciences, University of Waterloo, Waterloo, Ontario, Canada,Bureau d’information et d’études en santé des populations, Institut National de Santé Publique du Québec, Montreal, Canada
| | - Gilles Paradis
- Bureau d’information et d’études en santé des populations, Institut National de Santé Publique du Québec, Montreal, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Brian J. Potter
- Innovation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada,Division of Cardiology, Department of Medicine, Centre hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Jessica Healy-Profitós
- Bureau d’information et d’études en santé des populations, Institut National de Santé Publique du Québec, Montreal, Canada,Innovation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Siyi He
- Bureau d’information et d’études en santé des populations, Institut National de Santé Publique du Québec, Montreal, Canada,Innovation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
| | - Nathalie Auger
- Bureau d’information et d’études en santé des populations, Institut National de Santé Publique du Québec, Montreal, Canada,Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada,Innovation Hub, University of Montreal Hospital Research Centre, Montreal, Quebec, Canada,Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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104
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İnan-Erdoğan I, Akgül S, Işgın-Atıcı K, Tuğrul-Yücel T, Boduroğlu K, Derman O, Kanbur N. Effects of vitamin D and estrogen receptor polymorphisms on bone mineral density in adolescents with anorexia nervosa. J Pediatr Endocrinol Metab 2019; 32:1377-1384. [PMID: 31714887 DOI: 10.1515/jpem-2019-0240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 09/02/2019] [Indexed: 11/15/2022]
Abstract
Background Anorexia nervosa (AN) is a serious eating disorder that is associated with decreased bone mineral density (BMD) and greater lifetime risk for fractures. The aim of this study was to determine the correlation between BMD and genetic polymorphisms in AN. Methods This case-control study analyzed vitamin D receptor (VDR) (VDRBsml, VDRFokl) and estrogen receptor (ESR) (ESR1Xbal, ESR1Pvull) polymorphisms in 45 adolescents diagnosed with AN and 46 age-matched healthy controls. BMD values of the AN group were classified as low or normal, and polymorphisms were compared between cases and controls. The effects of body mass index (BMI), duration of disease and amenorrhea on BMD were also evaluated. Results In girls with AN, a positive effect of the bb genotype of VDRBsmI polymorphism on femur Z-scores (p = 0.103) and of the Ff genotype of VDRFokI polymorphism on vertebra Z-scores (p = 0.097) was observed. In boys with AN, a positive effect of the Ff genotype of VDRFokI polymorphism on vertebra BMD (g/cm2) was detected (p = 0.061). No association was detected between ESR polymorphisms. An inverse relationship was observed between BMD and duration of illness and amenorrhea. A direct relationship was detected between BMD and BMI. Conclusions Specific VDR gene polymorphism genotypes may have positive effects on BMD in patients with AN. Additionally, the lack of association between ESR gene polymorphisms on BMD could be attributed to the low estrogen status of the patient.
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Affiliation(s)
- Işıl İnan-Erdoğan
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Ankara, Turkey
| | - Sinem Akgül
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Division of Adolescent Medicine, Ankara, Turkey
| | - Kübra Işgın-Atıcı
- Hacettepe University, Department of Nutrition and Dietetics, Ankara, Turkey
| | - Tuğba Tuğrul-Yücel
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Division of Pediatric Genetics, Ankara, Turkey
| | - Koray Boduroğlu
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Division of Pediatric Genetics, Ankara, Turkey
| | - Orhan Derman
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Division of Adolescent Medicine, Ankara, Turkey
| | - Nuray Kanbur
- Hacettepe University Faculty of Medicine, İhsan Doğramacı Children's Hospital, Department of Pediatrics, Division of Adolescent Medicine, Ankara, Turkey
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105
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Foà C, Bertuol M, Deiana L, Rossi S, Sarli L, Artioli G. The Case/Care Manager in Eating Disorders: the nurse's role and responsibilities. ACTA BIO-MEDICA : ATENEI PARMENSIS 2019; 90:17-28. [PMID: 31714497 PMCID: PMC7233626 DOI: 10.23750/abm.v90i11-s.8989] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Accepted: 10/28/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIM OF THE WORK Despite its incidence, the Eating Disorder (ED) is underdiagnosed and, for its complexity, it requires multidisciplinary interventions. The Nurse and Case/Care Manager (CCM) have a central role in taking care of the patients with ED, even if the research concerning their role are lacking. Thus, the aim of the study was to investigate roles, activities and expectations of the nurse and the CCM in taking care of patients with ED. METHOD 25 Italian different professionals were interviewed (16 women, average age 43.4; SD = 9.23). The semi-structured interview has investigated: nurses' roles and activities; perceptions of nurses' evaluation; expectations on nurses' and CCM's roles; the interprofessional collaboration. RESULTS The nurses analyse patients' care needs and coordinate the multi-professional care with empathic attitude. Their "professionalism, skills, sensitivity, ability to relate to the patient-family unit" are expectations shared by various professionals. About the interprofessional collaboration, the action of professionals is not always well coordinated, the decisions are often not shared and hospital-territory connection is not always realised. The CCM would be the reference in this process for all interviewees. CONCLUSIONS In the three examined contexts the figure of the CCM was not present, but his/her importance was acknowledged in the management of the patient's care path and as a point of reference for health professionals. It seems important that CCM is institutionally recognized, because the CCM would ensure an efficient management of the clinical pathway and would guarantee the continuity and appropriateness of care.
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106
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Nyman-Carlsson E, Norring C, Engström I, Gustafsson SA, Lindberg K, Paulson-Karlsson G, Nevonen L. Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial. Psychother Res 2019; 30:1011-1025. [DOI: 10.1080/10503307.2019.1686190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
| | - Claes Norring
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Ingemar Engström
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Karolin Lindberg
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Gunilla Paulson-Karlsson
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Lauri Nevonen
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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107
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Anversa RG, Campbell EJ, Ch'ng SS, Gogos A, Lawrence AJ, Brown RM. A model of emotional stress‐induced binge eating in female mice with no history of food restriction. GENES BRAIN AND BEHAVIOR 2019; 19:e12613. [DOI: 10.1111/gbb.12613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Revised: 09/23/2019] [Accepted: 09/24/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Roberta G. Anversa
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental HealthUniversity of Melbourne Parkville Melbourne Australia
| | - Erin J. Campbell
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
| | - Sarah S. Ch'ng
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
| | - Andrea Gogos
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental HealthUniversity of Melbourne Parkville Melbourne Australia
| | - Andrew J. Lawrence
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental HealthUniversity of Melbourne Parkville Melbourne Australia
| | - Robyn M. Brown
- The Florey Institute of Neuroscience and Mental Health, Mental Health Division Parkville Melbourne Australia
- The Florey Department of Neuroscience and Mental HealthUniversity of Melbourne Parkville Melbourne Australia
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108
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Nickel K, Maier S, Endres D, Joos A, Maier V, Tebartz van Elst L, Zeeck A. Systematic Review: Overlap Between Eating, Autism Spectrum, and Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2019; 10:708. [PMID: 31649563 PMCID: PMC6796791 DOI: 10.3389/fpsyt.2019.00708] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Accepted: 09/03/2019] [Indexed: 12/17/2022] Open
Abstract
Background: Links between eating disorders (EDs) [e.g., anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED)] and the major neurodevelopmental disorders of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) have been repeatedly highlighted. In both ASD and ADHD, these links range from an elevated risk for EDs to common symptomatic overlaps and etiological commonalities with EDs. Methods: We performed a systematic literature search (through July 2019) with Medline via Ovid for epidemiological data on EDs (AN, BN, and BED) in combination with both ASD and ADHD. Results: The reviewed studies showed that, on average, 4.7% of patients with certain ED diagnoses (AN, BN, or BED) received an ASD diagnosis. Reliable data on the prevalence of EDs in ASD samples are still scarce. Comorbid ASD is most commonly diagnosed in patients with AN. The prevalence of ADHD in EDs ranged between 1.6% and 18%. Comorbid ADHD was more often reported in the AN-binge eating/purging subtype and BN than in the AN restrictive subtype. The prevalence of EDs in ADHD ranged between no association and a lifetime prevalence of 21.8% of developing an ED in women with ADHD. Conclusions: Studies on the prevalence rates of EDs in ADHD and ASD and vice versa are heterogeneous, but they indicate frequent association. While there is growing evidence of clinical overlaps between the three disorders, it remains difficult to determine whether overlapping characteristics (e.g., social withdrawal) are due to common comorbidities (e.g., depression) or are instead primarily associated with EDs and neurodevelopmental disorders. Furthermore, prospective studies are required to better understand how these disorders are related and whether ADHD and ASD could be either specific or nonspecific predisposing factors for the development of EDs.
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Affiliation(s)
- Kathrin Nickel
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Simon Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Dominique Endres
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Andreas Joos
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
- Department of Psychotherapeutic Neurology, Kliniken Schmieder, Gailingen, Germany
| | - Viktoria Maier
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ludger Tebartz van Elst
- Section for Experimental Neuropsychiatry, Department of Psychiatry and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Almut Zeeck
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
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DiVasta AD, Feldman HA, O’Donnell JM, Long J, Leonard MB, Gordon CM. Impact of Adrenal Hormone Supplementation on Bone Geometry in Growing Teens With Anorexia Nervosa. J Adolesc Health 2019; 65:462-468. [PMID: 31227390 PMCID: PMC7001735 DOI: 10.1016/j.jadohealth.2019.04.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 04/01/2019] [Accepted: 04/01/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE Adolescents with anorexia nervosa (AN) have decreased dehydroepiandrosterone (DHEA) and estrogen concentrations that may contribute to skeletal deficits. We sought to determine whether DHEA + estrogen replacement (ERT) prevented bone loss in young adolescents with AN. METHODS We recruited females with AN (n = 70, ages 11-18 years) into a 12-month, randomized, double-blind placebo-controlled trial. Participants were randomized to oral micronized DHEA 50 mg + 20 mcg ethinyl estradiol/.1 mg levonorgestrel daily (n = 35) or placebo (n = 35). Outcomes included serial measures of bone mineral density (BMD) by dual-energy X-ray absorptiometry (total body, hip, spine) and peripheral quantitative computed tomography (pQCT; tibia). Magnetic resonance imaging of T1-weighted images of the left knee determined physeal status (open/closed). RESULTS Sixty-two subjects completed the trial. Physeal closure status was the strongest predictor of aBMD changes. Among girls with open physes, those who received DHEA + ERT showed a decline in BMD Z-scores compared with those receiving placebo, whereas there was no effect in those with at least one closed physis. Treatment did not affect any pQCT measures, regardless of physeal closure status. CONCLUSIONS Combined DHEA + ERT did not significantly improve dual-energy X-ray absorptiometry or pQCT BMD measurements in young adolescent girls with AN, in contrast to an earlier trial showing benefit in older adolescents and young women. In girls with open physes, the mean change in the placebo arm was greater than that of the DHEA + ERT group. We conclude that DHEA + ERT is ineffective for preserving bone health in growing young adolescents with AN at the dose and route of administration described in this report.
