201
|
|
202
|
Hagan KE, Clark KE, Forbush KT. Incremental validity of weight suppression in predicting clinical impairment in bulimic syndromes. Int J Eat Disord 2017; 50:672-678. [PMID: 28093836 DOI: 10.1002/eat.22673] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 12/24/2016] [Accepted: 12/26/2016] [Indexed: 12/30/2022]
Abstract
Research has shown that weight suppression (WS; the difference between a person's highest and current body weight in pounds) is a robust predictor of weight gain and eating-disorder (ED) symptoms among individuals with bulimic syndromes. Given the important prognostic role that WS plays in ED course and outcome, we hypothesized that WS would represent a clinically useful indicator of impairment for bulimic syndromes. We further posited that WS would demonstrate incremental validity above-and-beyond other proposed indicators in explaining clinical impairment in bulimic syndromes. Participants were community-recruited adults (N = 101; 80.2% female) with full-threshold (n = 51) or subthreshold (n = 50) bulimia nervosa. Other indicators of impairment included body mass index, frequency of inappropriate compensatory behaviors, lifetime history of any internalizing disorder, and multiple purging. Clinical impairment was assessed with the clinical impairment assessment (CIA). Hierarchical linear regression tested whether WS added to the explanation of CIA score variance above-and-beyond other indicators of bulimic-syndrome impairment. WS was significantly associated with clinical impairment (p = .011), but did not demonstrate incremental validity over other independent variables in predicting CIA scores. WS explained an additional 1.7% of the variance in CIA scores above-and-beyond other variables and the independent effect of WS on CIA scores represented a medium-sized effect (Cohen's d = 0.521). Results suggested that WS may be an indicator of ED-related clinical impairment. Inquiring about WS could be an informative component of routine bulimic-syndrome assessment, given that WS explains some of the variance in clinical impairment in bulimic syndromes.
Collapse
Affiliation(s)
- Kelsey E Hagan
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., Lawrence, KS, 66045
| | - Kelsey E Clark
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., Lawrence, KS, 66045
| | - Kelsie T Forbush
- Department of Psychology, University of Kansas, 1415 Jayhawk Blvd., Lawrence, KS, 66045
| |
Collapse
|
203
|
Molendijk ML, Hoek HW, Brewerton TD, Elzinga BM. Childhood maltreatment and eating disorder pathology: a systematic review and dose-response meta-analysis. Psychol Med 2017; 47:1402-1416. [PMID: 28100288 DOI: 10.1017/s0033291716003561] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Meta-analyses have established a high prevalence of childhood maltreatment (CM) in patients with eating disorders (EDs) relative to the general population. Whether the prevalence of CM in EDs is also high relative to that in other mental disorders has not yet been established through meta-analyses nor to what extent CM affects defining features of EDs, such as number of binge/purge episodes or age at onset. Our aim is to provide meta-analyses on the associations between exposure to CM (i.e. emotional, physical and sexual abuse) on the occurrence of all types of EDs and its defining features. METHOD Systematic review and meta-analyses. Databases were searched until 4 June 2016. RESULTS CM prevalence was high in each type of ED (total N = 13 059, prevalence rates 21-59%) relative to healthy (N = 15 092, prevalence rates 1-35%) and psychiatric (N = 7736, prevalence rates 5-46%) control groups. ED patients reporting CM were more likely to be diagnosed with a co-morbid psychiatric disorder [odds ratios (ORs) range 1.41-2.46, p < 0.05] and to be suicidal (OR 2.07, p < 0.001) relative to ED subjects who were not exposed to CM. ED subjects exposed to CM also reported an earlier age at ED onset [effect size (Hedges' g) = -0.32, p < 0.05], to suffer a more severe form of the illness (g = 0.29, p < 0.05), and to binge-purge (g = 0.31, p < 0.001) more often compared to ED patients who did not report any CM. CONCLUSION CM, regardless of type, is associated with the presence of all types of ED and with severity parameters that characterize these illnesses in a dose dependent manner.
Collapse
Affiliation(s)
- M L Molendijk
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands
- Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
- Department of Epidemiology, Columbia University, New York, USA
| | - T D Brewerton
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - B M Elzinga
- Institute of Psychology, Clinical Psychology Unit, Leiden University, Leiden, The Netherlands
- Leiden Institute for Brain and Cognition, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
204
|
Ng KW, Kuek A, Lee HY. Eating psychopathology and psychosocial impairment in patients treated at a Singapore eating disorders treatment programme. Singapore Med J 2017; 59:33-38. [PMID: 28503699 DOI: 10.11622/smedj.2017042] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION There is limited data on the psychopathology of eating disorders in Singapore. This study: (a) described levels of eating psychopathology and psychosocial impairment among individuals diagnosed with eating disorders at our hospital; and (b) compared the related psychopathology of these patients. METHODS Between 1 August 2010 and 31 July 2012, 257 individuals who met the diagnostic criteria for eating disorders completed the Eating Disorder Examination Questionnaire (EDE-Q) and Clinical Impairment Assessment questionnaire (CIA). RESULTS A majority of participants were women and of Chinese ethnicity. Diagnoses included anorexia nervosa (AN; 41.6%), bulimia nervosa (BN; 29.6%) and eating disorder not otherwise specified (EDNOS; 28.8%). Mean age at presentation was 20.52 ± 7.14 years and mean body mass index was 17.84 ± 4.18 kg/m2. Individuals with AN were significantly younger at presentation and had shorter duration of untreated illness compared to those with BN and EDNOS. There were no significant differences in the CIA scores of the diagnostic groups. Participants with BN scored higher in all subscales of the EDE-Q than those with AN and EDNOS. Our sample scored lower in most subscales of EDE-Q when compared to treatment centres in Sweden, Australia and the United States. CONCLUSION Our clinical sample reported lower scores of psychopathology compared to overseas centres. This could be attributed to the higher percentages of BN and EDNOS diagnosed in overseas populations. Individuals with AN showed higher levels of psychopathology in our study compared to patients from the United States.
Collapse
Affiliation(s)
- Kah Wee Ng
- Department of Psychiatry, Singapore General Hospital, Singapore
| | - Angeline Kuek
- Australasian College of Health Service Management, Victoria, Australia
| | - Huei Yen Lee
- Department of Psychiatry, Singapore General Hospital, Singapore
| |
Collapse
|
205
|
Kuhn H, Mennella C, Magid M, Stamu-O'Brien C, Kroumpouzos G. Psychocutaneous disease: Clinical perspectives. J Am Acad Dermatol 2017; 76:779-791. [PMID: 28411771 DOI: 10.1016/j.jaad.2016.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 10/26/2016] [Accepted: 11/03/2016] [Indexed: 01/03/2023]
Abstract
Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.
Collapse
Affiliation(s)
- Helena Kuhn
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Constance Mennella
- Division of Child/Adolescent Psychiatry, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Michelle Magid
- Department of Psychiatry at Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Psychiatry, University of Texas Medical Branch at Galveston, Galveston, Texas; Department of Psychiatry, Texas A&M Health Science Center, Round Rock, Texas
| | | | - George Kroumpouzos
- Department of Dermatology, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Dermatology, Medical School of Jundiaí, São Paulo, Brazil; GK Dermatology, PC, South Weymouth, Massachusetts.
| |
Collapse
|
206
|
Elzakkers IFFM, Danner UN, Sternheim LC, McNeish D, Hoek HW, van Elburg AA. Mental capacity to consent to treatment and the association with outcome: a longitudinal study in patients with anorexia nervosa. BJPsych Open 2017; 3:147-153. [PMID: 28584660 PMCID: PMC5445260 DOI: 10.1192/bjpo.bp.116.003905] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Revised: 02/15/2017] [Accepted: 05/03/2017] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Relevance of diminished mental capacity in anorexia nervosa (AN) to course of disorder is unknown. AIMS To examine prognostic relevance of diminished mental capacity in AN. METHOD A longitudinal study was conducted in 70 adult female patients with severe AN. At baseline, mental capacity was assessed by psychiatrists, and clinical and neuropsychological data (decision-making) were collected. After 1 and 2 years, clinical and neuropsychological assessments were repeated, and remission and admission rates were calculated. RESULTS People with AN with diminished mental capacity had a less favourable outcome with regard to remission and were admitted more frequently. Their appreciation of illness remained hampered. Decision-making did not improve, in contrast to people with full mental capacity. CONCLUSIONS People with AN with diminished mental capacity seem to do less well in treatment and display decision-making deficiencies that do not ameliorate with weight improvement. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.
Collapse
Affiliation(s)
- Isis F F M Elzakkers
- , MD, MSc, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| | - Unna N Danner
- , PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Lot C Sternheim
- , PhD, Department of Psychology, Utrecht University, Utrecht, The Netherlands
| | - Daniel McNeish
- , PhD, Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Hans W Hoek
- , MD, PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands; Department of Epidemiology, Mailman School of Public Health, Columbia University New York, USA
| | - Annemarie A van Elburg
- , MD, PhD, Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Department of Psychology, Utrecht University, Utrecht, The Netherlands
| |
Collapse
|
207
|
Assessment of Sex Differences in Body Composition Among Adolescents With Anorexia Nervosa. J Adolesc Health 2017; 60:455-459. [PMID: 28087266 PMCID: PMC6402565 DOI: 10.1016/j.jadohealth.2016.11.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 10/06/2016] [Accepted: 11/08/2016] [Indexed: 01/29/2023]
Abstract
PURPOSE To compare deficits in fat mass (FM) and lean body mass (LM) among male and female adolescents with anorexia nervosa (AN) and to identify other covariates associated with body composition. METHODS We retrospectively reviewed electronic medical records of all subjects aged 9-20 years with a Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition diagnosis of AN and dual-energy x-ray absorptiometry scans after initial evaluation at Stanford between March 1997 and February 2011. From the dual-energy x-ray absorptiometry scans, LM and FM results were converted to age-, height-, sex-, and race-specific Z-scores for age using the National Health and Nutrition Examination Survey reference data. RESULTS A total of 16 boys and 119 girls with AN met eligibility criteria. The FM Z-score in girls with AN (-3.24 ± 1.50) was significantly lower than that in boys with AN (-2.41 ± .96) in unadjusted models (p = .007). LM was reduced in both girls and boys with AN, but there was no significant sex difference in LM Z-scores. In multivariate models, lower percentage median body mass index was significantly associated with lower FM Z-scores (β = .08, p < .0001) and lower LM Z-score (β = .03, p = .0002), whereas lower whole body bone mineral content Z-score was significantly associated with lower LM Z-score (β = .21, p = .0006). CONCLUSIONS FM deficits in girls were significantly greater than those in boys with AN in unadjusted models; however, the degree of malnutrition appeared to be the primary factor accounting for this difference. There were no significant sex differences in FM or LM in adjusted models.
Collapse
|
208
|
Nagata JM, Golden NH, Peebles R, Long J, Leonard MB, Chang AO, Carlson JL. Assessment of sex differences in bone deficits among adolescents with anorexia nervosa. Int J Eat Disord 2017; 50:352-358. [PMID: 27611361 PMCID: PMC6613779 DOI: 10.1002/eat.22626] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Revised: 08/19/2016] [Accepted: 08/21/2016] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The objective of this study was to compare sex differences in bone deficits among adolescents with anorexia nervosa (AN) and to identify other correlates of bone health. METHOD Electronic medical records of all patients 9-20 years of age with a DSM-5 diagnosis of AN who were evaluated by the eating disorders program at Stanford with dual-energy X-ray absorptiometry (DXA) between March 1997 and February 2011 were retrospectively reviewed. Whole body bone mineral content Z-scores and bone mineral density (BMD) Z-scores at multiple sites were recorded using the Bone Mineral Density in Childhood Study (BMDCS) reference data. RESULTS A total of 25 males and 253 females with AN were included, with median age 15 years (interquartile range [IQR] 14-17) and median duration of illness 9 months (IQR 5-13). Using linear regression analyses, no significant sex differences in bone deficits were found at the lumbar spine, total hip, femoral neck, or whole body when controlling for age, %mBMI, and duration of illness. Lower %mBMI was significantly associated with bone deficits at all sites in adjusted models. DISCUSSION This is the first study to evaluate sex differences in bone health among adolescents with AN, using novel DSM-5 criteria for AN and robust BMDCS reference data. We find no significant sex differences in bone deficits among adolescents with AN except for a higher proportion of females with femoral neck BMD Z-scores <-1. Degree of malnutrition was correlated with bone deficits at all sites. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:352-358).