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Affiliation(s)
- Amy D. DiVasta
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA,Division of Gynecology, Boston Children’s Hospital, Boston, MA, USA
| | - Henry A. Feldman
- Institutional Centers for Clinical and Translational Research, Boston Children’s Hospital, Boston, MA, USA,Division of Endocrinology, Boston Children’s Hospital, Boston, MA, USA
| | | | - Jin Long
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Mary B. Leonard
- Division of Pediatric Nephrology, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Catherine M. Gordon
- Division of Adolescent/Young Adult Medicine, Boston Children’s Hospital, Boston, MA, USA
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Hata T, Miyata N, Takakura S, Yoshihara K, Asano Y, Kimura-Todani T, Yamashita M, Zhang XT, Watanabe N, Mikami K, Koga Y, Sudo N. The Gut Microbiome Derived From Anorexia Nervosa Patients Impairs Weight Gain and Behavioral Performance in Female Mice. Endocrinology 2019; 160:2441-2452. [PMID: 31504398 DOI: 10.1210/en.2019-00408] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/20/2019] [Indexed: 12/26/2022]
Abstract
Anorexia nervosa (AN) results in gut dysbiosis, but whether the dysbiosis contributes to AN-specific pathologies such as poor weight gain and neuropsychiatric abnormalities remains unclear. To address this, germ-free mice were reconstituted with the microbiota of four patients with restricting-type AN (gAN mice) and four healthy control individuals (gHC mice). The effects of gut microbes on weight gain and behavioral characteristics were examined. Fecal microbial profiles in recipient gnotobiotic mice were clustered with those of the human donors. Compared with gHC mice, gAN mice showed a decrease in body weight gain, concomitant with reduced food intake. Food efficiency ratio (body weight gain/food intake) was also significantly lower in gAN mice than in gHC mice, suggesting that decreased appetite as well as the capacity to convert ingested food to unit of body substance may contribute to poor weight gain. Both anxiety-related behavior measured by open-field tests and compulsive behavior measured by a marble-burying test were increased only in gAN mice but not in gHC mice. Serotonin levels in the brain stem of gAN mice were lower than those in the brain stem of gHC mice. Moreover, the genus Bacteroides showed the highest correlation with the number of buried marbles among all genera identified. Administration of Bacteroides vulgatus reversed compulsive behavior but failed to exert any substantial effect on body weight. Collectively, these results indicate that AN-specific dysbiosis may contribute to both poor weight gain and mental disorders in patients with AN.
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Affiliation(s)
- Tomokazu Hata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noriyuki Miyata
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shu Takakura
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazufumi Yoshihara
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yasunari Asano
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tae Kimura-Todani
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Makoto Yamashita
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Xue-Ting Zhang
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Natsuru Watanabe
- Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Katsunaka Mikami
- Department of Psychiatry, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Yasuhiro Koga
- Department of Infectious Diseases, Tokai University School of Medicine, Isehara, Kanagawa, Japan
| | - Nobuyuki Sudo
- Department of Psychosomatic Medicine, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Abnormal structural brain network and hemisphere-specific changes in bulimia nervosa. Transl Psychiatry 2019; 9:206. [PMID: 31455767 PMCID: PMC6712015 DOI: 10.1038/s41398-019-0543-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 06/25/2019] [Accepted: 07/17/2019] [Indexed: 12/18/2022] Open
Abstract
Bulimia nervosa (BN) is characterized by episodic binge eating and purging behaviors. Disrupted neural processes of self-regulation, taste-rewarding, and body image has been associated with the pathogenesis of BN. However, the structural basis for these behavioral and functional deficits remains largely unknown. We employed diffusion tensor imaging and graph theory approaches (including the nodal properties and network-based statistics (NBS)) to characterize the whole-brain structural network of 48 BN and 44 healthy women. For nodal measures of strength, local efficiency, and betweenness centrality, BN patients displayed abnormal increases in multiple left-lateralized nodes within the mesocorticolimbic reward circuitry (including the orbitofrontal cortex, anterior cingulate, insular, medial temporal, and subcortical areas), lateral temporal-occipital cortex, and precuneus, while reduced global efficiency was observed in the right-lateralized nodes within the dorsolateral prefrontal cortex, mesocorticolimbic circuitry, somatosensory and visuospatial system. Several mesocorticolimbic nodes significantly correlated with BN symptoms. At a network level, we found increased left-lateralized connections primarily within the orbitofrontal cortex and its connections to mesocorticolimbic and lateral temporal-occipital areas, but reduced right-lateralized connections across the inferior frontal gyrus and insula, as well as their connections to the lateral temporal cortex. This study revealed BN-related changes in white-matter connections across the prefrontal control, mesocorticolimbic reward, somatosensory and visuospatial systems. The hemispheric-specific change could be an important aspect of the pathophysiology of BN. By characterizing whole-brain structural network changes of BN, our study provides novel evidence for understanding the behavioral and functional deficits of the disorder.
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112
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Moulton CD, Tharmaraja T, Hopkins CWP. Collaborative Care for Adults With Obesity and Depression. JAMA 2019; 322:367-368. [PMID: 31334784 DOI: 10.1001/jama.2019.6774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Calum D Moulton
- Department of Psychological Medicine, King's College London, London, England
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113
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Goldschen L, Lundblad W, Fertig AM, Auster LS, Schwarzbach HL, Chang JC. Navigating the university transition among women who self-report an eating disorder: A qualitative study. Int J Eat Disord 2019; 52:795-800. [PMID: 30874327 DOI: 10.1002/eat.23071] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although developmental milestones have been observed to alter eating disorder (ED) symptom burden, it remains unknown how the transition to university affects symptomatology. To address this gap, we designed a qualitative study to elucidate how students with an ED perceive their general university experience and to describe how the university environment shapes their ED. METHOD Undergraduate students who self-reported an ED were recruited through fliers, an undergraduate advocacy organization, and local treatment centers. We conducted audio-recorded semi-structured individual interviews. Two investigators separately coded verbatim transcripts using an editing approach, and final themes emerged from the pattern of descriptors. RESULTS Fifteen undergraduate students participated. Participants endorsed a variety of ED symptoms and sought various levels of treatment. Most participants transitioned to university with an already-established diagnosis. Participants described that ED symptoms tended to worsen in university for a variety of reasons including (a) minimization of ED severity, (b) loss of external accountability, (c) use of ED symptoms as a coping mechanism, and (d) glorification of ED behaviors in campus diet culture. Subsequently, the ED disrupted the university experience by (e) hindering participants' ability to focus on academic responsibilities and (f) leading to social isolation on campus. DISCUSSION We identified challenges unique to the university experience that can be addressed by ED treatment teams in order to provide anticipatory guidance and patient-centered care. Study limitations include lack of formal diagnostic ED assessment by research team and sampling of students from one university.
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Affiliation(s)
- Lauren Goldschen
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Wynne Lundblad
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Alexis M Fertig
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lauren S Auster
- School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Judy C Chang
- Department of Obstetrics, Gynecology & Reproductive Sciences, Magee-Womens Research Institute, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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114
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Kaitz J, Ray S, Harkins D. Barriers in addressing body image and eating issues in primary care: an overview of women's narratives. Women Health 2019; 60:260-270. [PMID: 31242820 DOI: 10.1080/03630242.2019.1635562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Disordered eating and body image concerns continue to be rising problems for young women that come with significant mental and physical health risks. Primary care may be a potential avenue for early identification and intervention of eating and body image issues. However, few studies have explored this area in depth. Preliminary studies show that few women discuss these issues with their primary care providers (PCPs), and the barriers to these conversations remain unknown. This study used an open-ended survey to explore women's narratives concerning their experiences and barriers to discussing eating and body image issues with their PCPs. A total sample of 102 female college students (aged 18-35 years) in the Boston area completed self-report questionnaires online (February 2015 through January 2016). Themes in both communication and relationship domain emerged. Communication themes for participants included: health information, prompting by the PCP, and other barriers. Relationship themes included: patient and provider characteristics, negative and positive emotions, and trust. According to these participants, many women experience negative interactions with their providers when discussing these sensitive topics. Strategies for improving these outcomes in primary care are discussed.
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Affiliation(s)
- Jenesse Kaitz
- Department of Psychology, Suffolk University, Boston, USA
| | - Sukanya Ray
- Department of Psychology, Suffolk University, Boston, USA
| | - Debra Harkins
- Department of Psychology, Suffolk University, Boston, USA
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115
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Eating disorders risk among medical students: a global systematic review and meta-analysis. Eat Weight Disord 2019; 24:397-410. [PMID: 29785631 DOI: 10.1007/s40519-018-0516-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 05/10/2018] [Indexed: 01/01/2023] Open
Abstract
PURPOSE Medical students appear to be a high-risk group to develop psychological problems including eating disorders (ED). The prevalence estimates of ED risk vary greatly between studies. This systematic review and meta-analysis was done to estimate the prevalence of ED risk among medical students. METHODS An electronic search of EMBASE, MEDLINE, ProQuest and Google Scholar was conducted. Studies that reported the prevalence of ED risk among medical students and were published in English peer-reviewed journals between 1982 and 2017 were included. Information about study characteristics and the prevalence of ED risk were extracted by four investigators. Each article was reviewed independently by at least two investigators. Estimates were pooled using random-effects meta-analysis using the DerSimonian-Laird method. The main outcome of interest was the prevalence of ED risk in medical students. RESULTS The prevalence of ED risk among medical students was extracted from nineteen cross-sectional studies across nine countries (total participants n = 5722). The overall pooled prevalence rate of ED risk was 10.4% (497/5722 students, 95% CI 7.8-13.0%), with statistically significant evidence between-study heterogeneity (Q = 295, τ2 = 0.003, I2 = 94.0%, P < 0.001). Prevalence estimates between studies ranged from 2.2 to 29.1%. CONCLUSION In this systematic review and meta-analysis, the summary prevalence of ED risk among medical students was 10.4%. Further research is needed to identify and prevent ED in this population. Studies are also needed to investigate concurrent pathologies associated with ED risk. LEVEL OF EVIDENCE Level I, systematic review and meta-analysis.
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116
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Kapsetaki ME, Easmon C. Eating disorders in musicians: a survey investigating self-reported eating disorders of musicians. Eat Weight Disord 2019; 24:541-549. [PMID: 28710741 PMCID: PMC6531399 DOI: 10.1007/s40519-017-0414-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 05/29/2017] [Indexed: 11/30/2022] Open
Abstract
PURPOSE This study aimed to estimate the prevalence of eating disorders (EDs) in musicians, and to evaluate their relation to perfectionism, stress, anxiety and depression. METHODS It examined: (1) the prevalence of EDs using the Eating Disorder Examination Questionnaire (EDE-Q), body mass index (BMI) and self-reports, (2) psychological risk factors using the Depression Anxiety Stress Scale (DASS-21) and perfectionism inventory and (3) demographic details, information about musical and career development, lifestyle, eating habits and health. A survey was distributed worldwide and a total of 301 English-speaking musicians aged 18 years and older participated. RESULTS Our screening tools for EDs showed a high prevalence of EDs in musicians: the EDE-Q Global Score (EDE-QGS) showed pathological values in 18.66% of the musicians and when questioned about lifetime prevalence, 32.3% of the musicians answered positively. The median BMI was within the normal range. Regarding general mental health, the DASS-21 showed that depression and stress were severe, anxiety was extremely severe and the perfectionism inventory composite score was 26.53. There was no significant difference on the EDE-QGS between musicians who perform different types of music, but music students, professionals, soloists and musicians travelling overseas had a higher percentage of pathological EDE-QGS. Perfectionism was higher in classical musicians and there was a low positive correlation between EDE-QGS and the risk factors: perfectionism, depression, anxiety, stress, peer pressure and social isolation. CONCLUSION EDs are prevalent in musicians and possible risk factors are their increased perfectionism, depression, anxiety and stress due to the demands of their job.
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Affiliation(s)
| | - Charlie Easmon
- Division of Surgery and Interventional Science, University College London, London, UK
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117
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Sakamoto T, Lefor AK, Kubota T. Non-occlusive mesenteric ischaemia associated with anorexia nervosa. BMJ Case Rep 2019; 12:12/5/e229703. [PMID: 31129642 DOI: 10.1136/bcr-2019-229703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Non-occlusive mesenteric ischaemia (NOMI) is a life-threatening condition that requires emergent intervention and anorexia nervosa is a chronic eating disorder that requires careful medical and nutritional management. A 54-year-old woman with a history of anorexia nervosa and undergoing chronic haemodialysis developed abdominal pain and called an ambulance. On arrival, she was in shock and abdominal examination was consistent with diffuse peritonitis. Computed tomography scan suggested ischaemia from the distal ileum to the ascending colon. Emergency laparotomy revealed NOMI from the distal ileum to the transverse colon. The treatment strategy included staged operations and careful medical management to optimise nutritional support and electrolyte management with survival of the patient. NOMI and anorexia nervosa are both difficult to manage. Meticulous interdisciplinary management can result in a good outcome.
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Affiliation(s)
- Takashi Sakamoto
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
| | | | - Tadao Kubota
- Department of Surgery, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Japan
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118
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Brockmeyer T, Friederich HC, Küppers C, Chowdhury S, Harms L, Simmonds J, Gordon G, Potterton R, Schmidt U. Approach bias modification training in bulimia nervosa and binge-eating disorder: A pilot randomized controlled trial. Int J Eat Disord 2019; 52:520-529. [PMID: 30689229 DOI: 10.1002/eat.23024] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 12/13/2018] [Accepted: 01/07/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Bulimia nervosa (BN) and binge-eating disorder (BED) are associated with poorly controlled approach behavior toward food resulting in binge eating. Approach bias modification (ABM) may reduce these automatic action tendencies (i.e., approach bias) toward food and may thus decrease binge eating and related symptoms. METHOD A total of 56 patients with BN/BED participated in this double-blind, randomized controlled trial (RCT) comparing real and sham ABM. The real ABM condition adopted an implicit learning paradigm in which participants were trained to show avoidance behavior in response to food cues. Participants in the sham condition used a similar task but were not trained to avoid food cues. Both conditions comprised 10 training sessions within 4 weeks. RESULTS Participants in both groups experienced significant reductions in binge eating, eating disorder symptoms, trait food craving, and food cue reactivity. Real ABM tended to result in greater reductions in eating disorder symptoms than sham ABM. Food intake, approach bias, and attention bias toward food did not change. DISCUSSION This is the first RCT on ABM in eating disorders. The findings provide limited support for the efficacy of ABM in BN/BED and pose questions regarding its active ingredients and its usefulness as a stand-alone treatment for eating disorders.
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Affiliation(s)
- Timo Brockmeyer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.,Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany.,Department of Clinical Psychology and Psychotherapy, Institute of Psychology, University of Goettingen, Goettingen, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Carolyn Küppers
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Sharmain Chowdhury
- Department of Psychosomatic Medicine and Psychotherapy, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany
| | - Louisa Harms
- Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Heidelberg, Germany
| | - Jess Simmonds
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Gemma Gordon
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Rachel Potterton
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom.,Eating Disorders Unit, South London and Maudsley NHS Foundation Trust, London, United Kingdom
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119
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Steiger H, Booij L, Kahan `E, McGregor K, Thaler L, Fletcher E, Labbe A, Joober R, Israël M, Szyf M, Agellon LB, Gauvin L, St-Hilaire A, Rossi E. A longitudinal, epigenome-wide study of DNA methylation in anorexia nervosa: results in actively ill, partially weight-restored, long-term remitted and non-eating-disordered women. J Psychiatry Neurosci 2019; 44:205-213. [PMID: 30693739 PMCID: PMC6488489 DOI: 10.1503/jpn.170242] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 05/30/2018] [Accepted: 09/04/2018] [Indexed: 12/12/2022] Open
Abstract
Background This study explored state-related tendencies in DNA methylation in people with anorexia nervosa. Methods We measured genome-wide DNA methylation in 75 women with active anorexia nervosa (active), 31 women showing stable remission of anorexia nervosa (remitted) and 41 women with no eating disorder (NED). We also obtained post-intervention methylation data from 52 of the women from the active group. Results Comparisons between members of the active and NED groups showed 58 differentially methylated sites (Q < 0.01) that corresponded to genes relevant to metabolic and nutritional status (lipid and glucose metabolism), psychiatric status (serotonin receptor activity) and immune function. Methylation levels in members of the remitted group differed from those in the active group on 265 probes that also involved sites associated with genes for serotonin and insulin activity, glucose metabolism and immunity. Intriguingly, the direction of methylation effects in remitted participants tended to be opposite to those seen in active participants. The chronicity of Illness correlated (usually inversely, at Q < 0.01) with methylation levels at 64 sites that mapped onto genes regulating glutamate and serotonin activity, insulin function and epigenetic age. In contrast, body mass index increases coincided (at Q < 0.05) with generally increased methylation-level changes at 73 probes associated with lipid and glucose metabolism, immune and inflammatory processes, and olfaction. Limitations Sample sizes were modest for this type of inquiry, and findings may have been subject to uncontrolled effects of medication and substance use. Conclusion Findings point to the possibility of reversible epigenetic alterations in anorexia nervosa, and suggest that an adequate pathophysiological model would likely need to include psychiatric, metabolic and immune components.
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Affiliation(s)
- Howard Steiger
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Linda Booij
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - `Esther Kahan
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Kevin McGregor
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Lea Thaler
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Emilie Fletcher
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Aurelie Labbe
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Ridha Joober
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Mimi Israël
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Moshe Szyf
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Luis B. Agellon
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Lise Gauvin
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Annie St-Hilaire
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
| | - Erika Rossi
- From the Eating Disorders Program, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Israël, St-Hilaire, Rossi); the Research Centre, Douglas University Institute (Steiger, Kahan, Thaler, Fletcher, Joober, Israël, St-Hilaire, Rossi); the Department of Psychiatry, McGill University (Steiger, Booij, Thaler, Joober, Israël, St-Hilaire); the Department of Psychology, Concordia University (Booij); the Sainte-Justine Hospital Research Centre, University of Montreal (Booij); the Department of Epidemiology, Biostatistics, and Occupational Health, McGill University (McGregor); the Department of Decision Sciences, HEC Montreal (Labbe); the Department of Pharmacology and Therapeutics, McGill University (Szyf); the School of Human Nutrition, McGill University (Agellon); and the Centre de recherche du Centre Hospitalier, de l’Université de Montréal (CRCHUM) (Gauvin), Montreal, Que., Canada
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Sex differences in perceptual hand maps: A meta-analysis. Acta Psychol (Amst) 2019; 196:1-10. [PMID: 30933684 DOI: 10.1016/j.actpsy.2019.03.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Revised: 02/08/2019] [Accepted: 03/07/2019] [Indexed: 02/08/2023] Open
Abstract
A large body of research has suggested that localisation of the hand in external space relies on distorted representations of the hand. We developed a paradigm for measuring implicit perceptual maps of the hand (Longo & Haggard, 2010, Proc Natl Acad Sci USA, 107, 11727-11732), which show systematic deviation from actual hand shape, including overestimation of hand width and underestimation of finger length. Recently, Coelho and Gonzalez (in press, Psychol Res) reported sex differences in these perceptual hand maps, with women showing greater overestimation of hand width, but less underestimation of finger length than men. In the current study, I conducted a meta-analysis of 19 experiments using this paradigm by myself and my colleagues. The results replicated the sex differences reported by Coelho and Gonzalez. Importantly, however, these sex differences were not apparent when actual hand size was included as a covariate in analyses, suggesting that they may, at least in part, be due to women having smaller hands on average than men.
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Castillo I, Solano S, Sepúlveda AR. A controlled study of an integrated prevention program for improving disordered eating and body image among Mexican university students: A 3-month follow-up. EUROPEAN EATING DISORDERS REVIEW 2019; 27:541-556. [PMID: 30997721 DOI: 10.1002/erv.2674] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/05/2019] [Accepted: 03/10/2019] [Indexed: 12/14/2022]
Abstract
Obesity and eating disorders are currently two significant health problems in Mexico. The aim of this study was to examine the effects of an integrated prevention program on university students through an exploratory controlled study that targeted specific predisposing factors of disordered eating and obesity related to healthy eating, physical activity, body image satisfaction and perceived pressure to be thin. A total of 388 university students participated (264 females and 124 males) and were assigned either to an intervention condition or one of the two control conditions (study skills vs. nonintervention); each comprised of a total of eight workshops lasting 90 min. The program did not have any effect on the male students. In contrast, there was an interaction effect for time and group in thin-ideal internalization (η2 = 0.04) and in disordered eating attitudes/behaviours (η2 = 0.03); both showed improvements over time only among the female sample. Though, the effect size was insignificant, which means that the effectiveness of this integrated prevention program was limited. Integrated prevention approaches to eating and weight-related problems are still nascent in Mexico, and further research in this field is warranted so as to fine tune future prevention programs.