Collapse
Affiliation(s)
- Jason M. Nagata
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Neville H. Golden
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Rebecka Peebles
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jin Long
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Mary B. Leonard
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Audrey O. Chang
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| | - Jennifer L. Carlson
- Department of Pediatrics, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
209
|
Palavras MA, Hay P, Filho CADS, Claudino A. The Efficacy of Psychological Therapies in Reducing Weight and Binge Eating in People with Bulimia Nervosa and Binge Eating Disorder Who Are Overweight or Obese-A Critical Synthesis and Meta-Analyses. Nutrients 2017; 9:nu9030299. [PMID: 28304341 PMCID: PMC5372962 DOI: 10.3390/nu9030299] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 03/10/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
Recurrent binge eating episodes, the core feature of Bulimia Nervosa (BN) and Binge Eating Disorder (BED), are frequently comorbid with obesity. Psychological interventions, notably Cognitive Behavioural Therapy (CBT), are effective for binge eating reduction in BED or BN but less so for weight loss. Behavioural Weight Loss Therapy (BWLT) shows effectiveness for binge eating reduction and weight loss but the latter appears poorly sustained over time. Our aim was to review evidence for efficacy of psychological therapies for BN/BED associated with overweight or obesity in reducing binge frequency and weight. A systematic search for randomized controlled trials with adult samples who had BN or BED was conducted considering articles in English, French, Spanish and Portuguese with no restrictions for the timeline publication ending in March 2016. A quality appraisal of the trials and meta-analyses comparing BWLT to CBT were done. This review identified 2248 articles for screening and 19 published articles were selected. No trials of BN were identified. This review found CBT was favoured compared to BWLT with regard to short-term binge eating reduction. However, insufficient evidence was found for superiority for BWLT efficacy compared to CBT considering binge eating remission, reduction of binge eating frequency and weight loss. More research is needed to test the efficacy of psychological treatments for BED or BN with co-morbid overweight or obesity, including trials evaluating binge eating remission and weight loss in the long-term.
Collapse
Affiliation(s)
- Marly Amorim Palavras
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
- School of Medicine, Western Sydney University, Sydney 2751, Australia.
| | - Phillipa Hay
- CAPES Foundation, Ministry of Education of Brazil, Brasilia 70047-900, Brazil.
- Centre for Health Research, School of Medicine, Western Sydney University, Sydney 2751, Australia.
| | - Celso Alves Dos Santos Filho
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
| | - Angélica Claudino
- Eating Disorders Program (PROATA), Department of Psychiatry, Federal University of São Paulo (UNIFESP), São Paulo 04038-000, Brazil.
| |
Collapse
|
210
|
Södersten P, Bergh C, Leon M, Brodin U, Zandian M. Cognitive behavior therapy for eating disorders versus normalization of eating behavior. Physiol Behav 2017; 174:178-190. [PMID: 28322911 DOI: 10.1016/j.physbeh.2017.03.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2016] [Revised: 01/18/2017] [Accepted: 03/08/2017] [Indexed: 12/22/2022]
Abstract
We examine the science and evidence supporting cognitive behavior therapy (CBT) for the treatment of bulimia nervosa and other eating disorders. Recent trials focusing on the abnormal cognitive and emotional aspects of bulimia have reported a remission rate of about 45%, and a relapse rate of about 30% within one year. However, an early CBT trial that emphasized the normalization of eating behavior had a better outcome than treatment that focused on cognitive intervention. In support of this finding, another treatment, that restores a normal eating behavior using mealtime feedback, has an estimated remission rate of about 75% and a relapse rate of about 10% over five years. Moreover, when eating behavior was normalized, cognitive and emotional abnormalities were resolved at remission without cognitive therapy. The critical aspect of the CBT treatment of bulimia nervosa therefore may actually have been the normalization of eating behavior.
Collapse
Affiliation(s)
- P Södersten
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden.
| | - C Bergh
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - M Leon
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - U Brodin
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| | - M Zandian
- Karolinska Institutet, Section of Applied Neuroendocrinology, Mandometer Clinic, Huddinge, S-14104 Huddinge, Sweden
| |
Collapse
|
211
|
Svedlund NE, Norring C, Ginsberg Y, von Hausswolff-Juhlin Y. Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among adult eating disorder patients. BMC Psychiatry 2017; 17:19. [PMID: 28095885 PMCID: PMC5240294 DOI: 10.1186/s12888-016-1093-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 10/30/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Very little is known about the prevalence of ADHD symptoms in Bulimia Nervosa and Binge Eating Disorder and even less in other eating disorders. This knowledge gap is of clinical importance since stimulant treatment is proven effective in Binge Eating Disorder and discussed as a treatment possibility for Bulimia Nervosa. The objective of this study was to explore the prevalence and types of self-reported ADHD symptoms in an unselected group of eating disorder patients assessed in a specialized eating disorder clinic. METHODS In total 1165 adults with an eating disorder were assessed with a battery of standardized instruments, for measuring inter alia ADHD screening, demographic variables, eating disorder symptoms and psychiatric comorbidity. Chi-square tests were used for categorical variables and Kruskal-Wallis tests for continuous variables. RESULTS Almost one third (31.3 %) of the patients scored above the screening cut off indicating a possible ADHD. The highest prevalence rates (35-37 %) were found in Bulimia Nervosa and Anorexia Nervosa bingeing/purging subtype, while Eating Disorder Not Otherwise Specified type 1-4 and Binge Eating Disorder patients reported slightly below average (26-31 %), and Anorexia Nervosa restricting subtype patients even lower (18 %). Presence of binge eating, purging, loss of control over eating and non-anorectic BMI were related to results indicating a possible ADHD. Psychiatric comorbidity correlated to ADHD symptoms without explaining the differences between eating disorder diagnoses. CONCLUSIONS There is a high frequency of ADHD symptoms in patients with binge eating/purging eating disorders that motivates further studies, particularly concerning the effects of ADHD medication. The finding that the frequency of ADHD symptoms in anorexia nervosa with binge eating/purging is as high as in bulimia nervosa highlights the need also for this group.
Collapse
Affiliation(s)
- Nils Erik Svedlund
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden. .,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850, Stockholm, Sweden.
| | - Claes Norring
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850 Stockholm, Sweden
| | - Ylva Ginsberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden
| | - Yvonne von Hausswolff-Juhlin
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden ,Stockholm Centre for Eating Disorders, att: Nils Erik Svedlund, Wollmar Yxkullsgatan 27 B, 11850 Stockholm, Sweden
| |
Collapse
|
212
|
Food matters: how the microbiome and gut-brain interaction might impact the development and course of anorexia nervosa. Eur Child Adolesc Psychiatry 2017; 26:1031-1041. [PMID: 28144744 PMCID: PMC5591351 DOI: 10.1007/s00787-017-0945-7] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 01/10/2017] [Indexed: 12/13/2022]
Abstract
Anorexia nervosa (AN) is one of the most common chronic illnesses in female adolescents and exhibits the highest mortality risk of all psychiatric disorders. Evidence for the effectiveness of psychotherapeutic or psychopharmacological interventions is weak. Mounting data indicate that the gut microbiome interacts with the central nervous system and the immune system by neuroendocrine, neurotransmitter, neurotrophic and neuroinflammatory afferent and efferent pathways. There is growing evidence that the gut microbiota influences weight regulation and psychopathology, such as anxiety and depression. This article reviews how the gut-brain interaction may impact the development and course of AN. A "leaky gut", characterized by antigens traversing the intestinal wall, was demonstrated in an animal model of AN, and could underlie the low-grade inflammation and increased risk of autoimmune diseases found in AN. Moreover, starvation has a substantial impact on the gut microbiome, and diets used for re-nutrition based on animal products may support the growth of bacteria capable of triggering inflammation. As there is currently no empirically derived agreement on therapeutic re-nourishment in AN, this review discusses how consideration of gut-brain interactions may be important for treatment regarding the determination of target weight, rapidity of weight gain, refeeding methods and composition of the diet which might all be of importance to improve long-term outcome of one of the most chronic psychiatric disorders of adolescence.
Collapse
|
213
|
de Jong M, Korrelboom K, van der Meer I, Deen M, Hoek HW, Spinhoven P. Effectiveness of enhanced cognitive behavioral therapy (CBT-E) for eating disorders: study protocol for a randomized controlled trial. Trials 2016; 17:573. [PMID: 27914473 PMCID: PMC5135785 DOI: 10.1186/s13063-016-1716-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 11/19/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND While eating disorder not otherwise specified (EDNOS) is the most common eating disorder (ED) diagnosis in routine clinical practice, no specific treatment methods for this diagnosis have yet been developed and studied. Enhanced cognitive behavioral therapy (CBT-E) has been described and put to the test as a transdiagnostic treatment protocol for all EDs, including EDNOS. Initial research in the UK suggests that CBT-E is more effective for EDs, especially bulimia nervosa (BN) and EDNOS, than the earlier version of CBT. These positive results of CBT-E have to be replicated in more detail, preferably by independent researchers in different countries. Being the first Dutch study into CBT-E, the results from this national multicenter study - on three sites specialized in EDs - will deliver important information about the effectiveness of CBT-E in several domains of ED pathology, while providing input for the upcoming update of the Dutch Multidisciplinary Guideline for the Treatment of Eating Disorders. METHODS/DESIGN A multicenter randomized controlled trial will be conducted. One hundred and thirty-two adult outpatients (aged 18 years and older) with an ED diagnosis and a Body Mass index (BMI) of between 17.5 and 40 will be randomly allocated to the control or the intervention group. Subjects in the control group will receive Treatment as Usual (standard outpatient treatment provided at the participating sites). Subjects in the intervention group will receive 20 sessions of CBT-E in 20 weeks. The design is a 2 (group) × 5 (time) repeated measures factorial design in which neither therapists nor patients will be blinded for treatment allocation. The primary outcome measure is recovery from the ED. Secondary outcome measures include ED psychopathology, common mental disorders, anxiety and depressive symptoms, health-related quality of life, health care use and productivity loss. Self-esteem, perfectionism and interpersonal problems will be examined as putative predictors and mediators of the effect of treatment. Also, an economic evaluation from a societal perspective will be undertaken. All relevant effects, direct and indirect costs will be included. Utility scores will measure the effects. Measurements will take place at pretreatment, 6 weeks, 20 weeks, 40 weeks and 80 weeks. DISCUSSION This effectiveness study into CBT-E has the aim of broadening the scope and generalizability of former studies. If CBT-E appears to be at least as effective as traditional diagnosis-specific treatments for a broad range of ED patients, training in one protocol would be sufficient for clinicians to treat patients with different kinds of EDs. It gives the opportunity to offer treatment for a severe mental disorder with fewer resources, thereby increasing the accessibility of specialized care for patients with an ED. TRIAL REGISTRATION Netherlands Trial Register, NTR4485 . Registered on 2 April 2014.