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Affiliation(s)
- Iraís Castillo
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain.,School of Nutrition, Autonomous University of Zacatecas, Zacatecas, Mexico
| | - Santos Solano
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
| | - Ana R Sepúlveda
- Department of Biological and Health Psychology, School of Psychology, Autonomous University of Madrid, Madrid, Spain
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122
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Dental and periodontal health in adults with eating disorders: A case-control study. J Dent 2019; 84:55-59. [PMID: 30876949 DOI: 10.1016/j.jdent.2019.03.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/04/2019] [Accepted: 03/07/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study evaluates dental and periodontal health in anorexia nervosa and bulimia nervosa patients. METHODS Seventy females with eating disorders (36 anorexia nervosa) attending a public hospital Psychiatry and Addiction unit were compared with age-matched controls (n = 70). Full-mouth examination and oral hygiene behaviours were recorded for all participants. RESULTS More frequent dental attendance and toothbrushing were observed in patients with eating disorders than in controls (p < 0.01), while lower plaque index and bleeding on probing were observed in controls than in patients (p ≤ 0.03). Percentages of sites with gingival recession >2 mm were higher in patients with eating disorders than in controls (2.3 ± 4.1 versus 0.0 ± 0.1, p < 0.01). The BEWE score >2 was significantly more frequent in bulimia nervosa patients than in anorexia nervosa patients (76.5% versus 41.7%, p < 0.01). Regarding periodontal parameters, mean plaque index, bleeding on probing and clinical attachment loss were increased in anorexia nervosa patients compared to bulimia nervosa patients. CONCLUSIONS The present data suggest different oral health approaches in eating disorder patients according to diagnosis type. CLINICAL SIGNIFICANCE Periodontal and dental health should be considered rigorously in patients with eating disorders. Personalized oral hygiene recommendations and treatments can be delivered according to the type of eating disorder.
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Volpe U, Monteleone AM, Ricca V, Corsi E, Favaro A, Santonastaso P, De Giorgi S, Renna C, Abbate Daga G, Amianto F, Balestrieri M, Luxardi GL, Clerici M, Alamia A, Segura-Garcia C, Rania M, Monteleone P, Maj M. Pathways to specialist care for eating disorders: An Italian multicentre study. EUROPEAN EATING DISORDERS REVIEW 2019; 27:274-282. [PMID: 30848056 DOI: 10.1002/erv.2669] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/13/2018] [Accepted: 02/07/2019] [Indexed: 12/17/2022]
Abstract
Two hundred forty six patients with eating disorders (EDs) recruited from eight Italian specialized treatment centres were administered with the World Health Organization "Encounter Form," a standardized schedule that makes it possible to characterize the clinical pathways that patients follow to reach specialized care. The median time from symptoms onset to specialized care was 114 weeks. Primary "points of access to care" were general practitioners (25%), psychiatrists (18%), and clinical nutritionists (17%), followed by various other carers. All patients received specific psychotherapy, whereas only 11% of them were given psychotropic drugs. EDs are characterized by complex care pathways, with low rates of direct access to specialized care. Although the role of general practitioners remains crucial, they tend to follow different clinical routes to refer ED patients. Educational programmes on EDs should be addressed to general practitioners and clinical nutritionists, in order to ease the transition of ED patients to a mental health care setting.
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Affiliation(s)
- Umberto Volpe
- Department of Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Alessio M Monteleone
- Department of Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
| | - Valdo Ricca
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Elisa Corsi
- Department of Health Sciences, Florence University School of Medicine, Florence, Italy
| | - Angela Favaro
- Neuroscience Department, University of Padua, Padua, Italy
| | | | - Serafino De Giorgi
- Dipartimento di Salute Mentale ASL Lecce, Centro per la Cura e la Ricerca sui Disturbi del Comportamento Alimentare, Lecce, Italy
| | - Caterina Renna
- Dipartimento di Salute Mentale ASL Lecce, Centro per la Cura e la Ricerca sui Disturbi del Comportamento Alimentare, Lecce, Italy
| | - Giovanni Abbate Daga
- Department of Neuroscience, Psychiatry Section, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, Psychiatry Section, AOU Cittá della Salute e della Scienza di Torino, Turin, Italy
| | - Matteo Balestrieri
- Clinica Psichiatrica, DAME, Azienda Sanitaria Universitaria Integrata di Udine (ASUIUD), Udine, Italy
| | | | - Massimo Clerici
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Alberto Alamia
- Department of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Marianna Rania
- Department of Health Sciences, University Magna Graecia of Catanzaro, Catanzaro, Italy
| | - Palmiero Monteleone
- Department of Mental Health, University of Campania "L. Vanvitelli", Naples, Italy.,Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", Section of Neuroscience, University of Salerno, Salerno, Italy
| | - Mario Maj
- Department of Mental Health, University of Campania "L. Vanvitelli", Naples, Italy
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Nicoletti CF, Delfino HBP, Ferreira FC, Pinhel MADS, Nonino CB. Role of eating disorders-related polymorphisms in obesity pathophysiology. Rev Endocr Metab Disord 2019; 20:115-125. [PMID: 30924001 DOI: 10.1007/s11154-019-09489-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Human biological system provides innumerable neuroendocrine inputs for food intake control, with effects on appetite's modulation and the satiety signs. Its regulation is very complex, engaging several molecular interactions with many tissues, hormones, and neural circuits. Thus, signaling molecules that control food intake are critical for normal energy homeostasis and a deregulation of these pathways can lead to eating disorders and obesity. In line of this, genetic factors have a significantly influence of the regulation of neural circuits controlling the appetite and satiety pathways, as well as the regulation of brain reward systems. Single Nucleotide Polymorphisms (SNPs) in genes related to hypothalamic appetite and satiety mechanisms, further in multiple neurotransmitter systems may contribute to the development of major Eating Disorders (EDs) related to obesity, among them Binge Eating Disorder (BED) and Bulimia Nervosa (BN), which are discussed in this review.
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Affiliation(s)
- Carolina Ferreira Nicoletti
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | | | - Flávia Campos Ferreira
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
| | - Marcela Augusta de Souza Pinhel
- Department of Internal Medicine, Ribeirao Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil
- Laboratory of Studies in Biochemistry and Molecular Biology, Department of Molecular Biology, São José do Rio Preto Medical School, São Paulo, Brazil
| | - Carla Barbosa Nonino
- Department of Health Sciences, Ribeirão Preto Medical School - FMRP/USP - Laboratory of Nutrigenomic Studies, University of São Paulo, Av Bandeirantes, 3900, Monte Alegre, Ribeirão Preto, SP, CEP: 14049-900, Brazil.
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Thiebaut S, Jaussent I, Maimoun L, Beziat S, Seneque M, Hamroun D, Lefebvre P, Godart N, Renard E, Courtet P, Guillaume S. Impact of bipolar disorder on eating disorders severity in real-life settings. J Affect Disord 2019; 246:867-872. [PMID: 30795493 DOI: 10.1016/j.jad.2018.12.128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/25/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Comorbidity of bipolar disorder (BD) and eating disorders (ED) is common and increases the course and severity of BD. However, the impact of comorbid BD on the clinical profile of ED patients remains unclear. Most studies have focused on patients primarily assessed for BD and data on patients with a primary diagnosis of ED are sparse. We investigated the association between a dual diagnosis and severity in terms of clinical, neuropsychological dimensions and daily functioning. METHOD Two hundred and sixty-one patients with ED were consecutively recruited. BD was screened with the MINI and further confirmed in the French expert centre network. The severity of ED symptoms was assessed with the EDE-Q and EDI-2, daily functioning with the FAST. The neurocognitive assessment targeted attention, set-shifting and decision-making. RESULTS Forty-nine patients screened positive for BD, but diagnosis was confirmed in only thirty patients (11.5% of the cohort). After multiple adjustments, comorbidity was associated with greater severity on the total score and three subscales of the EDE-Q and on four of the ten dimensions of the EDI-2. Comorbid BD was associated with lower daily functioning but not with lower neuropsychological performance. LIMITATIONS Sample referred to specialist clinics not large enough to authorize an analysis by subtype and cross-sectional evaluation. CONCLUSION The association between ED and BD increases ED severity for most of these core features. It negatively impacts daily functioning. The results also highlight issues about the validity of screening tools to detect BD in patients with ED.
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Affiliation(s)
- S Thiebaut
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France; Inserm U1061, Université de Montpellier, Montpellier, France.
| | - I Jaussent
- Inserm U1061, Université de Montpellier, Montpellier, France
| | - L Maimoun
- Département de Médecine Nucléaire, Hôpital Lapeyronie, CHRU Montpellier, Montpellier, France; Physiologie et Médecine Expérimentale du Cœur et des Muscles, INSERM U1046, UMR9214 CNRS, Université de Montpellier, France
| | - S Beziat
- Inserm U1061, Université de Montpellier, Montpellier, France
| | - M Seneque
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France; Inserm U1061, Université de Montpellier, Montpellier, France
| | - D Hamroun
- Direction de la Recherche et de l'Innovation, CHRU Montpellier, Montpellier, France
| | - P Lefebvre
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France
| | - N Godart
- Equipe de Recherche, Fondation Santé des Etudiants de France, Paris, France; CESP, INSERM 1178, Université Paris-Descartes, UVSQ, Villejuif, France
| | - E Renard
- Department of Endocrinology, Diabetes, Nutrition, Montpellier University Hospital, Montpellier, France; INSERM Clinical Investigation Center 1411, Montpellier, France; Institute of Functional Genomics, CNRS UMR 5203/INSERM U1191, University of Montpellier, Montpellier, France
| | - Ph Courtet
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France; Inserm U1061, Université de Montpellier, Montpellier, France
| | - S Guillaume
- Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, CHRU Montpellier, Montpellier, France; Inserm U1061, Université de Montpellier, Montpellier, France
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Milano W, Capasso A. Psychopharmacological Options in the Multidisciplinary and Multidimensional Treatment of Eating Disorders. Open Neurol J 2019. [DOI: 10.2174/1874205x01913010022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Eating Disorders (ED) are a syndrome characterized by persistent alteration of eating behavior and the conditions that cause insufficient ingestion and/or adsorption of foods. There are three different ED diseases: Anorexia Nervosa (AN), Bulimia Nervosa (BN) and Binge Eating Disorders (BED). ED are complex conditions that arise from a combination of long-standing behavioral, emotional, psychological, interpersonal, and social factors. A common trait to all EDs is the incongruous diet, often based on arbitrary parameters, disconnected from physiological needs, with a strong alteration of the sensations of hunger and satiety, to which variations in weight, body composition, health status and quality of life of patients occur. Although EDs are relatively frequent psychiatric disorders in the general population, especially in adolescent and juvenile age groups, evidence based on the scientific evidence of the efficacy of the pharmacological treatment of EDAs remains modest. The currently available international guidelines related to the pharmacological treatment of EDs are currently few and not always adequately informative, as they are affected by the lack of studies on the subject. As a further consequence of this it is not surprising that, with the sole exception of fluoxetine for the treatment of Bulimia Nervosa (BN) symptoms, no psychopharmaceutical has been authorized by national and international regulators for the treatment of ED.