Collapse
Affiliation(s)
- Martie de Jong
- Center for Eating Disorders - PsyQ, part of Parnassia Psychiatric Institute, The Hague, The Netherlands.
| | - Kees Korrelboom
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands
| | - Iris van der Meer
- Center for Eating Disorders - PsyQ, part of Parnassia Psychiatric Institute, The Hague, The Netherlands
| | - Mathijs Deen
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Leiden University, Institute of Psychology, Methodology and Statistics Unit, Leiden, The Netherlands
| | - Hans W Hoek
- Parnassia Psychiatric Institute, The Hague, The Netherlands.,Department of Psychiatry, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.,Department of Epidemiology, Columbia University, Mailman School of Public Health, New York, NY, USA
| | - Philip Spinhoven
- Leiden University, Institute of Psychology, Leiden, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
214
|
Zeeck A, Hartmann A, Wild B, De Zwaan M, Herpertz S, Burgmer M, von Wietersheim J, Resmark G, Friederich HC, Tagay S, Dinkel A, Loewe B, Teufel M, Orlinsky D, Herzog W, Zipfel S. How do patients with anorexia nervosa "process" psychotherapy between sessions? A comparison of cognitive-behavioral and psychodynamic interventions. Psychother Res 2016; 28:873-886. [PMID: 27808005 DOI: 10.1080/10503307.2016.1252866] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVE Patients' processing of psychotherapy between sessions ("inter-session process" (ISP)) has been repeatedly shown to be related to outcome. The aim of this study was to compare ISP characteristics of cognitive-behavioral vs. psychodynamic psychotherapy in the treatment of anorexia nervosa (AN) and their relation to outcome. METHODS Data of 106 patients participating in a randomized-controlled trial who received either 40 sessions of enhanced cognitive-behavioral therapy (CBT-E) or focal psychodynamic therapy (FPT) were analyzed. The ISP was measured with the Inter-session Experience Questionnaire (IEQ). Three outcome classes were distinguished: full recovery, partial recovery, and still fulfilling all AN criteria. RESULTS Patients receiving CBT-E reported more on "applying therapy" in the initial and the final treatment phase compared to FPT patients. In terms of process-outcome relations, higher levels of "recreating the therapeutic dialogue between sessions," "recreating the therapeutic dialogue with negative emotions" as well as "applying therapy with negative emotions" in the final phase of treatment predicted negative outcome in FPT, whereas overall higher levels of negative emotions predicted negative outcome in CBT-E. CONCLUSIONS In outpatient treatment in AN, the processing of therapy as measured by the IEQ showed surprisingly few differences between CBT-E and FPT. However, different ISP patterns were predictive of outcome, pointing to different mechanisms of change.
Collapse
Affiliation(s)
- A Zeeck
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - A Hartmann
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| | - B Wild
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - M De Zwaan
- c Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Hannover , Hannover , Germany
| | - S Herpertz
- d Department of Psychosomatic Medicine and Psychotherapy , LWL-University Medical Center of the Ruhr-University Bochum , Bochum , Germany
| | - M Burgmer
- e Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Münster , Münster , Germany
| | - J von Wietersheim
- f Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Ulm , Ulm , Germany
| | - G Resmark
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - H-C Friederich
- h Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Düsseldorf , Düsseldorf , Germany
| | - S Tagay
- i Department of Psychosomatic Medicine and Psychotherapy , University Duisburg-Essen , Duisburg , Germany
| | - A Dinkel
- j Department of Psychosomatic Medicine and Psychotherapy , University of Technology München , München , Germany
| | - B Loewe
- k Institute and Outpatient Clinic for Psychosomatic Medicine and Psychotherapy , University Medical Center Hamburg-Eppendorf , Hamburg , Germany
| | - M Teufel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | - D Orlinsky
- l Department of Comparative Human Development , University of Chicago , Chicago , IL , USA
| | - W Herzog
- b Center for Psychosocial Medicine, Department of General Internal Medicine and Psychosomatics , Heidelberg University Hospital , Heidelberg , Germany
| | - S Zipfel
- g Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Tübingen , Tübingen , Germany
| | -
- a Department of Psychosomatic Medicine and Psychotherapy , University Medical Center Freiburg , Freiburg , Germany
| |
Collapse
|
215
|
Abstract
PURPOSE OF REVIEW This is the first review of studies on the epidemiology of eating disorders on the African continent. RECENT FINDINGS The majority of articles found through our search did not assess formal diagnoses, but only screened for eating attitudes and behaviors. Only four studies - including only one recent study - provided specific epidemiological data on anorexia nervosa, bulimia nervosa, and/or eating disorder not otherwise specified (EDNOS). No cases of anorexia nervosa according to Diagnostic and Statistical Manual of Mental Disorders (DSM)-IV criteria were found among a total of 1476 (young) females. The combined point-prevalence rate of bulimia nervosa is 0.87% (95% CI 0.22-1.51) and of EDNOS is 4.45% (95% CI 2.74-6.16) in young women in Africa. SUMMARY The epidemiological study of eating disorders in Africa is still in its infancy. Over time in total four studies providing epidemiological data on specific, formally assessed eating disorders were found. No cases of anorexia nervosa were reported in African epidemiological studies, which concurs with the very low prevalence rates of anorexia nervosa in Latin Americans and in African Americans in the USA. With the DSM-5 criteria for anorexia nervosa, some women in the African studies would have fulfilled the criteria for anorexia nervosa. The prevalence rate of bulimia nervosa in women in Africa is within the range reported for western populations, as well as African Americans and Latin Americans.
Collapse
|
216
|
Abstract
PURPOSE OF REVIEW Eating disorders are currently not considered to be limited to Western culture. We systematically reviewed the existing literature on the prevalence of eating disorders in Latin America. RECENT FINDINGS Of 1583 records screened, 17 studies from Argentina, Brazil, Chile, Colombia, Mexico, and Venezuela were included in the analysis. Most studies reported point-prevalence rates and only three studies provided lifetime and 12-month prevalence rates. We found a mean point-prevalence rate of 0.1% for anorexia nervosa, 1.16% for bulimia nervosa, and 3.53% for binge-eating disorder (BED) in the general population. Heterogeneity for bulimia nervosa and BED was large. This meta-analysis indicates that the prevalence of anorexia nervosa seems to be lower, whereas the prevalence of bulimia nervosa and especially of BED seems to be higher in Latin America than in Western countries. SUMMARY Our findings show that eating disorders are common mental disorders in Latin America. However, some facets of Latin American culture might be protective for the development of anorexia nervosa and increase the risk for bulimia nervosa and BED. Further studies investigating the epidemiology of eating disorders and their relation to culture in Latin America are needed. VIDEO ABSTRACT SPANISH ABSTRACT.
Collapse
|
217
|
|
218
|
Abstract
PURPOSE OF REVIEW In 2015, the findings of the most recent Global Burden of Disease Study (GBD), GBD 2013, were published. Burden was quantified for two eating disorders: anorexia nervosa and bulimia nervosa. RECENT FINDINGS In GBD 2013, burden was attributed to both anorexia nervosa and bulimia nervosa particularly in young females in high-income countries. As low- and middle-income countries continue to develop and undergo cultural change, the burden of anorexia nervosa and bulimia nervosa in these countries will potentially rise. However, eating disorders present unique challenges in regards to epidemiological data and burden quantification methodology which makes trends in burden difficult to determine. SUMMARY This article presents the GBD 2013 burden findings for anorexia nervosa and bulimia nervosa and explores the methodology underpinning these estimates. Limitations of the available raw data and methodological challenges are discussed along with the real world implications of these findings and opportunities for the field.
Collapse
|
219
|
Ji J, Sundquist J, Sundquist K. Association between anorexia nervosa and type 2 diabetes in Sweden: Etiological clue for the primary prevention of type 2 diabetes. Endocr Res 2016; 41:310-316. [PMID: 26906648 DOI: 10.3109/07435800.2016.1141948] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
AIM Caloric restriction has been found to be protective against the development of type 2 diabetes mellitus (T2D) in experimental animal studies. However, studies examining this association in humans are limited. In the present study, we examined whether individuals with anorexia nervosa, one marker of severe caloric restriction in humans, have a low incidence of T2D by using several Swedish registries. METHODS Individuals with anorexia nervosa were identified from the Swedish Hospital Discharge Register and Outpatient Register between 1964 and 2010. Standardized incidence ratios (SIRs) for T2D were studied among individuals with anorexia nervosa compared to those without the disorder. RESULTS A total of 17,135 individuals were identified with anorexia nervosa in Sweden. From this tally, 34 of them developed T2D, demonstrating a reduced risk of T2D with a SIR of 0.70, compared to individuals without anorexia nervosa. Patients with severe anorexia, indicated by more frequent hospitalizations, had a statistically non-significant lower incidence of T2D than those with fewer hospitalizations. A sibling study, controlled for familial confounding, found a statistically non-significant association between anorexia nervosa and T2D. CONCLUSION Our study found that severe caloric restriction by using individuals with anorexia nervosa as a proxy was negatively associated with T2D, which might provide a biological basis for the primary prevention of T2D. Further studies are needed to explore whether moderate caloric restriction can effectively prevent the development of T2D in general population.
Collapse
Affiliation(s)
- Jianguang Ji
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
| | - Jan Sundquist
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
- b Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , CA , USA
| | - Kristina Sundquist
- a Center for Primary Health Care Research , Lund University/Region Skåne , Sweden
- b Stanford Prevention Research Center , Stanford University School of Medicine , Stanford , CA , USA
| |
Collapse
|
220
|
Mohler-Kuo M, Schnyder U, Dermota P, Wei W, Milos G. The prevalence, correlates, and help-seeking of eating disorders in Switzerland. Psychol Med 2016; 46:2749-2758. [PMID: 27444809 DOI: 10.1017/s0033291716001136] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Eating disorders (EDs) have long-term physical and mental impacts on those affected. However, few population-based studies have estimated the prevalence of EDs. We aimed to estimate the lifetime and 12-month prevalence rates of EDs using DSM-IV criteria, and to examine differences against the DSM-5 criteria for anorexia. METHOD A nationally representative sample of 10 038 residents in Switzerland was interviewed, and prevalence rates for anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED) were assessed using WHO Composite International Diagnostic Interviews (WHO-CIDI). RESULTS The lifetime prevalence rate for any ED was found to be 3.5%. Lifetime prevalence estimates for AN, BN, and/or BED were 1.2%, 2.4%, and 2.4%, respectively, among women and 0.2%, 0.9%, and 0.7%, respectively, among men. Utilizing the DSM-5 criteria, the prevalence of AN in women increased by more than 50%, from 1.2% to 1.9%. Among those meeting the criteria for any ED, only 49.4% of men and 67.9% of women had ever sought professional help about their problems with eating or weight. CONCLUSIONS The higher prevalence of BN we detected relative to other studies should prompt further monitoring for a possible increasing trend. The female v. male ratios, especially for bulimia and BED, are decreasing. Given that more than half of those affected have never consulted any professional about their problems with eating or weight, routine inquiries about eating and weight by clinicians, school teachers/psychologists, and family members may help those who are at risk, especially among men.