This narrative review focuses on the advantages and limitations of drugs used in the treatment of ED.
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Medication in AN: A Multidisciplinary Overview of Meta-Analyses and Systematic Reviews. J Clin Med 2019; 8:jcm8020278. [PMID: 30823566 PMCID: PMC6406645 DOI: 10.3390/jcm8020278] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 02/19/2019] [Accepted: 02/20/2019] [Indexed: 12/12/2022] Open
Abstract
Drugs are widely prescribed for anorexia nervosa in the nutritional, somatic, and psychiatric fields. There is no systematic overview in the literature, which simultaneously covers all these types of medication. The main aims of this paper are (1) to offer clinicians an overview of the evidence-based data in the literature concerning the medication (psychotropic drugs and medication for somatic and nutritional complications) in the field of anorexia nervosa since the 1960s, (2) to draw practical conclusions for everyday practise and future research. Searches were performed on three online databases, namely MEDLINE, Epistemonikos and Web of Science. Papers published between September 2011 and January 2019 were considered. Evidence-based data were identified from meta-analyses, if there were none, from systematic reviews, and otherwise from trials (randomized or if not open-label studies). Evidence-based results are scarce. No psychotropic medication has proved efficacious in terms of weight gain, and there is only weak data suggesting it can alleviate certain psychiatric symptoms. Concerning nutritional and somatic conditions, while there is no specific, approved medication, it seems essential not to neglect the interest of innovative therapeutic strategies to treat multi-organic comorbidities. In the final section we discuss how to use these medications in the overall approach to the treatment of anorexia nervosa.
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128
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Attachment and eating disorders: a research update. Curr Opin Psychol 2019; 25:59-64. [DOI: 10.1016/j.copsyc.2018.03.003] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/07/2018] [Accepted: 03/10/2018] [Indexed: 12/26/2022]
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Koga A, Toda K, Tatsushima K, Matsuubayashi S, Tamura N, Imamura M, Kawai K. Portal hypertension in prolonged anorexia nervosa with laxative abuse: A case report of three patients. Int J Eat Disord 2019; 52:211-215. [PMID: 30636007 PMCID: PMC6590132 DOI: 10.1002/eat.23007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 11/07/2018] [Accepted: 12/08/2018] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There has been no report on portal hypertension related to anorexia nervosa (AN). METHOD We describe three cases of portal hypertension manifesting with collateral circulation represented by gastroesophageal varices in prolonged AN with laxative abuse and self-vomiting. These women, in their 20s to 50s, were diagnosed as having AN binging and purging type (AN-BP) that included self-induced vomiting and abuse of irritating laxatives (more than 100 tablets daily). RESULTS Case 1 showed prominent ascites and a gastro-renal shunt on computed tomography scanning. Case 2 showed gastroesophageal varices on endoscopic examination. Case 3 showed gastroesophageal varices on computed tomography scanning and endoscopic examination. We performed liver biopsies in all patients and found only slight pericellular fibrosis. Our patients showed typical symptoms of portal hypertension, although liver cirrhosis was not present. DISCUSSION We speculated that abnormal eating and purging behaviors were involved in the development of portal hypertension. We hypothesized that long-term laxative abuse, dehydration, and abnormal eating behavior are involved in the development of portal hypertension, considering these were common features in our patients. Portal hypertension and gastroesophageal varices should be considered as one of the potentially existing complications in prolonged AN-BP with self-induced vomiting and abuse of irritating laxatives.
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Affiliation(s)
- Aiko Koga
- Department of Psychosomatic MedicineKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
| | - Kenta Toda
- Department of Psychosomatic MedicineKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
| | - Keita Tatsushima
- Department of Psychosomatic MedicineKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
| | - Sunao Matsuubayashi
- Department of Psychosomatic MedicineFukuoka Tokusyuukai HospitalKasuga CityFukuokaJapan
| | - Naho Tamura
- Department of Psychosomatic MedicineKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
| | - Masatoshi Imamura
- Department of Gastroenterology and HepatologyKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
| | - Keisuke Kawai
- Department of Psychosomatic MedicineKohnodai Hospital, National Center for Global Health MedicineIchikawa CityChibaJapan
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Södersten P, Brodin U, Sjöberg J, Zandian M, Bergh C. Treatment outcomes for eating disorders in Sweden: data from the national quality registry. BMJ Open 2019; 9:e024179. [PMID: 30647041 PMCID: PMC6340438 DOI: 10.1136/bmjopen-2018-024179] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To report the outcomes of eating disorders treatment in Sweden in 2012-2016. DESIGN The number of patients treated and the number of patients not fulfilling an eating disorders diagnosis (remission) at 1 year of follow-up at the clinics listed in the National Quality Registry for Eating Disorders Treatment were analysed. The published outcomes at three clinics, which used survival analysis to estimate outcomes, were compared with their outcomes in the registry. Outcomes at the three biggest clinics were compared. SETTING All eating disorders clinics. PARTICIPANTS All patients treated at eating disorders clinics. INTERVENTION Cognitive-behavioural therapy at most clinics and normalisation of eating behaviour at the three clinics with published outcomes. OUTCOME MEASURE Proportion of patients in remission. RESULTS About 2600 patients were treated annually, fewer than half were followed up and remission rates decreased from 21% in 2014 to 14% in 2016. Outcomes, which differed among clinics and within clinics over time, have been publicly overestimated by excluding patients lost to follow-up. The published estimated rate of remission at three clinics that treated 1200 patients in 1993-2011 was 27%, 28% and 40% at 1 year of follow-up. The average rate of remission over the three last years at the biggest of these clinics was 36% but decreased from 29% and 30% to 16 and 14% at the two other of the biggest clinics. CONCLUSIONS With more than half the patients lost to follow-up and no data on relapse in the National Quality Registry, it is difficult to estimate the effects of eating disorders treatment in Sweden. Analysis of time to clinically significant events, including an extended period of follow-up, has improved the quality of the estimates at three clinics. Overestimation of remission rates has misled healthcare policies. The effect of eating disorders treatment has also been overestimated internationally.
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Affiliation(s)
- Per Södersten
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
| | - Ulf Brodin
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
| | | | - Modjtaba Zandian
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Mandometer Clinic, Huddinge, Sweden
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Lackner S, Mörkl S, Müller W, Fürhapter-Rieger A, Oberascher A, Lehofer M, Bieberger C, Wonisch W, Amouzadeh-Ghadikolai O, Moser M, Mangge H, Zelzer S, Holasek SJ. Novel approaches for the assessment of relative body weight and body fat in diagnosis and treatment of anorexia nervosa: A cross-sectional study. Clin Nutr 2019; 38:2913-2921. [PMID: 30670293 DOI: 10.1016/j.clnu.2018.12.031] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 10/26/2018] [Accepted: 12/21/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND & AIMS Anorexia nervosa (AN) is a severe psychosomatic disease that seriously affects nutritional status. Therapeutic approaches primarily aim for rapid weight restoration by high caloric diets and activity restriction. This often promotes abdominal body fat gain, which potentially negatively influences the patient's compliance and increases the risk of relapse. This study focused on the evaluation of body weight and subcutaneous adipose tissue (SAT) in AN patients by novel approaches. METHODS The SAT of AN patients (n = 18, body mass index (BMI) 15.3 ± 1.3 kg/m2) was determined by a highly accurate and reliable ultrasound method. The sum of SAT thicknesses of eight sites (DINCL) was calculated. Individual metabolic profiles were analyzed. The mass index (MI), which considers body proportions, was used in addition to BMI. Additional to the standard laboratory diagnostics, dermal carotenoids measured by resonance Raman spectroscopy, leptin, and oxidative stress indicators were determined. RESULTS The mean MI was 15.7 ± 1.4 kg/m2. The DINCL considerably differed between individuals with the same BMI. Half of the patients (Group 1) had low DINCL: 1.3-28.4 mm, and Group 2 showed values up to 58.2 mm (corresponding to approximately 6 kg SAT mass). The two group means differed by more than 300% (P < 0.001). Accordingly, leptin levels significantly differed (P < 0.001). Mean SAT thicknesses were significantly higher in Group 2 at all eight sites. The groups also significantly differed in two oxidative stress parameters: total antioxidative capacity, malondialdehyde-modified low density lipoprotein immunoglobulin M (MDA-LDL IgM), and in the carotenoid level. CONCLUSION Half of the patients had sufficiently high fat mass, despite very low BMI. Consequently, their muscle (and other organ) masses must have been extremely low. Diagnostic criteria and treatment protocols for AN should consider each patient's body composition. In addition to dietary treatments, muscle training at low energy turnover rates may be essential for avoiding unnecessary body fat gain, better treatment results, and long-term recovery.
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Affiliation(s)
- Sonja Lackner
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Sabrina Mörkl
- Department of Psychiatry and Psychotherapeutic Medicine, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Wolfram Müller
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria.
| | - Alfred Fürhapter-Rieger
- Department of Biophysics, Medical University of Graz, Gottfried Schatz Research Center, Neue Stiftingtalstraße, Graz, Austria
| | - Andreas Oberascher
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
| | - Michael Lehofer
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Claudia Bieberger
- State Hospital Graz South-West, Location South, Wagner Jauregg Platz, Graz, Austria
| | - Willibald Wonisch
- Department of Physiological Chemistry, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria
| | | | - Maximilian Moser
- Department of Physiology, Medical University of Graz, Otto Loewi Research Center, Neue Stiftingtalstraße, Graz, Austria; Human Research Institute, Franz-Pichler-Straße, Weiz, Austria
| | - Harald Mangge
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sieglinde Zelzer
- Clinical Institute for Medical and Chemical Laboratory Diagnosis, Medical University of Graz, Auenbruggerplatz, Graz, Austria
| | - Sandra Johanna Holasek
- Department of Immunology and Pathophysiology, Medical University of Graz, Otto Loewi Research Center, Heinrichstraße, Graz, Austria
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132
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Milos G, Wolf M, Robetin L, Sprenger M, Monteverde S, Schaer D. [Integrated Complex Treatment for Extreme Anorexia Nervosa; An Interdisciplinary Treatment Concept of the University Hospital Zurich]. PRAXIS 2019; 108:923-930. [PMID: 31662109 DOI: 10.1024/1661-8157/a003356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Integrated Complex Treatment for Extreme Anorexia Nervosa; An Interdisciplinary Treatment Concept of the University Hospital Zurich Abstract. The serious physical mental and psychosocial morbidity due to anorexia nervosa is often perceived by sufferers as less serious than from their environment. Doctors and other healthcare professionals are therefore confronted with the difficulty that urgent medical treatment is considered as unnecessary or even threatening by those affected. Although patients with anorexia nervosa usually wish to improve their condition, they are usually only able to tolerate treatment aimed at normalizing eating behavior and gaining weight in response to high external pressure. In view of this situation, an interdisciplinary team with experience in these treatments is required to treat these patients. Close cooperation is necessary to ensure a supporting treatment framework.