Collapse
Affiliation(s)
- M Mohler-Kuo
- Epidemiology, Biostatistics, and Prevention Institute,University of Zurich,Zurich,Switzerland
| | - U Schnyder
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| | - P Dermota
- Epidemiology, Biostatistics, and Prevention Institute,University of Zurich,Zurich,Switzerland
| | - W Wei
- Epidemiology, Biostatistics, and Prevention Institute,University of Zurich,Zurich,Switzerland
| | - G Milos
- Department of Psychiatry and Psychotherapy,University Hospital Zurich,Zurich,Switzerland
| |
Collapse
|
221
|
Eating disorders in children and adolescents: what does the gynecologist need to know? Curr Opin Obstet Gynecol 2016; 28:381-92. [DOI: 10.1097/gco.0000000000000317] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
222
|
Sultson H, van Meer F, Sanders N, van Elburg AA, Danner UN, Hoek HW, Adan RAH, Smeets PAM. Associations between neural correlates of visual stimulus processing and set-shifting in ill and recovered women with anorexia nervosa. Psychiatry Res Neuroimaging 2016; 255:35-42. [PMID: 27518327 DOI: 10.1016/j.pscychresns.2016.07.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2015] [Revised: 04/27/2016] [Accepted: 07/07/2016] [Indexed: 11/18/2022]
Abstract
Women ill with anorexia nervosa (AN) have been shown to exhibit altered cognitive functioning, particularly poor set-shifting (SS). In this study, we investigated whether brain activation in frontal and parietal regions during visual stimulus processing correlates with SS ability. Women currently ill with AN (AN; N=14), recovered women (REC; N=14) and healthy controls (HC; N=15), viewed alternating blocks of food and non-food pictures during functional magnetic resonance imaging (fMRI). The Berg's Card Sorting Task was completed outside the scanner to measure SS. A priori regions of interest (ROIs) were defined in frontal and parietal regions. The activation during visual stimulus processing in several ROIs correlated positively with poor SS ability in REC, particularly in the left dorsal anterior cingulate cortex (dACC). The correlations with poor SS ability were opposite in AN patients, particularly in the right dACC. These findings underscore that addressing heightened levels of cognitive control associated with higher frontal activation could reduce cognitive inflexibility in recovered women. In AN, greater activation in frontal and parietal regions might be necessary to perform at normal levels during various tasks. Thus, weight restoration could be necessary for AN patients prior to addressing cognitive inflexibility.
Collapse
Affiliation(s)
- Hedvig Sultson
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Floor van Meer
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands
| | - Nicole Sanders
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Annemarie A van Elburg
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Unna N Danner
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands
| | - Hans W Hoek
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Parnassia Psychiatric Institute, The Hague, The Netherlands; Department of Psychiatry, University Medical Center Groningen, Groningen, The Netherlands
| | - Roger A H Adan
- Altrecht Eating Disorders Rintveld, Altrecht Mental Health Institute, Zeist, The Netherlands; Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Paul A M Smeets
- Image Sciences Institute, University Medical Center Utrecht, Heidelberglaan 100, Q02.4.45, 3584 CX Utrecht, The Netherlands; Division of Human Nutrition, Wageningen University & Research Center, Wageningen, The Netherlands.
| |
Collapse
|
223
|
Peterson CM, Fischer S, Loiselle K, Shaffer A. FBT With Adjunctive Parent Emotion Coaching in an Adolescent Male With Anorexia Nervosa. Clin Case Stud 2016. [DOI: 10.1177/1534650116664586] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Family-based therapy (FBT) is the gold standard of treatment for adolescents with anorexia nervosa (AN) and has shown to be more effective than other forms of treatment in several randomized controlled trials. However, FBT is a behaviorally based intervention that does not explicitly address emotional distress often exhibited by patients and their parents. This case study describes the treatment of a 14-year-old adolescent male with AN using FBT as the primary treatment modality. We also implemented an adjunctive treatment designed to address parents’ emotion communication skills (ECSs) to reduce emotion dysregulation and family conflict in the implementation of FBT and in the process of AN recovery. Over the course of 29 sessions, the adolescent has evidenced an increase in weight from 84 pounds to 110.25 pounds and significant decreases in weight and shape concerns. This case provides preliminary support for the feasibility and effectiveness of an adjunct parent emotion coaching intervention combined with FBT for an adolescent male with AN.
Collapse
|
224
|
Dingemans AE, van Son GE, Aardoom JJ, Bruidegom K, Slof-Op 't Landt MCT, van Furth EF. Predictors of psychological outcome in patients with eating disorders: A routine outcome monitoring study. Int J Eat Disord 2016; 49:863-73. [PMID: 27177503 DOI: 10.1002/eat.22560] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/16/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Identifying predictors of psychological outcome for patients with eating disorders may improve the effectiveness of treatment. Patients with different pre-treatment characteristics and symptoms may benefit from different therapies. This study aimed to identify potential predictors of treatment outcome in a large naturalistic cohort of patients with an eating disorder. METHOD The study sample included patients (N = 1153) with all types of eating disorders who were receiving residential, day, or outpatient treatment. Remission was defined by means of four different indicators based on the Eating Disorder Examination-Questionnaire global score: 1. achieving reliable change; 2. showing a 50% reduction in baseline symptom severity; 3. reaching the clinical significance cut-off point; and 4. a combination of indicators 2 and 3. Potential predictor variables were investigated in univariate and multivariate Cox regression models. RESULTS Different predictors were found for the four outcome criteria. Patients with high levels of interpersonal distrust at baseline were less likely to have achieved reliable change in eating disorder psychopathology. Higher self-esteem and less body dissatisfaction at baseline was independently associated with a symptom reduction of more than 50% and/or reaching the clinical significance cut-off point. Contrary to our expectations, no differences in outcome were found between the eating disorder subtypes. DISCUSSION Clinically, it is important to reduce the risk of poor outcome and to achieve a rapid response in treatment using an intervention designed for this purpose, such as shared decision making or an intervention directed at self-esteem or body image, which may act as a catalyst for change. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:863-873).
Collapse
Affiliation(s)
| | | | - Jiska J Aardoom
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | - Kiki Bruidegom
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands
| | | | - Eric F van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, the Netherlands.,Department of Psychiatry, Leiden University Medical Center, B1-P, PO Box 9600, 2300 RC Leiden, the Netherlands
| |
Collapse
|
225
|
Nahum Sacks K, Friger M, Shoham-Vardi I, Abokaf H, Spiegel E, Sergienko R, Landau D, Sheiner E. Prenatal exposure to gestational diabetes mellitus as an independent risk factor for long-term neuropsychiatric morbidity of the offspring. Am J Obstet Gynecol 2016; 215:380.e1-7. [PMID: 27018463 DOI: 10.1016/j.ajog.2016.03.030] [Citation(s) in RCA: 94] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Accepted: 03/17/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND The reported rates of gestational diabetes mellitus are constantly escalating and little is known about long-term complications in the offspring. Evidence from the field of epigenetics strongly advocates the need for research on the neuropsychiatric complications in offspring prenatally exposed to gestational diabetes mellitus. OBJECTIVE We sought to assess whether in utero exposure to gestational diabetes mellitus increases the risk of long-term neuropsychiatric morbidity in the offspring. STUDY DESIGN A population-based cohort study compared the incidence of hospitalizations due to neuropsychiatric disease between singletons exposed and unexposed to gestational diabetes mellitus. Deliveries occurred in the years 1991 through 2014 in a regional tertiary medical center. Perinatal deaths, multiple gestations, mothers with pregestational diabetes or lack of prenatal care, and children with congenital malformations were excluded from the study. A multivariate generalized estimating equation logistic regression model analysis was used to control for confounders and for maternal clusters. RESULTS During the study period 231,271 deliveries met the inclusion criteria; 5.4% of the births were to mothers diagnosed with gestational diabetes mellitus (n = 12,642), of these 4.3% had gestational diabetes type A1 (n = 10,076) and 1.1% had gestational diabetes type A2 (n = 2566). During the follow-up period, a significant linear association was noted between the severity of the gestational diabetes (no gestational diabetes, gestational diabetes mellitus A1, gestational diabetes mellitus A2) and neuropsychiatric disease of the offspring (1.02% vs 1.36% vs 1.68%, respectively, P < .001). A Kaplan-Meier curve demonstrated that children born to women with gestational diabetes mellitus had higher cumulative incidence of neuropsychiatric morbidity. Using a generalized estimating equation multivariable logistic regression model, controlling for time-to-event, maternal age, gestational age at delivery, maternal obesity, maternal preeclampsia and fertility treatments, maternal gestational diabetes mellitus was found to be an independent risk factor for long-term neuropsychiatric disease of the offspring (gestational diabetes mellitus A1 [adjusted odds ratio, 1.83; 95% confidence interval, 1.53-2.19] and gestational diabetes mellitus A2 [adjusted odds ratio, 1.64; 95% confidence interval, 1.18-2.27]). Within the limits of our database, our findings also point to a possible association between in utero exposure to gestational diabetes mellitus and autistic spectrum disorder of the offspring (adjusted odds ratio, 4.44; 95% confidence interval, 1.55-12.69), which was found significant also after controlling for time-to-event, maternal age, gestational age at delivery, and offspring weight at birth. CONCLUSION Exposure to maternal gestational diabetes mellitus is an independent risk factor for long-term neuropsychiatric morbidity in the offspring.
Collapse
Affiliation(s)
- Kira Nahum Sacks
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ilana Shoham-Vardi
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Hanaa Abokaf
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel; Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Spiegel
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Department of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Daniella Landau
- Department of Pediatrics, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Eyal Sheiner
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
| |
Collapse
|
226
|
Mikschl S, Schlegl S, Külz AK, Rief W, Voderholzer U. Funktionalitäten von Essstörungen - Ergebnisse einer Analyse im stationären Setting. VERHALTENSTHERAPIE 2016. [DOI: 10.1159/000448496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
227
|
Pisetsky EM, Utzinger LM, Peterson CB. Incorporating Social Support in the Treatment of Anorexia Nervosa: Special Considerations for Older Adolescents and Young Adults. COGNITIVE AND BEHAVIORAL PRACTICE 2016; 23:316-328. [PMID: 27429544 DOI: 10.1016/j.cbpra.2015.09.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Currently, research support is strongest for family-based treatment (FBT) for the treatment of anorexia nervosa (AN) in adolescents. However, a strong evidence base for treatments for older adolescents and young adults with AN is lacking. Emphasizing social support in the treatment of AN may be beneficial for older adolescents and young adults with AN. This paper provides a brief review of the literature on FBT for adolescent AN and provides a case example of adolescent AN treated with FBT. We then discuss novel treatments that have incorporated social support for older adolescents and young adults with AN, such as modified FBT and couples-based interventions. We provide case studies of each of these novel treatment approaches as well. Additionally, this paper highlights and discusses developmental considerations and challenges in working with older adolescents and young adults with AN.
Collapse
Affiliation(s)
- Emily M Pisetsky
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| | | | - Carol B Peterson
- Department of Psychiatry, University of Minnesota, Minneapolis, MN
| |
Collapse
|
228
|
Affiliation(s)
- Ellen S Rome
- Department of General Pediatrics, Cleveland Clinic Children's Hospital, Cleveland, OH
| | | |
Collapse
|
229
|
Bora E, Köse S. Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: A specific İmpairment of cognitive perspective taking in anorexia nervosa? Int J Eat Disord 2016; 49:739-40. [PMID: 27425037 DOI: 10.1002/eat.22572] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 05/20/2016] [Accepted: 05/22/2016] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Deficits in theory of mind (ToM), ability to infer mental states of others, can play a significant role in interpersonal difficulties and/or unawareness of illness observed in AN and other eating disorders including bulimia Nervosa (BN). METHOD Current meta-analysis aimed to summarize available evidence for deficits in ToM in AN and BN and examine the effects of number of study-level variables on observed findings. In this meta-analysis, 15 studies (22 samples with eating disorders) investigating ToM performances of 677 individuals with AN or BN and 514 healthy controls were included. RESULTS AN was associated with significant deficits in ToM (d = 0.59) which were more pronounced in the acute patients (d = 0.67). Small sized deficits in ToM were observed in BN (d = 0.34) and recovered AN (d = 0.35). Both cognitive perspective-taking (ToM-PT) (d = 0.99) and decoding mental states (ToM-decoding) (d = 0.61) aspects of ToM were impaired in acute AN. ToM-decoding impairment in BN was modest. There was no evidence for significant ToM-PT deficit in BN. Several study-level variables including longer duration of illness, lower BMI, and depressive symptoms were associated with more severe deficits in ToM in AN. DISCUSSION ToM deficits, particularly in ToM-PT, can be a specific feature of AN but not BN. ToM impairment can contribute to poor insight, treatment resistance, and social impairment in AN. © 2016 Wiley Periodicals, Inc. RESUMEN META ANÁLISIS DE LA TEORÍA DE LA MENTE EN ANOREXIA NERVOSA Y BULIMIA NERVOSA: ¿Un deterioro de la toma de perspectiva cognitiva en Anorexia Nervosa? OBJETIVO Las deficiencias en la teoría de la mente (ToM), la habilidad parar inferir los estados mentales de otros, pueden jugar una función significativa en las dificultades interpersonales y/o falta de reconocimiento de la enfermedad observada en Anorexia Nervosa (AN) y otros trastornos de la conducta alimentaria incluyendo la Bulimia Nervosa (BN). MÉTODO Los meta análisis actuales dirigidos a resumir la evidencia disponible sobre el déficit en ToM en AN y BN y examinar los efectos de un número de variables a nivel estudio en los resultados observados. En este meta análisis fueron incluidos 15 estudios (22 muestras con trastornos alimenticios) investigando la función de ToM de 677 individuos con AN o BN y 514 controles sanos. RESULTADOS La AN fue relacionada con déficit significativo en ToM (d=0.59) los cuales fueron pronunciados en los pacientes agudos (d=0.67). Se observaron déficits de tamaño pequeño en BN (d=0.34) y AN recuperada (d=0.35). La toma de perspectiva cognitiva (ToM-PT) (d=0.99) y la descodificación de los procesos mentales (descodificación de ToM) (d=0.61) fueron deteriorados en la AN aguda. El deterioro en la descodificación de ToM en BN fue moderado. No se encontró evidencia significativa de déficit en ToM-PT en BN. Algunas variables a nivel estudio incluyendo la larga duración de la enfermedad, índice de masa corporal (IMC) bajo y síntomas depresivos fueron asociados con mayores déficit severos en ToM en AN. DISCUSIÓN: El déficit en ToM, particularmente en ToM-PT puede ser una característica específica en la AN pero no en la BN. El deterioro en la descodificación de ToM puede contribuir a mala percepción, resistencia al tratamiento y deterioro social en AN. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2016; 49:739-749).
Collapse
Affiliation(s)
- Emre Bora
- Department of Psychiatry, The Melbourne Neuropsychiatry Centre, the University of Melbourne and Melbourne Health, Carlton South, VIC, Australia; 6328 Sok no:38/2, Yali Mahallesi, Izmir, Turkey
| | - Sezen Köse
- Department of Child and Adolescent Psychiatry, Ege University, Izmir, Turkey
| |
Collapse
|
230
|
Ridout KK, Kole J, Fitzgerald KL, Ridout SJ, Donaldson AA, Alverson B. Daily Laboratory Monitoring is of Poor Health Care Value in Adolescents Acutely Hospitalized for Eating Disorders. J Adolesc Health 2016; 59:104-9. [PMID: 27338666 PMCID: PMC11346632 DOI: 10.1016/j.jadohealth.2016.03.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 03/01/2016] [Accepted: 03/14/2016] [Indexed: 02/06/2023]
Abstract
PURPOSE This study investigates how the clinical practice guideline-recommended laboratory monitoring for refeeding syndrome impacts management and outcomes of adolescents with eating disorders hospitalized for acute medical stabilization and examines the value of laboratory monitoring (defined as the patient health outcomes achieved per dollar spent). METHODS A retrospective chart review of medical admissions in a children's hospital between October 2010 and February 2014 was performed. Encounters were identified using International Classification of Diseases, Ninth Revision codes of eating disorders as primary or secondary diagnoses. Exclusion criteria included systemic diseases associated with significant electrolyte abnormalities. Chart abstraction was performed using a predetermined form. Costs were estimated by converting hospital-fixed Medicaid charges using a statewide cost-to-charge ratio. RESULTS Of the 196 patient encounters, there were no cases of refeeding syndrome. A total of 3,960 key recommended laboratories were obtained; 1.9% were below normal range and .05% were critical values. Of these, .28% resulted in supplementation; none were associated with a change in inpatient management. Total laboratory costs were $269,250.85; the calculated health care value of this monitoring is 1.04 × 10(-8) differential outcomes per dollar spent. CONCLUSIONS This study provides evidence to suggest that daily laboratory monitoring for refeeding syndrome is a poor health care value in the management of adolescents hospitalized for acute medical stabilization with eating disorders. This initial analysis suggests that starting at a relatively low caloric level and advancing nutrition slowly may negate the need for daily laboratory assessment, which may have important implications for current guidelines.
Collapse
Affiliation(s)
- Kathryn K Ridout
- Department of Psychiatry and Human Behavior, Mood Disorders Research Program, Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island.
| | - Jonathan Kole
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Kelly L Fitzgerald
- Department of Medical Education, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Samuel J Ridout
- Department of Psychiatry and Human Behavior, Mood Disorders Research Program, Laboratory for Clinical and Translational Neuroscience, Butler Hospital, Providence, Rhode Island; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Abigail A Donaldson
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Pediatrics, Division of Adolescent Medicine, Hasbro Children's Hospital, Providence, Rhode Island
| | - Brian Alverson
- Department of Pediatrics, Alpert Medical School of Brown University, Providence, Rhode Island; Department of Pediatrics, Division of Hospitalist Medicine, Hasbro Children's Hospital, Providence, Rhode Island
| |
Collapse
|
231
|
McIntosh VVW, Jordan J, Carter JD, Frampton CMA, McKenzie JM, Latner JD, Joyce PR. Psychotherapy for transdiagnostic binge eating: A randomized controlled trial of cognitive-behavioural therapy, appetite-focused cognitive-behavioural therapy, and schema therapy. Psychiatry Res 2016; 240:412-420. [PMID: 27149410 DOI: 10.1016/j.psychres.2016.04.080] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 02/05/2016] [Accepted: 04/23/2016] [Indexed: 10/21/2022]
Abstract
Cognitive-behavioural therapy (CBT) is the recommended treatment for binge eating, yet many individuals do not recover, and innovative new treatments have been called for. The current study compares traditional CBT with two augmented versions of CBT; schema therapy, which focuses on early life experiences as pivotal in the history of the eating disorder; and appetite-focused CBT, which emphasises the role of recognising and responding to appetite in binge eating. 112 women with transdiagnostic DSM-IV binge eating were randomized to the three therapies. Therapy consisted of weekly sessions for six months, followed by monthly sessions for six months. Primary outcome was the frequency of binge eating. Secondary and tertiary outcomes were other behavioural and psychological aspects of the eating disorder, and other areas of functioning. No differences among the three therapy groups were found on primary or other outcomes. Across groups, large effect sizes were found for improvement in binge eating, other eating disorder symptoms and overall functioning. Schema therapy and appetite-focused CBT are likely to be suitable alternative treatments to traditional CBT for binge eating.
Collapse
Affiliation(s)
- Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand; Canterbury District Health Board, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | | | - Janice M McKenzie
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Latner
- Psychology Department, University of Hawaii at Manoa, Hawaii, USA
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| |
Collapse
|
232
|
Aardoom JJ, Dingemans AE, Spinhoven P, van Ginkel JR, de Rooij M, van Furth EF. Web-Based Fully Automated Self-Help With Different Levels of Therapist Support for Individuals With Eating Disorder Symptoms: A Randomized Controlled Trial. J Med Internet Res 2016; 18:e159. [PMID: 27317358 PMCID: PMC4930527 DOI: 10.2196/jmir.5709] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 04/08/2016] [Accepted: 05/13/2016] [Indexed: 11/23/2022] Open
Abstract
Background Despite the disabling nature of eating disorders (EDs), many individuals with ED symptoms do not receive appropriate mental health care. Internet-based interventions have potential to reduce the unmet needs by providing easily accessible health care services. Objective This study aimed to investigate the effectiveness of an Internet-based intervention for individuals with ED symptoms, called “Featback.” In addition, the added value of different intensities of therapist support was investigated. Methods Participants (N=354) were aged 16 years or older with self-reported ED symptoms, including symptoms of anorexia nervosa, bulimia nervosa, and binge eating disorder. Participants were recruited via the website of Featback and the website of a Dutch pro-recovery–focused e-community for young women with ED problems. Participants were randomized to: (1) Featback, consisting of psychoeducation and a fully automated self-monitoring and feedback system, (2) Featback supplemented with low-intensity (weekly) digital therapist support, (3) Featback supplemented with high-intensity (3 times a week) digital therapist support, and (4) a waiting list control condition. Internet-administered self-report questionnaires were completed at baseline, post-intervention (ie, 8 weeks after baseline), and at 3- and 6-month follow-up. The primary outcome measure was ED psychopathology. Secondary outcome measures were symptoms of depression and anxiety, perseverative thinking, and ED-related quality of life. Statistical analyses were conducted according to an intent-to-treat approach using linear mixed models. Results The 3 Featback conditions were superior to a waiting list in reducing bulimic psychopathology (d=−0.16, 95% confidence interval (CI)=−0.31 to −0.01), symptoms of depression and anxiety (d=−0.28, 95% CI=−0.45 to −0.11), and perseverative thinking (d=−0.28, 95% CI=−0.45 to −0.11). No added value of therapist support was found in terms of symptom reduction although participants who received therapist support were significantly more satisfied with the intervention than those who did not receive supplemental therapist support. No significant differences between the Featback conditions supplemented with low- and high-intensity therapist support were found regarding the effectiveness and satisfaction with the intervention. Conclusions The fully automated Internet-based self-monitoring and feedback intervention Featback was effective in reducing ED and comorbid psychopathology. Supplemental therapist support enhanced satisfaction with the intervention but did not increase its effectiveness. Automated interventions such as Featback can provide widely disseminable and easily accessible care. Such interventions could be incorporated within a stepped-care approach in the treatment of EDs and help to bridge the gap between mental disorders and mental health care services. Trial Registration Netherlands Trial Registry: NTR3646; http://www.trialregister.nl/trialreg/admin/ rctview.asp?TC=3646 (Archived by WebCite at http://www.webcitation.org/6fgHTGKHE)
Collapse
|
233
|
Peterson CM, Tissot AM, Matthews A, Hillman JB, Peugh JL, Rawers E, Tong J, Mitan L. Impact of short-term refeeding on appetite and meal experiences in new onset adolescent eating disorders. Appetite 2016; 105:298-305. [PMID: 27263068 DOI: 10.1016/j.appet.2016.05.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 05/02/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
Restrictive eating disorders (ED) are increasing and represent a serious risk to the health of adolescent females. Restrictive ED in youth are often treated through aggressive short-term refeeding. Although evidence supports that this intervention is the "gold standard" for improving ED outcomes in youth, little research has specifically probed appetite and meal-related responses to this type of intensive, short-term refeeding in newly diagnosed individuals. Information about appetite and meal-related dysfunction could provide valuable insights regarding treatment-interfering features of ED in both acute inpatient and longer-term outpatient treatment. The purpose of this study was to evaluate the hunger, fullness, olfactory, and gustatory responses of adolescents with newly-diagnosed restrictive ED and to probe how and when these responses are altered by refeeding. Using a quasi-experimental ecologically valid methodology, this study described and compared profiles of hunger, fullness, olfactory, and gustatory responses in adolescent females (n = 15) with newly diagnosed restrictive ED at hospital admission (i.e., severe malnutrition) and after medical refeeding, in comparison to healthy controls (n = 15). Results showed that newly diagnosed (i.e., malnourished) adolescents with ED showed significantly different meal-related experiences than controls. Refeeding improved some of these differences, but not all. Following refeeding, females with ED continued to show lower hunger, greater fullness, and lower pleasantness of smell ratings compared to controls. Unpleasantness of taste ratings maladaptively increased, such that females who were re-fed reported more aversive scents than pre-treatment. Profiles of meal-related responses were also identified and compared between groups. The applicability of these findings are discussed within the context of critical periods of change during refeeding treatment and potentially promising intervention targets that might enhance treatment outcomes for adolescents with newly onset, restrictive ED.