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Affiliation(s)
- Gabriella Milos
- Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik, Zentrum für Essstörungen, Zürich
| | - Maria Wolf
- Universitätsspital Zürich, Klinik für Konsiliarpsychiatrie und Psychosomatik, Zentrum für Essstörungen, Zürich
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
| | - Lara Robetin
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
| | - Melanie Sprenger
- Universitätsspital Zürich, Klinik für Endokrinologie, Diabetologie und Klinische Ernährung, Ernährungsberatung, Zürich
| | | | - Dominik Schaer
- Universitätsspital Zürich, Klinik und Poliklinik für Innere Medizin, Zürich
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133
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Gramaglia C, Gambaro E, Zeppegno P. Alexithymia and Treatment Outcome in Anorexia Nervosa: A Scoping Review of the Literature. Front Psychiatry 2019; 10:991. [PMID: 32116818 PMCID: PMC7033613 DOI: 10.3389/fpsyt.2019.00991] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Accepted: 12/13/2019] [Indexed: 01/09/2023] Open
Abstract
Alexithymia is of great interest as an outcome predictor of recovery from anorexia nervosa, since it may interfere with both treatment compliance and patients' ability to benefit from the adopted interventions. For this reason, in the last years new treatment approaches targeting emotion identification, expression, and regulation have been applied and tested. Using the PRISMA methodology, we performed a scoping review of the literature about treatment outcome in anorexia nervosa, in terms of changes in alexithymia as assessed by its most commonly used self-report measure, the Toronto Alexithymia Scale (TAS). The Medline and Scopus databases were searched, and articles were included if matching the following criteria: dealing with patients affected by anorexia nervosa, without limits of age; involving the application of any kind of targeted therapy or treatment; assessing alexithymia and the effect of a treatment intervention on alexithymia, using the TAS. Ten studies were eventually included; overall, according to the selected studies, alexithymia levels often remain high even after specific treatment. Further research aimed at a deeper understanding of the actual impact of alexithymia on the outcome of anorexia, as well as exploring alternative treatment strategies for alexithymia in eating disorders (EDs), are warranted.
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Affiliation(s)
- Carla Gramaglia
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Eleonora Gambaro
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
| | - Patrizia Zeppegno
- Institute of Psychiatry, Università degli Studi del Piemonte Orientale, Novara, Italy.,S.C. Psichiatria, Azienda Ospedaliero Universitaria Maggiore della Carità, Novara, Italy
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134
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Rubo M, Forrer F, Munsch S. [E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder]. PRAXIS 2019; 108:911-915. [PMID: 31662114 DOI: 10.1024/1661-8157/a003350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
E-Therapies for Anorexia Nervosa, Bulimia Nervosa and Binge Eating Disorder Abstract. Eating disorders can often be treated with psychotherapy, but mostly due to a lack of trained clinicians, the majority of the persons concerned do not receive any treatment. In recent years, internet-based psychotherapy (e-therapy) was proposed and tested in several pilot projects as a novel possibility to offer a larger number of places on a treatment program with a constant number of available clinicians. Recent results are promising, but before an implementation into standard care can take place, more detailed knowledge must be provided as to which patients may be recommended this type of therapy as an equivalent alternative to traditional face-to-face therapy.
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Affiliation(s)
- Marius Rubo
- Klinische Psychologie und Psychotherapie, Universität Fribourg
| | | | - Simone Munsch
- Klinische Psychologie und Psychotherapie, Universität Fribourg
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135
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Jahanbin E. Yoga Therapy and Eating Disorders. CASPIAN JOURNAL OF HEALTH RESEARCH 2019. [DOI: 10.29252/cjhr.4.1.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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136
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Naessén S, Söderqvist G, Carlström K. So similar and so different: Circulating androgens and androgen origin in bulimic women. J Steroid Biochem Mol Biol 2019; 185:184-188. [PMID: 30172682 DOI: 10.1016/j.jsbmb.2018.08.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 07/27/2018] [Accepted: 08/29/2018] [Indexed: 11/16/2022]
Abstract
Hyper androgen state frequently can be diagnosed in bulimic women. Eating disorder not otherwise specified (EDNOS) recognized as a less severe form of bulimia nervosa (BN). The objective of the study was to determine whether androgen levels and androgen origin differs in bulimic women compared to control subjects. Forty-six women with bulimia nervosa (BN), 31 with eating disorder not otherwise specified, purging type (EDNOS P) and 56 matched healthy controls were studied with respect to serum testosterone (T), 5alpha-dihydrotestosterone (DHT), sex hormone-binding globulin (SHBG), deyhydroepiahndrosterone sulfate (DHEAS) and luteinizing hormone (LH) and to ovarian morphology. Despite all groups had almost identical androgen and SHBG levels; there were differences in the origin of circulating T and DHT. Correlation analysis suggest major differences in the formation of circulating testosterone (T) and 5α-dihydrotestosterone (DHT) with BN being more like the control subjects with peripheral formation from 4-androsterne-3,17-dione (A-4), dehydroepiandrosterone sulfate (DHEAS) and also from T. While in EDNOS group a possible direct ovarian T secretion and a DHEAS modulating action of androgens on pituitary gonadotropin secretion is present. The origin of circulating T and DHT differs between bulimics. Our findings do probably not reflect direct actions of circulating DHT on pituitary LH secretion in the women with EDNOS, but rather the effect of A-4, T via conversion to DHT in the central nervous system, indicating psych/endocrine differences between the two groups of bulimic women.
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Affiliation(s)
- Sabine Naessén
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
| | - Gunnar Söderqvist
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
| | - Kjell Carlström
- Department of Women's and Children's Health, Division of Obstetrics and Gynaecology, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden
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137
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Kostenloses Programmpaket zur Primärprävention bei Essstörungen. PSYCHOTHERAPEUT 2018. [DOI: 10.1007/s00278-018-0322-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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138
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Programs on a Diet?: An Examination of Athletic Departments’ Eating Disorder Policies at NCAA Division I Universities. JOURNAL OF CLINICAL SPORT PSYCHOLOGY 2018. [DOI: 10.1123/jcsp.2018-0060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Disordered eating (DE) plays a significant role in the overall health and athletic performance of collegiate athletes. The present study sought to determine how many NCAA Division I Football Bowl Subdivision Institutions have a policy that specifically addresses the prevention and management of DE for their participating athletes and to examine the content of the existing policies. The study searched for policies in the 128 FBS institutions through an online web-search and by contacting athletic department personnel. A total of 33 currently existing policies on athletes with eating disorders (EDs) were found, 13 of which were found online. A documentary analysis was then conducted to determine the type of information that policies include. Sixteen major themes were found throughout the analysis, including themes that related to prevention, risk factors, identification, treatment, referral, and return-to-play guidelines.
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139
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Imperatori C, Mancini M, Della Marca G, Valenti EM, Farina B. Feedback-Based Treatments for Eating Disorders and Related Symptoms: A Systematic Review of the Literature. Nutrients 2018; 10:E1806. [PMID: 30463330 PMCID: PMC6265864 DOI: 10.3390/nu10111806] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/15/2018] [Accepted: 11/16/2018] [Indexed: 01/27/2023] Open
Abstract
The effectiveness of biofeedback and neurofeedback has been investigated in a range of psychiatric disorders. However, to date, there are few studies on the clinical usefulness of feedback-based techniques for eating disorders (EDs) and EDs-related symptoms (e.g., food craving). A systematic search of PubMed, Scopus and PsychINFO identified 162 articles. Among these, thirteen studies exploring the therapeutic use of biofeedback and neurofeedback in EDs or EDs-related symptoms were included. Biofeedback and neurofeedback were implemented respectively in five and eight of all reviewed articles. No studies incorporated different feedback modalities or both biofeedback and neurofeedback. The considered studies provide preliminary data of the usefulness of feedback-based techniques in the treatment of several dysfunctional eating behaviors (e.g., food craving, rumination). Although no significant effect has been reported for other important EDs-related symptoms (i.e., body image disturbance), feedback-based techniques are also associated with significant modifications of both sympathetic reaction to food-related stimuli and brain activity in several regions of the reward system (e.g., insula). Taken together the results of the present review suggest that feedback-based treatments may be useful in the treatment of several dysfunctional eating behaviors operating both on top-down and bottom-up individual coping strategies. Methodological and clinical issues are also discussed.
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Affiliation(s)
- Claudio Imperatori
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
| | - Miranda Mancini
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
| | - Giacomo Della Marca
- Sleep Disorders Unit, Institute of Neurology, Catholic University, 00153 Rome, Italy.
| | - Enrico Maria Valenti
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
- Department of Dynamic and Clinical Psychology, Sapienza University of Rome, 00185 Rome, Italy.
| | - Benedetto Farina
- Department of Human Sciences, European University of Rome, Via degli Aldobrandeschi 190, 00163 Roma, Italy.
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140
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Störchle P, Müller W, Sengeis M, Lackner S, Holasek S, Fürhapter-Rieger A. Measurement of mean subcutaneous fat thickness: eight standardised ultrasound sites compared to 216 randomly selected sites. Sci Rep 2018; 8:16268. [PMID: 30389952 PMCID: PMC6214952 DOI: 10.1038/s41598-018-34213-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 10/04/2018] [Indexed: 12/11/2022] Open
Abstract
Ultrasound (US) provides the most accurate technique for thickness measurements of subcutaneous adipose tissue (SAT) layers. This US method was recently standardised using eight sites to capture SAT patterning and allows distinguishing between fat and embedded fibrous structures. These eight sites chosen for fat patterning studies do not represent the mean SAT thickness measured all over the body that is necessary for determining subcutaneous fat mass. This was obtained by SAT measurements at 216 sites distributed randomly all over the body. Ten participants with BMI below 28.5kgm-2 and SAT means (from eight sites) ranging from 3 mm to 10 mm were selected. The means from eight sites overestimated the means obtained from 216 sites (i.e. 2160 US measurements in the ten participants); the calibration factor of 0.65 corrects this; standard deviation (SD) was 0.05, i.e. 8%. The SD of the calibration factor transforms linearly when estimating the error range of the whole body's SAT volume (body surface area times the calibrated mean SAT thickness). The SAT masses ranged from 3.2 to 12.4 kg in this group. The standard deviations resulting from solely the calibration factor uncertainty were ±0.3 and ±1.0 kg, respectively. For these examples, the SAT percentages were 4.9(±0.4)% and 13.3(±1.0)%.