Collapse
Affiliation(s)
- Claire M Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
| | | | - Abigail Matthews
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James L Peugh
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Emily Rawers
- University of Cincinnati, College of Medicine, Cincinnati, OH, USA
| | | | - Laurie Mitan
- Division of Adolescent and Transition Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
234
|
Hammerle F, Huss M, Ernst V, Bürger A. Thinking dimensional: prevalence of DSM-5 early adolescent full syndrome, partial and subthreshold eating disorders in a cross-sectional survey in German schools. BMJ Open 2016; 6:e010843. [PMID: 27150185 PMCID: PMC4861098 DOI: 10.1136/bmjopen-2015-010843] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Investigating for the first time in Germany Diagnostic and Statistical Manual Fifth Edition (DSM-5) prevalences of adolescent full syndrome, Other Specified Feeding or Eating Disorder (OSFED), partial and subthreshold anorexia nervosa (AN), bulimia nervosa (BN) and binge eating disorder (BED). METHOD A national school-based cross-sectional survey with nine schools in Germany was undertaken that was aimed at students from grades 7 and 8. Of the 1775 students who were contacted to participate in the study, 1654 participated (participation rate: 93.2%). The sample consisted of 873 female and 781 male adolescents (mean age=13.4 years). Prevalence rates were established using direct symptom criteria with a structured inventory (SIAB-S) and an additional self-report questionnaire (Eating Disorder Inventory 2 (EDI-2)). RESULTS Prevalences for full syndrome were 0.3% for AN, 0.4% for BN, 0.5% for BED and 3.6% for OSFED-atypical AN, 0% for BN (low frequency/limited duration), 0% for BED (low frequency/limited duration) and 1.9% for purging disorder (PD). Prevalences of partial syndrome were 10.9% for AN (7.1% established with cognitive symptoms only, excluding weight criteria), 0.2% for BN and 2.1% for BED, and of subthreshold syndrome were 0.8% for AN, 0.3% for BN and 0.2% for BED. Cases on EDI-2 scales were much more pronounced with 12.6-21.1% of the participants with significant sex differences. CONCLUSIONS The findings were in accordance with corresponding international studies but were in contrast to other German studies showing much higher prevalence rates. The study provides, for the first time, estimates for DSM-5 prevalences of eating disorders in adolescents for Germany, and evidence in favour of using valid measures for improving prevalence estimates. TRIAL REGISTRATION NUMBER DRKS00005050; Results.
Collapse
Affiliation(s)
- Florian Hammerle
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Michael Huss
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Verena Ernst
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Arne Bürger
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital of Würzburg, Wuerzburg, Germany
| |
Collapse
|
235
|
Matthews A, Peterson CM. Intensive Family-Based Therapy During an Acute Medical Admission for Anorexia Nervosa. Clin Case Stud 2016. [DOI: 10.1177/1534650116642575] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Family-based therapy (FBT) is the evidence-based treatment of choice for anorexia nervosa (AN) in adolescents, with numerous studies providing support for its efficacy in the outpatient realm. This case report describes the application of a brief FBT intervention during an inpatient medical admission for an adolescent presenting with medical instability secondary to new onset AN. The intensive, four-session FBT-guided intervention included (a) psychoeducation and illness externalization, (b) parent skills training, (c) meal coaching, and (d) behavioral contracting. Self-report assessment and anthropometric data collected at pre-, post-, and 5 months following the intervention suggest increase in body mass index (BMI) and percent ideal body weight, increased parental understanding of AN and parental self-efficacy in managing the illness, decreased parent emotional burden of the illness, and decreases in overall adolescent Eating Disorder Examination Questionnaire (EDE-Q) scores. This case report provides preliminary evidence for the acceptability and effectiveness of a brief FBT-based intervention during medical stabilization for adolescents with AN and their families before proceeding to outpatient FBT.
Collapse
|
236
|
Schmidt U, Adan R, Böhm I, Campbell IC, Dingemans A, Ehrlich S, Elzakkers I, Favaro A, Giel K, Harrison A, Himmerich H, Hoek HW, Herpertz-Dahlmann B, Kas MJ, Seitz J, Smeets P, Sternheim L, Tenconi E, van Elburg A, van Furth E, Zipfel S. Eating disorders: the big issue. Lancet Psychiatry 2016; 3:313-5. [PMID: 27063378 DOI: 10.1016/s2215-0366(16)00081-x] [Citation(s) in RCA: 149] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/22/2016] [Accepted: 02/24/2016] [Indexed: 12/16/2022]
Affiliation(s)
- Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London SE5 8AF, UK.
| | - Roger Adan
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands; Rintveld Hospital, Zeist, Netherlands
| | - Ilka Böhm
- Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Dresden, Germany
| | - Iain C Campbell
- Department of Psychological Medicine, King's College London, London SE5 8AF, UK
| | | | - Stefan Ehrlich
- Department of Child and Adolescent Psychiatry, Technische Universität Dresden, Dresden, Germany
| | | | | | - Katrin Giel
- Eberhard-Karls Universität, Tübingen, Germany
| | | | - Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London SE5 8AF, UK
| | - Hans W Hoek
- Groningen University, Groningen, Netherlands
| | | | - Martien J Kas
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Paul Smeets
- Brain Center Rudolf Magnus, University Medical Center Utrecht, Utrecht, Netherlands
| | - Lot Sternheim
- University Clinics, Utrecht University, Utrecht, Netherlands
| | | | | | - Eric van Furth
- Rivierduinen Eating Disorders Ursula, Leiden, Netherlands; Leiden University Medical Center, Leiden, Netherlands
| | | |
Collapse
|
237
|
Peterson CM, Baker JH, Thornton LM, Trace SE, Mazzeo SE, Neale MC, Munn-Chernoff MA, Lichtenstein P, Pedersen NL, Bulik CM. Genetic and environmental components to self-induced vomiting. Int J Eat Disord 2016; 49:421-7. [PMID: 26711867 PMCID: PMC4834264 DOI: 10.1002/eat.22491] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVE We examined the association between the genetic and environmental factors contributing to the liability to having ever engaged in self-induced vomiting (SIV initiation) and the genetic and environmental factors contributing to regular SIV behaviors (weekly or daily) for weight control. METHOD SIV was assessed in 3,942 women from monozygotic twin pairs and 2,790 women from same-sex dizygotic twin pairs, aged 20-47, from the Swedish Twin study of Adults: Genes and Environment. A causal-contingent-common pathway model assessed the extent to which genetic and environmental factors that influence initiation of SIV also influence regular SIV behaviors. RESULTS In the best-fit model, genetic and individual-specific environmental factors influenced liability to SIV initiation. The genetic factors influencing regular SIV behaviors were the same as the genetic factors influencing SIV initiation. Additional individual-specific environmental factors that were unrelated to SIV initiation influenced regular SIV behaviors. DISCUSSION Our findings provide evidence that the underlying liabilities for SIV initiation and regular SIV lie on the same continuum given the degree of overlap in risk between SIV initiation and regular SIV behaviors. Further, the lack of specific genetic factors and the importance of individual-specific environmental factors for regular SIV behaviors highlight the significance of environmental factors in the etiology of eating disorder symptomatology and the non-deterministic nature of genetic factors. Finally, our results suggest that when it comes to preventing individuals from developing regular SIV behavior, intervening at an environmental level is warranted.
Collapse
Affiliation(s)
- Claire M. Peterson
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jessica H. Baker
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | - Sara E. Trace
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| | - Suzanne E. Mazzeo
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Michael C. Neale
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Psychology, University of Southern California, Los Angeles CA, USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill NC, USA,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill NC, USA
| |
Collapse
|
238
|
Smink FRE, van Hoeken D, Donker GA, Susser ES, Oldehinkel AJ, Hoek HW. Three decades of eating disorders in Dutch primary care: decreasing incidence of bulimia nervosa but not of anorexia nervosa. Psychol Med 2016; 46:1189-1196. [PMID: 26671456 DOI: 10.1017/s003329171500272x] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Whether the incidence of eating disorders in Western, industrialized countries has changed over time has been the subject of much debate. The purpose of this primary-care study was to examine changes in the incidence of eating disorders in The Netherlands during the 1980s, 1990s and 2000s. METHOD A nationwide network of general practitioners (GPs), serving a representative sample (~1%) of the total Dutch population, recorded newly diagnosed patients with anorexia nervosa (AN) and bulimia nervosa (BN) in their practice during 1985-1989, 1995-1999, and 2005-2009. GPs are key players in the Dutch healthcare system, as their written referral is mandatory in order to get access to specialized (mental) healthcare, covered by health insurance. Health insurance is virtually universal in The Netherlands (99% of the population). A substantial number of GPs participated in all three study periods, during which the same case identification criteria were used and the same psychiatrist was responsible for making the final diagnoses. Incidence rates were calculated and for comparison between periods, incidence rate ratios. RESULTS The overall incidence rate of BN decreased significantly in the past three decades (from 8.6 per 100,000 person-years in 1985-1989 to 6.1 in 1995-1999, and 3.2 in 2005-2009). The overall incidence of AN remained fairly stable during three decades, i.e. 7.4 per 100,000 person-years in 1985-1989, 7.8 in 1995-1999, and 6.0 in 2005-2009. CONCLUSIONS The incidence rate of BN decreased significantly over the past three decades, while the overall incidence rate of AN remained stable.
Collapse
Affiliation(s)
- F R E Smink
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - D van Hoeken
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| | - G A Donker
- NIVEL Primary Care Database, Sentinel Practices,Utrecht,The Netherlands
| | - E S Susser
- Department of Epidemiology,Columbia University,Mailman School of Public Health,New York,USA
| | - A J Oldehinkel
- Department of Psychiatry,University Medical Center Groningen,University of Groningen,Groningen,The Netherlands
| | - H W Hoek
- Parnassia Psychiatric Institute,The Hague,The Netherlands
| |
Collapse
|
239
|
Errichiello L, Iodice D, Bruzzese D, Gherghi M, Senatore I. Prognostic factors and outcome in anorexia nervosa: a follow-up study. Eat Weight Disord 2016; 21:73-82. [PMID: 26253365 DOI: 10.1007/s40519-015-0211-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Accepted: 07/27/2015] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND AND AIMS Anorexia nervosa is an eating disorder characterized by food restriction, irrational fear of gaining weight and consequent weight loss. High mortality rates have been reported, mostly due to suicide and malnutrition. Good outcomes largely vary between 18 and 42%. We aimed to assess outcome and prognostic factors of a large group of patients with anorexia nervosa. Moreover we aimed to identify clusters of prognostic factors related to specific outcomes. METHODS We retrospectively reviewed data of 100 patients diagnosed with anorexia nervosa previously hospitalized in a tertiary level structure. Then we performed follow-up structured telephone interviews. RESULTS We identified four dead patients, while 34% were clinically recovered. In univariate analysis, short duration of inpatient treatment (p = 0.003), short duration of disorder (p = 0.001), early age at first inpatient treatment (p = 0.025) and preserved insight (p = 0.029) were significantly associated with clinical recovery at follow-up. In multiple logistic regression analysis, duration of first inpatient treatment, duration of disorder and preserved insight maintained their association with outcome. Moreover multiple correspondence analysis and cluster analysis allowed to identify different typologies of patients with specific features. Notably, group 1 was characterized by two or more inpatient treatments, BMI ≤ 14, absence of insight, history of long-term inpatient treatments, first inpatient treatment ≥30 days. While group 4 was characterized by preserved insight, BMI ≥ 16, first inpatient treatment ≤14 days, no more than one inpatient treatment, no psychotropic drugs intake, duration of illness ≤4 years. CONCLUSIONS We confirmed the association between short duration of inpatient treatment, short duration of disorder, early age at first inpatient treatment, preserved insight and clinical recovery. We also differentiated patients with anorexia nervosa in well-defined outcome groups according to specific clusters of prognostic factors. Our study might help clinicians to evaluate prognosis of patients with anorexia nervosa.
Collapse
Affiliation(s)
- Luca Errichiello
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy.
| | - Davide Iodice
- Local Health Authority of Matera, Operating Unit Adult Mental Health, Policoro Hospital, Policoro (Matera), Italy
| | - Dario Bruzzese
- Department of Public Health, "Federico II" University, Naples, Italy
| | - Marco Gherghi
- Department of Economics and Statistics, "Federico II" University, Naples, Italy
| | - Ignazio Senatore
- Section of Psychotherapy, Section of Psychiatry, Department of Neurosciences, "Federico II" University, Naples, Italy
| |
Collapse
|
240
|
Misra M, Golden NH, Katzman DK. State of the art systematic review of bone disease in anorexia nervosa. Int J Eat Disord 2016; 49:276-92. [PMID: 26311400 PMCID: PMC4769683 DOI: 10.1002/eat.22451] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/23/2015] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Low bone mineral density (BMD) is a known consequence of anorexia nervosa (AN) and is particularly concerning during adolescence, a critical time for bone accrual. A comprehensive synthesis of available data regarding impaired bone health, its determinants, and associated management strategies in AN is currently lacking. This systematic review aims to synthesize information from key physiologic and prospective studies and trials, and provide a thorough understanding of impaired bone health in AN and its management. METHOD Search terms included "anorexia nervosa" AND "bone density" for the period 1995-2015, limited to articles in English. Papers were screened manually based on journal impact factor, sample size, age of participants, and inclusion of a control group. When necessary, we included seminal papers published before 1995. RESULTS AN leads to low BMD, impaired bone quality and increased fracture risk. Important determinants are low lean mass, hypogonadism, IGF-1 deficiency, and alterations in other hormones that impact bone health. Weight gain and menses restoration are critical for improving bone outcomes in AN. Physiologic estrogen replacement as the transdermal patch was shown to increase bone accrual in one study in adolescent females with AN; however, residual deficits persist. Bisphosphonates are potentially useful in adults with AN. DISCUSSION To date, evidence suggests that the safest and most effective strategy to improve bone health in AN is normalization of weight with restoration of menses. Pharmacotherapies that show promise include physiologic estradiol replacement (as the transdermal estradiol patch), and in adults, bisphosphonates. Further studies are necessary to determine the best strategies to normalize BMD in AN.
Collapse
Affiliation(s)
- Madhusmita Misra
- Division of Pediatric Endocrinology and the Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts,Correspondence to: Madhusmita Misra, MD, MPH, Division of Pediatric Endocrinology and the Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts.
| | - Neville H. Golden
- Division of Adolescent Medicine, Stanford University School of Medicine, Palo Alto, California
| | - Debra K. Katzman
- Division of Adolescent Medicine, Hospital for Sick Children and University of Toronto, Toronto, Canada
| |
Collapse
|
241
|
Rosen E, Sabel AL, Brinton JT, Catanach B, Gaudiani JL, Mehler PS. Liver dysfunction in patients with severe anorexia nervosa. Int J Eat Disord 2016; 49:151-8. [PMID: 26346046 DOI: 10.1002/eat.22436] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Revised: 05/25/2015] [Accepted: 06/03/2015] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Evaluation of liver dysfunction in patients with severe anorexia nervosa (AN) has typically been limited to small case series. We report an investigation into the admission characteristics and clinical outcomes associated with liver dysfunction in a large cohort of adults hospitalized for medical stabilization of severe AN. METHODS We retrospectively evaluated electronic medical records to quantify the cumulative incidence of elevated aspartate aminotransferase (AST) and alanine aminotransferase (ALT). We compared mean (±SD), frequencies (%), and median (IQR) values of clinical covariates of interest by incidence of liver enzyme elevation. The study included 181 adults, admitted for medical stabilization of AN, from October 1, 2008 to December 31, 2013. RESULTS AST and ALT were mildly elevated in 27.6% of patients and severely elevated (more than three times the upper limit of normal) in 35.4% of patients. On admission, patients with severely elevated liver enzymes had a lower body mass index (BMI) (11.9 ± 1.8 kg/m(2) vs.13.3 ± 1.7 kg/m(2)), lower percentage ideal body weight (56.5% ± 7.7% vs. 63.5% ± 8.3%), and lower prealbumin (64% vs. 37%) compared with the rest of the cohort (p < 0.001). While hospitalized, patients with severely elevated liver enzymes more often developed hypoglycemia, hypophosphatemia, and experienced longer lengths of stay (p < 0.001). DISCUSSION Elevated liver enzymes are common in our patient population with severe AN. Liver enzymes reached near normal values by the time of discharge. Severely elevated liver enzymes were associated with a lower BMI and the development of hypoglycemia.
Collapse
Affiliation(s)
- Elissa Rosen
- Department of Medicine, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Medicine, University of Colorado, Denver Health, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Allison L Sabel
- Department of Patient Safety and Quality, Denver Health, Denver, Colorado.,Department of Biostatistics and Informatics Colorado School of Public Health, University of Colorado, Aurora, Colorado
| | - John T Brinton
- Department of Medicine, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Medicine, University of Colorado, Denver Health, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Brittany Catanach
- Department of Medicine, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Medicine, University of Colorado, Denver Health, Denver, Colorado
| | - Jennifer L Gaudiani
- Department of Medicine, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Medicine, University of Colorado, Denver Health, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado
| | - Philip S Mehler
- Department of Medicine, University of Colorado, School of Medicine, Aurora, Colorado.,Department of Medicine, University of Colorado, Denver Health, Denver, Colorado.,ACUTE Center for Eating Disorders at Denver Health, Denver, Colorado.,Eating Recovery Center, Denver, Colorado
| |
Collapse
|
242
|
Padfield GJ, Escudero CA, DeSouza AM, Steinberg C, Gibbs K, Puyat JH, Lam PY, Sanatani S, Sherwin E, Potts JE, Sandor G, Krahn AD. Characterization of Myocardial Repolarization Reserve in Adolescent Females With Anorexia Nervosa. Circulation 2016; 133:557-65. [PMID: 26769740 DOI: 10.1161/circulationaha.115.016697] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 12/29/2015] [Indexed: 11/16/2022]
Abstract
BACKGROUND Patients with anorexia nervosa exhibit abnormal myocardial repolarization and are susceptible to sudden cardiac death. Exercise testing is useful in unmasking QT prolongation in disorders associated with abnormal repolarization. We characterized QT adaptation during exercise in anorexia. METHODS AND RESULTS Sixty-one adolescent female patients with anorexia nervosa and 45 age- and sex-matched healthy volunteers performed symptom-limited cycle ergometry during 12-lead ECG monitoring. Changes in the QT interval during exercise were measured, and QT/RR-interval slopes were determined by using mixed-effects regression modeling. Patients had significantly lower body mass index than controls; however, resting heart rates and QT/QTc intervals were similar at baseline. Patients had shorter exercise times (13.7±4.5 versus 20.6±4.5 minutes; P<0.001) and lower peak heart rates (159±20 versus 184±9 beats/min; P<0.001). The mean QTc intervals were longer at peak exercise in patients (442±29 versus 422±19 ms; P<0.001). During submaximal exertion at comparable heart rates (114±6 versus 115±11 beats/min; P=0.54), the QTc interval had prolonged significantly more in patients than controls (37±28 versus 24±25 ms; P<0.016). The RR/QT slope, best described by a curvilinear relationship, was more gradual in patients than in controls (13.4; 95% confidence interval, 12.8-13.9 versus 15.8; 95% confidence interval, 15.3-16.4 ms QT change per 10% change in RR interval; P<0.001) and steepest in patients within the highest body mass index tertile versus the lowest (13.9; 95% confidence interval, 12.9-14.9 versus 12.3; 95% confidence interval, 11.3-13.3; P=0.026). CONCLUSIONS Despite the absence of manifest QT prolongation, adolescent anorexic females have impaired repolarization reserve in comparison with healthy controls. Further study may identify impaired QT dynamics as a risk factor for arrhythmias in anorexia nervosa.
Collapse
Affiliation(s)
- Gareth J Padfield
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Carolina A Escudero
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Astrid M DeSouza
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Christian Steinberg
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Karen Gibbs
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Joseph H Puyat
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Pei Yoong Lam
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Shubhayan Sanatani
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Elizabeth Sherwin
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - James E Potts
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - George Sandor
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.)
| | - Andrew D Krahn
- From Heart Rhythm Services, Division of Cardiology, University of British Columbia, Vancouver, Canada (G.J.P., C.S., K.G., A.D.K.); British Columbia Children's Hospital, Vancouver, Canada (C.A.E., A.M.D., P.Y.L., S.S., E.S., J.E.P., G.S.); and Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, Canada (J.H.P.).
| |
Collapse
|
243
|
Tritos NA, Klibanski A. Effects of Growth Hormone on Bone. PROGRESS IN MOLECULAR BIOLOGY AND TRANSLATIONAL SCIENCE 2016; 138:193-211. [PMID: 26940392 DOI: 10.1016/bs.pmbts.2015.10.008] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE Describe the effects of growth hormone (GH) and insulin-like growth factor 1 (IGF-1) on the skeleton. FINDINGS The GH and IGF-1 axis has pleiotropic effects on the skeleton throughout the lifespan by influencing bone formation and resorption. GH deficiency leads to decreased bone turnover, delayed statural growth in children, low bone mass, and increased fracture risk in adults. GH replacement improves adult stature in GH deficient children, increases bone mineral density (BMD) in adults, and helps to optimize peak bone acquisition in patients, during the transition from adolescence to adulthood, who have persistent GH deficiency. Observational studies suggest that GH replacement may mitigate the excessive fracture risk associated with GH deficiency. Acromegaly, a state of GH and IGF-1 excess, is associated with increased bone turnover and decreased BMD in the lumbar spine observed in some studies, particularly in patients with hypogonadism. In addition, patients with acromegaly appear to be at an increased risk of morphometric-vertebral fractures, especially in the presence of active disease or concurrent hypogonadism. GH therapy also has beneficial effects on statural growth in several conditions characterized by GH insensitivity, including chronic renal failure, Turner syndrome, Prader-Willi syndrome, postnatal growth delay in patients with intrauterine growth retardation who do not demonstrate catchup growth, idiopathic short stature, short stature homeobox-containing (SHOX) gene mutations, and Noonan syndrome. SUMMARY GH and IGF-1 have important roles in skeletal physiology, and GH has an important therapeutic role in both GH deficiency and insensitivity states.
Collapse
Affiliation(s)
- Nicholas A Tritos
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA.