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Affiliation(s)
- Paul Störchle
- Medical University of Graz, Institute of Biophysics, Graz, Austria
| | - Wolfram Müller
- Medical University of Graz, Institute of Biophysics, Graz, Austria.
| | - Marietta Sengeis
- Medical University of Graz, Institute of Biophysics, Graz, Austria
| | - Sonja Lackner
- Medical University of Graz, Institute of Pathophysiology and Immunology, Graz, Austria
| | - Sandra Holasek
- Medical University of Graz, Institute of Pathophysiology and Immunology, Graz, Austria
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141
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Kouidrat Y, Amad A, Stubbs B, Louhou R, Renard N, Diouf M, Lalau JD, Loas G. Disordered eating behaviors as a potential obesogenic factor in schizophrenia. Psychiatry Res 2018; 269:450-454. [PMID: 30195737 DOI: 10.1016/j.psychres.2018.08.083] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 08/17/2018] [Accepted: 08/24/2018] [Indexed: 10/28/2022]
Abstract
Whilst people with schizophrenia have high levels of obesity and metabolic disease, our understanding of their eating behaviors is still limited. Our aim was to evaluate the relationships between eating behavior and clinical data in schizophrenia. A cross-sectional study including 66 schizophrenia outpatients compared to 81 healthy controls was undertaken. Eating behavior was assessed using the shortened 21-item version of the Three-Factor Eating Questionnaire (TFEQ-R21). The patients had a mean of 44 ± 11 years; a mean BMI of 30.3 ± 8 kg/m2 (vs. 24 ± 3.3 kg/m2 for controls) and a mean duration of illness of 7.2 ± 6 years. All mean TFEQ scores were significantly higher in patients (indicating poorer eating behaviors) compared to controls after adjustment for age and sex, BMI and smoking status. Among patients, mean TFEQ scores were not significantly different between men and women samples. The "cognitive restraint" factor was significantly higher in schizophrenia patients with a BMI < 25 than in the group of overweight patients with a BMI > 25. Our findings suggest that disordered eating behaviors affect schizophrenia patients regardless of gender or duration of disease compared to controls. More research is needed to help clarify the relationships between eating behaviors and weight-related outcomes in schizophrenia.
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Affiliation(s)
- Youssef Kouidrat
- Department of Nutrition, Maritime Hospital of Berck, AP-HP, 62600 Berck, France; Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom; Department of Endocrinology, University of Picardie-Jules Verne, Amiens, France.
| | - Ali Amad
- Psychiatry Department, Univ Lille Nord de France, CHRU de Lille, F-59000 Lille, France
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, United Kingdom; Physiotherapy Department, South London and Maudsley NHS Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, United Kingdom
| | - Rufin Louhou
- Department of Nutrition, Maritime Hospital of Berck, AP-HP, 62600 Berck, France
| | - Nathalie Renard
- Department of Endocrinology, University of Picardie-Jules Verne, Amiens, France
| | - Momar Diouf
- Department of Endocrinology, University of Picardie-Jules Verne, Amiens, France
| | - Jean-Daniel Lalau
- Department of Endocrinology, University of Picardie-Jules Verne, Amiens, France
| | - Gwenole Loas
- Department of Psychiatry, Erasme Hospital, ULB, 1070 Brussels, Belgium
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142
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Coelho LA, Schacher JP, Scammel C, Doan JB, Gonzalez CLR. Long- but not short-term tool-use changes hand representation. Exp Brain Res 2018; 237:137-146. [PMID: 30353213 DOI: 10.1007/s00221-018-5408-y] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 10/17/2018] [Indexed: 01/13/2023]
Abstract
Tool-use has been found to change body representation. For example, participants who briefly used a mechanical grabber to pick up objects perceived their forearms to be longer immediately after its use (e.g., Cardinali et al., Curr Biol 19(12):R478-R479, 2009; they incorporated the tool into their perceived arm size). While some studies have investigated the long-term effects of tool-use on body representation, none of these studies have used a tool that encapsulates the entire body part (e.g., a glove). Moreover, the relationship between tool-use and the body model (the representation of the body's spatial characteristics) has yet to be explored. To test this, we recruited 19 elite baseball players (EBP) and 18 age-matched controls to participate in a hand representation task. We included EBP because of their many years (8+) of training with a tool (baseball glove). The task required participants to place their hands underneath a covered glass tabletop (no vision of their hands), and to point to where they believed 10 locations (the tips and bases of each finger) were on their hands (Coelho et al., Psychol Res 81(6):1224-1231, 2017). Each point's XY coordinates was tracked using an Optotrak camera. From these coordinates, we mapped out the participants perceived hand size. The results showed that when compared to the controls, EBP underestimated hand width and finger length of both hands. This indicates that long-term tool use produces changes in the body model for both, the trained and untrained hands. We conducted a follow-up study to examine if 15 min of glove use would change perceived hand size in control participants. Novice baseball players (participants without baseball experience: NBP) were recruited and hand maps were derived before and after 15 min of active catching with a glove. Results showed no significant differences between the pre and post hand maps. When we compared between the two experiments, the EBP showed smaller hand representation for both hand width and finger length, than the NBP. We discuss these results in relation to theories of altered body ownership.
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Affiliation(s)
- Lara A Coelho
- The Brain in Action Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.
| | - Jason P Schacher
- The Brain in Action Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.,The Engineering and Human Performance Lab, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Cory Scammel
- The Brain in Action Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada.,The Engineering and Human Performance Lab, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Jon B Doan
- The Engineering and Human Performance Lab, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
| | - Claudia L R Gonzalez
- The Brain in Action Laboratory, Department of Kinesiology and Physical Education, University of Lethbridge, Lethbridge, AB, T1K 3M4, Canada
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143
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Strand M, von Hausswolff-Juhlin Y, Fredlund P, Lager A. Symptoms of disordered eating among adult international adoptees: A population-based cohort study. EUROPEAN EATING DISORDERS REVIEW 2018; 27:236-246. [PMID: 30334309 DOI: 10.1002/erv.2653] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Revised: 09/13/2018] [Accepted: 10/01/2018] [Indexed: 12/21/2022]
Abstract
OBJECTIVE There is a paucity of data on disordered eating among adoptees. The aim of the present study was to explore the prevalence of symptoms of disordered eating and body image concerns among international adoptees in a large representative community survey on health-related behaviours. METHOD Combining survey data from the Stockholm Public Health Cohort and Swedish population data, adult international adoptees were compared with total participant data to assess differences in disordered eating and body dissatisfaction. RESULTS International adoptee women displayed significantly higher levels of self-induced vomiting, loss-of-control eating, food preoccupation, underweight, and wish for thinness compared with nonadoptee women, albeit with small or very small effect sizes. No significant differences were found in terms of mean body mass index, cognitive restraint, or emotional eating. CONCLUSION International adoptee women were disproportionally affected on several measures of disordered eating, although the magnitude of these differences were generally small in absolute terms.
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Affiliation(s)
- Mattias Strand
- Research and Development Unit, Stockholm Centre for Eating Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Research and Development Unit, Stockholm Centre for Eating Disorders, Stockholm, Sweden.,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, and Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Peeter Fredlund
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
| | - Anton Lager
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.,Centre for Epidemiology and Community Medicine, Stockholm County Council, Stockholm, Sweden
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144
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Lewis YD, Gilon Mann T, Enoch‐Levy A, Dubnov‐Raz G, Gothelf D, Weizman A, Stein D. Obsessive–compulsive symptomatology in female adolescent inpatients with restrictive compared with binge–purge eating disorders. EUROPEAN EATING DISORDERS REVIEW 2018; 27:224-235. [DOI: 10.1002/erv.2638] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/05/2018] [Accepted: 08/08/2018] [Indexed: 11/05/2022]
Affiliation(s)
- Yael Doreen Lewis
- Hanotrim Eating Disorders UnitShalvata Mental Health Center Hod Hasharon Israel
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
| | - Tal Gilon Mann
- Pediatric Psychosomatic DepartmentSafra Children's Hospital, Sheba Medical Center Tel Hashomer Israel
| | - Adi Enoch‐Levy
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Pediatric Psychosomatic DepartmentSafra Children's Hospital, Sheba Medical Center Tel Hashomer Israel
| | - Gal Dubnov‐Raz
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Pediatric Psychosomatic DepartmentSafra Children's Hospital, Sheba Medical Center Tel Hashomer Israel
| | - Doron Gothelf
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- The Child Psychiatry DivisionSafra Children's Hospital, Sheba Medical Center Tel Hashomer Israel
- Sagol School of NeuroscienceTel Aviv University Tel Aviv Israel
| | - Abraham Weizman
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Felsenstein Medical Research Center and Geha Mental Health Center Petah Tikva Israel
| | - Daniel Stein
- Sackler Faculty of MedicineTel Aviv University Tel Aviv Israel
- Pediatric Psychosomatic DepartmentSafra Children's Hospital, Sheba Medical Center Tel Hashomer Israel
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145
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Miniati M, Callari A, Maglio A, Calugi S. Interpersonal psychotherapy for eating disorders: current perspectives. Psychol Res Behav Manag 2018; 11:353-369. [PMID: 30233263 PMCID: PMC6130260 DOI: 10.2147/prbm.s120584] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Interpersonal psychotherapy (IPT) is a time-limited and affect-, life-event-, and present-focused psychotherapy originally conceptualized for unipolar depression, and then adapted to the treatment of other disorders, including eating disorders (EDs). The purpose of this paper is to conduct a systematic review of studies on IPT for EDs. Methods The authors performed literature searches, study selection, method, and quality evaluation independently. Data were summarized using a narrative approach. Results Of the 534 papers retrieved, 37 studies met the inclusion criteria, and 15 were considered for the systematic review (randomized controlled trials and long-term follow-up studies derived from the randomized controlled trials). Their analysis revealed six main findings: 1) no significant differences between IPT and cognitive-behavioral therapy (CBT) were found when administered as monotherapy to patients with anorexia nervosa; 2) when administered as monotherapy to patients with bulimia nervosa (BN), IPT had lower outcomes than CBT and its enhanced version; 3) patients with BN who remitted with IPT showed a prolonged time spent in clinical remission, when followed up on the long term; 4) IPT and CBT, with different timings and methods, have both shown efficacy in the mid-term/long-term period in patients with BN; 5) CBT and its enhanced version produced rapid changes in the acute phase. IPT led to improvements occurring later, with slower changes that tended to maintain efficacy in the long term; 6) abstinence from binge eating with group IPT for binge eating disorder is stable and maintained (or further improved) in the long term. Conclusion IPT is a reasonable, cost-effective alternative to CBT for the overall ED spectrum.
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Affiliation(s)
- Mario Miniati
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Antonio Callari
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Alessandra Maglio
- Department of Clinical and Experimental Medicine, Section of Psychiatry, University of Pisa, Pisa, Italy,
| | - Simona Calugi
- Department of Eating and Weight Disorders, Villa Garda Hospital, Verona, Italy
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146
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Nyman-Carlsson E, Birgegård A, Engström I, Gustafsson SA, Nevonen L. Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 27:76-85. [PMID: 30094893 DOI: 10.1002/erv.2630] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 04/17/2018] [Accepted: 07/04/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome. METHODS Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology. RESULTS In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms. CONCLUSIONS Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.
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Affiliation(s)
| | - Andreas Birgegård
- Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden
| | - Ingemar Engström
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Sanna Aila Gustafsson
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Department of Clinical Neuroscience, Resource Centre for Eating Disorders, Karolinska Institute, Stockholm, Sweden.,University Health Care Research Centre and Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Lauri Nevonen
- Faculty of Medicine and Health, Örebro University, Örebro, Sweden.,Praktikertjänst Psychiatry AB, Stockholm, Sweden
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147
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Probst M, Kürsa K, Van Damme T, Diedens J, Vanderlinden J. Changes in eating disorder characteristics over the years. EUROPEAN EATING DISORDERS REVIEW 2018; 26:417-421. [PMID: 29774627 DOI: 10.1002/erv.2603] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 01/11/2018] [Accepted: 04/12/2018] [Indexed: 11/07/2022]
Abstract
Since 1980, the diagnostic criteria of patients with eating disorders (ED) have changed over the years. Are these changes also expressed in the clinical features of the ED patients? A cross-sectional sample was drawn consisting of 100 consecutive female patients' files diagnosed with anorexia nervosa (AN) and bulimia nervosa (BN) and bulimia nervosa and admitted at an inpatient unit from the first of January 1990, 2000, and 2010, respectively. Several reliable and well-validated questionnaires (Eating Disorder Inventory, Body Attitude Test, Symptom Checklist, and the Beck Depression Inventory) were administered and scores were compared. The ratio AN/BN remained the same (65/35). No differences were found between the three cohorts except for depression, which increased over the years. This pattern is the same for the subsamples of anorexia nervosa and bulimia nervosa. Specific characteristics of eating disorder pathology did not change across time.
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Affiliation(s)
- Michel Probst
- Department of Rehabilitation Sciences, KU Leuven, Belgium.,Eating Disorder Unit, UPC-KU Leuven, Belgium
| | - Kärt Kürsa
- Department of Rehabilitation Sciences, KU Leuven, Belgium
| | - Tine Van Damme
- Department of Rehabilitation Sciences, KU Leuven, Belgium
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148
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Elzakkers IFFM, Danner UN, Grisso T, Hoek HW, van Elburg AA. Assessment of mental capacity to consent to treatment in anorexia nervosa: A comparison of clinical judgment and MacCAT-T and consequences for clinical practice. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:27-35. [PMID: 29853010 DOI: 10.1016/j.ijlp.2018.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 01/22/2018] [Accepted: 02/13/2018] [Indexed: 06/08/2023]
Abstract
Informed consent requires adequate mental capacity to consent to treatment. Mental capacity (MC) to consent to treatment refers to the ability to make medical decisions. MC is assessed in a general psychiatric interview, but this clinical assessment is known to overestimate mental capacity in patients and the inter rater reliability is low. The MacArthur Competence Assessment Tool for Treatment (MacCAT-T) has emerged as the gold standard to assess mental capacity to consent to treatment. The MacCAT-T is a semi-structured interview designed to aid clinicians in this assessment and has shown good inter rater reliability in patients with schizophrenia and other mental disorders, but has hardly been studied in patients with anorexia nervosa. Patients with anorexia nervosa (AN) regularly avoid treatment, even when severely ill and discussion includes assessing MC to consent to treatment. The aim of this study is to compare clinical judgment and the MacCAT-T in evaluating MC in patients with AN which in turn may influence use of the MacCAT-T in daily practice. In a sample of 70 consecutively referred severely ill patients with AN with a mean BMI of 15.5 kg/m2 and a mean duration of illness of 8.6 years, clinical assessment of MC by experienced psychiatrists and the outcome of the MacCAT-T interview were compared. Agreement (κ-value) was calculated. Agreement between clinical assessment and outcome of the MacCAT-T was questionable (κ 0.23). Unlike in other psychiatric populations, clinicians judged a high proportion of patients with AN as having diminished MC. The MacCAT-T can be useful in assessing MC in AN when used in addition to clinical judgment to aid clinicians in complex cases. Why clinicians judge a relatively high proportion of patients with AN as having diminished MC, in contrast to lower proportions in other psychiatric disorders, is an area in need of further research.
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Affiliation(s)
- Isis F F M Elzakkers
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands
| | - Thomas Grisso
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, The Netherlands; Department of Epidemiology, Mailman School of Public Health, Columbia University New York, USA
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, The Netherlands; Utrecht University, Department of Psychology, The Netherlands.
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149
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Blanchet C, Mathieu MÈ, St-Laurent A, Fecteau S, St-Amour N, Drapeau V. A Systematic Review of Physical Activity Interventions in Individuals with Binge Eating Disorders. Curr Obes Rep 2018; 7:76-88. [PMID: 29460067 DOI: 10.1007/s13679-018-0295-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Our systematic review aims to assess the overall evidence available in the literature regarding the role of physical activity (PA) in individuals with binge eating disorder (BED) and better understand the potential underlying mechanisms of action. RECENT FINDINGS Currently, the most effective and well-established psychological treatment for BED is cognitive behavioral therapy (CBT) with a remission rate around 80%. CBT is sometimes combined with pharmacotherapy targeting comorbidities associated with BED, such as obesity and depression. Another avenue of treatment that has been less studied is PA. It has been suggested that PA addresses the underlying mechanisms of BED and, thus, increases treatment efficiency. This systematic review provides additional knowledge concerning the benefits of PA in the treatment of individuals with BED including reduction of binge eating (BE) episodes and improvement in other associated comorbidities. Potential mechanisms of action of PA include neurochemical alterations affecting the reward system, reduction of negative affect, and its anorexigenic effects.
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Affiliation(s)
- Claudine Blanchet
- Département des Sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Marie-Ève Mathieu
- Département de kinésiologie, Université de Montréal, Montréal, QC, Canada
| | - Audrey St-Laurent
- Département des Sciences de l'activité physique, Université du Québec à Trois-Rivières, Trois-Rivières, Canada
| | - Shirley Fecteau
- Centre intégré universitaire en santé et services sociaux de la Capitale-Nationale, Faculté de Médecine, Université Laval, Québec City, QC, Canada
| | - Nathalie St-Amour
- Département des Sciences infirmières, Université du Québec à Rimouski, Lévis, QC, Canada
- Programme de traitement des troubles du comportement alimentaire, Clinique St-Amour, Lévis, QC, Canada
| | - Vicky Drapeau
- Département d'éducation physique, PEPS, Université Laval, 2300, rue de la Terrasse, suite 2214, Québec City, QC, G1V 0A6, Canada.
- Centre de recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Québec City, QC, Canada.
- Institut sur la nutrition et les aliments fonctionnels (INAF), Université Laval, Québec City, QC, Canada.
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150
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Curzio O, Maestro S, Rossi G, Calderoni S, Giombini L, Scardigli S, Ragione LD, Muratori F. Transdiagnostic vs. disorder-focused perspective in children and adolescents with eating disorders: Findings from a large multisite exploratory study. Eur Psychiatry 2018; 49:81-93. [PMID: 29413810 DOI: 10.1016/j.eurpsy.2017.12.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 11/21/2017] [Accepted: 12/22/2017] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The transdiagnostic model of eating disorders (ED) proposes common cognitive mechanisms in patients with ED psychopathology. Little is known about their role in the maintenance of ED in children and adolescents. This study aimed to determine whether the relationships between key factors (low self-esteem, weight and shape control, clinical perfectionism, interpersonal problems, distress and mood instability) and core maintaining mechanisms (binge-eating and restraint) would support a transdiagnostic theory in young patients. METHODS A total of 419 patients (mean age 14.7 ± 2.14 years; age range: 7-18 years; males 13.8%) diagnosed with an ED were assessed in six Italian clinical centers in 2013. Multiple comparisons between ED diagnosis, correlation analysis and principal component analysis (PCA) were performed. RESULTS Of the entire collective, 51.5% of patients were diagnosed with Anorexia Nervosa (AN), 12.3% were diagnosed with Bulimia Nervosa (BN) and 36.2% with Eating Disorder Not Otherwise Specified (EDNOS). In PCA, the core ED mechanisms, dietary restraint and binge eating, acted as poles of attraction of the other variables. The AN group was particularly linked to restraint and the BN group was particularly related to "Bulimia". Considering the diagnostic subtypes, there were no significant differences between the anorexic binge-purging group, bulimic purging group and bulimic non-purging group, which constituted a unique cluster related to affective, interpersonal problems and to perfectionism, indicating a very homogeneous subgroup. Restricting anorexic group (AN-R), related to shape concern and anxious-depressed mood, was not linked to the other subtypes. EDNOS appeared to be opposed to the AN-R group; the binge eating disorder group appeared to be independent from others. CONCLUSION Our results suggest the presence of both specific and transdiagnostic mechanisms in ED subtypes, whose knowledge is of relevance for clinical practice.
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Affiliation(s)
- O Curzio
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy
| | - S Maestro
- IRCCS Stella Maris Foundation, Pisa, Italy.
| | - G Rossi
- Unit of Epidemiology and Biostatistics, Institute of Clinical Physiology, National Research Council, Pisa, Italy; G Monasterio Foundation, CNR-Tuscany Region, Pisa, Italy
| | - S Calderoni
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
| | - L Giombini
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | | | - L Dalla Ragione
- Eating Disorders Services - ASL n. 1 'Palazzo Francisci', Todi, Italy
| | - F Muratori
- IRCCS Stella Maris Foundation, Pisa, Italy; Department of Clinical and Experimental Medicine, University of Pisa, Italy
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