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, Massachusetts, USA; Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
244
|
Sundquist J, Ohlsson H, Winkleby MA, Sundquist K, Crump C. School Achievement and Risk of Eating Disorders in a Swedish National Cohort. J Am Acad Child Adolesc Psychiatry 2016; 55:41-46.e1. [PMID: 26703908 PMCID: PMC4691282 DOI: 10.1016/j.jaac.2015.09.021] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/19/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE High achievement in school has been associated with increased risk of eating disorders, including anorexia nervosa (AN) and bulimia nervosa (BN), but causality of these relationships is unclear. We sought to examine the association between school achievement and AN or BN in a national cohort and to determine the possible contribution of familial confounding using a co-relative design. METHOD This national cohort study involved 1,800,643 persons born in Sweden during 1972 to 1990 who were still living in Sweden at age 16 years and were followed up for AN and BN identified from inpatient and outpatient diagnoses through 2012. We used Cox regression to examine the association between school achievement and subsequent risk of AN or BN, and stratified Cox models to examine the gradient in this association across different strata of co-relative pairs (first cousins, half siblings, full siblings). RESULTS School achievement was positively associated with risk of AN among females and males (hazard ratio [HR] per additional 1 standard deviation, females: HR = 1.29; 95% CI = 1.25-1.33; males: HR = 1.29; 95% CI = 1.10-1.52), and risk of BN among females but not males (females: HR = 1.16; 95% CI = 1.11-1.20; males: HR = 1.05; 95% CI = 0.84-1.31). In co-relative analyses, as the degree of shared genetic and environmental factors increased (e.g., from first-cousin to full-sibling pairs), the association between school achievement and AN or BN substantially decreased. CONCLUSION In this large national cohort study, high achievement in school was associated with increased risk of AN and BN, but this appeared to be explained by unmeasured familial (genetic and environmental) factors.
Collapse
Affiliation(s)
- Jan Sundquist
- Lund University, Center for Primary Health Care Research, Malmö, Sweden
| | - Henrik Ohlsson
- Lund University, Center for Primary Health Care Research, Malmö, Sweden
| | | | | | | |
Collapse
|
245
|
Lalonde MP, O'Connor K, St-Pierre-Delorme ME, Perreault V, Wilson S. Diet and Doubt: A Clinical Case Study of Inference-Based Therapy for Bulimia Nervosa. J Cogn Psychother 2016; 30:263-276. [PMID: 32755929 DOI: 10.1891/0889-8391.30.4.263] [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: 11/25/2022]
Abstract
There is a recognized overlap between eating disorders (EDs) and obsessive-compulsive disorder (OCD) in terms of diagnosis, phenomenology, epidemiology, and psychological characteristics related to the disorder. In light of these similarities, a cognitive inference-based therapy (IBT) program, shown to be effective in treating OCD, was adapted for EDs. This case study describes the application of IBT treatment for a 35-year-old woman diagnosed with bulimia nervosa who also demonstrated overvalued ideation related to her body weight and shape. Over a 20-week period, the client's ED pathology significantly decreased. Notably, the frequency of binge episodes was reduced by 90% from pre- to posttreatment and by 100% at 6-month follow-up. Significant reductions were also observed in dietary restriction and overvalued ideation. This case study has important implications for the treatment of individuals with both an ED and strong overvalued ideas.
Collapse
Affiliation(s)
| | - Kieron O'Connor
- Research Center, Montréal Mental Health University Institute
| | | | | | - Samantha Wilson
- Research Center, Montréal Mental Health University Institute
| |
Collapse
|
246
|
Disentangling the Association Between Child Abuse and Eating Disorders: A Systematic Review and Meta-Analysis. Psychosom Med 2016; 78:79-90. [PMID: 26461853 DOI: 10.1097/psy.0000000000000233] [Citation(s) in RCA: 178] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVES The aim of this systematic review and meta-analysis was to estimate the association between distinct types of child abuse--sexual (CSA), physical (CPA), and emotional (CEA)--and different eating disorders (EDs). METHODS Electronic databases were searched through January 2014. Studies reporting rates of CSA, CPA, and CEA in people with anorexia nervosa (AN), bulimia nervosa (BN), and binge eating disorder (BED), as compared with individuals without EDs, were included. Pooled analyses were based on odds ratios (ORs), with relevant 95% confidence intervals (CIs), weighting each study with inverse variance models with random effects. Risk of publication bias was estimated. RESULTS Thirty-two of 1714 studies assessed for eligibility met the inclusion criteria, involving more than 14,000 individuals. The association between EDs and any child abuse showed a random-effects pooled OR of 3.21 (95% CI = 2.29-4.51, p < .001) with moderate heterogeneity (I2 = 57.2%, p = .005), whereas for CSA, this was 1.92 (95% CI = 1.13-3.28, p = .017), 2.73 (95% CI = 1.96-3.79, p < .001), and 2.31 (95% CI = 1.66-3.20, p < .001), for AN, BN, and BED, respectively. However, adjusting for publication bias, the estimate for CSA and AN was not significant (OR = 1.06, 95% CI = 0.59-1.88, p = .85). Although CPA was associated with AN, BN, and BED, CEA was associated just with BN and BED. CONCLUSIONS BN and BED are associated with childhood abuse, whereas AN shows mixed results. Individuals with similar trauma should be monitored for early recognition of EDs. TRIAL REGISTRATION The protocol was registered in PROSPERO (an international prospective register of systematic reviews) with the reference number CRD42014007360.
Collapse
|
247
|
Misra M, Klibanski A. Anorexia Nervosa and Its Associated Endocrinopathy in Young People. Horm Res Paediatr 2016; 85:147-57. [PMID: 26863308 PMCID: PMC4792745 DOI: 10.1159/000443735] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 01/04/2016] [Indexed: 12/23/2022] Open
Abstract
Anorexia nervosa (AN) is a condition of severe undernutrition associated with adaptive changes in many endocrine axes. These changes include hypogonadotropic hypogonadism, acquired growth hormone resistance with low insulin-like growth factor 1 (IGF-1) levels, hypercortisolemia, altered secretion of adipokines and appetite-regulating hormones, and low bone mineral density (BMD). Bone health is impaired subsequent to a low body mass index, decreased lean mass, and the endocrine changes described above. In addition to low areal BMD, AN is characterized by a decrease in volumetric BMD, changes in bone geometry, and reductions in strength estimates, leading to an increased risk for fracture. Weight restoration is essential for restoration of normal endocrine function; however, hypercortisolemia, high peptide YY levels, and ghrelin dynamics may not completely normalize. In some patients, hypogonadotropic hypogonadism persists despite weight restoration. Weight gain and menstrual recovery are critical for improving bone health in AN; however, residual deficits may persist. Physiologic estrogen replacement using transdermal, but not oral, estrogen increases bone accrual in adolescents with AN, while bisphosphonates improve BMD in adults. Recombinant human IGF-1 and teriparatide have been used in a few studies as bone anabolic therapies. More data are necessary to determine the optimal therapeutic strategies for low BMD in AN.
Collapse
Affiliation(s)
- Madhusmita Misra
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114,Pediatric Endocrine Unit, Massachusetts General Hospital for Children and Harvard Medical School, Boston, MA 02114
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital and Harvard Medical School, Boston, MA, 02114
| |
Collapse
|
248
|
Reese ED, Pollert GA, Veilleux JC. Self-regulatory predictors of eating disorder symptoms: Understanding the contributions of action control and willpower beliefs. Eat Behav 2016; 20:64-9. [PMID: 26643592 DOI: 10.1016/j.eatbeh.2015.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Revised: 08/31/2015] [Accepted: 11/11/2015] [Indexed: 11/19/2022]
Abstract
Action orientation, or the ability to regulate both positive and negative affect to perform goal-directed action, has been associated with eating behavior in previous research. Additionally, differences in beliefs about self-control have been shown to influence behavior, but it is unclear how these beliefs impact disordered eating behavior or how they may interact with other self-regulatory mechanisms to predict eating outcomes. In this study, 1128 participants were recruited online via Amazon Mechanical Turk to answer questions about self-regulation constructs and eating behavior. A three-way moderated regression analysis was used to assess relationships between two subtypes of action orientation (failure-related action orientation, or AOF, which describes an ability to up-regulate positive affect, and decision-related action orientation, or AOD, which describes an ability to down-regulate negative affect), willpower beliefs, and binge eating. Results revealed a significant three-way interaction between AOD, AOF, and willpower beliefs such that the interaction between AOF and willpower beliefs was only significant for those with low AOD. These findings suggest an ability to down-regulate negative affect (high AOF) is a protective factor against increased disordered eating, though this may not be the case for individuals with an inability to up-regulate positive affect (low AOD) and simultaneously ascribe to beliefs that willpower is a limited resource.
Collapse
Affiliation(s)
- Elizabeth D Reese
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, United States
| | - Garrett A Pollert
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, United States
| | - Jennifer C Veilleux
- Department of Psychological Science, University of Arkansas, 216 Memorial Hall, Fayetteville, AR 72701, United States.
| |
Collapse
|
249
|
Sapronova MR, Shnayder NA. Predictors and modifiers of impulse control disorders in Parkinson`s disease. Zh Nevrol Psikhiatr Im S S Korsakova 2016. [DOI: 10.17116/jnevro2016116111145-156] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
250
|
Bartholdy S, McClelland J, Kekic M, O'Daly OG, Campbell IC, Werthmann J, Rennalls SJ, Rubia K, David AS, Glennon D, Kern N, Schmidt U. Clinical outcomes and neural correlates of 20 sessions of repetitive transcranial magnetic stimulation in severe and enduring anorexia nervosa (the TIARA study): study protocol for a randomised controlled feasibility trial. Trials 2015; 16:548. [PMID: 26634828 PMCID: PMC4668644 DOI: 10.1186/s13063-015-1069-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 11/18/2015] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Anorexia nervosa (AN) is a serious mental disorder with multiple comorbidities and complications. In those with a severe and enduring form of the illness (SEED-AN), treatment responsivity is poor and the evidence base limited. Thus, there is a need for novel treatment strategies. This paper describes the theoretical background and protocol of a feasibility randomised controlled trial (RCT) of real versus sham (placebo) therapeutic repetitive transcranial magnetic stimulation (rTMS) in SEED-AN. The aim of this trial is to obtain information that will guide decision making and protocol development in relation to a future large-scale RCT of rTMS in this group of patients, and also to assess the preliminary efficacy and neural correlates of rTMS treatment. DESIGN Forty-four adults from the community with a DSM-5 diagnosis of AN, an illness duration>3 years and a previous course of unsuccessful treatment will be randomly allocated to receive 20 sessions of either real or sham rTMS, in a parallel group design. As this is a feasibility study, no primary outcome has been defined and a broad range of outcome variables will be examined. These include weight/body mass index (BMI), eating disorder psychopathology, other psychopathology (for example, depression, anxiety), quality of life, neuropsychological processes (such as self-regulation, attentional bias and food choice behaviour), neuroimaging measures (that is, changes in brain structure or function), tolerability and acceptability of rTMS, and additional service utilisation. The feasibility of conducting a large-scale RCT of rTMS and the appropriateness of rTMS as a treatment for SEED-AN will be evaluated through: assessment of recruitment and retention rates, acceptability of random allocation, blinding success (allocation concealment), completion of treatment sessions and research assessments (baseline, post-treatment and follow-up assessments). The acceptability and tolerability of the treatment will be assessed via semi-structured interviews. DISCUSSION The effect sizes generated and other findings from this trial will inform a future large-scale RCT with respect to decisions on primary outcome measures and other aspects of protocol development. Additionally, results from this study will provide a preliminary indication of the efficacy of rTMS treatment for AN, the neural correlates of the illness, and potential biomarkers of clinical response. TRIAL REGISTRATION ISRCTN14329415 . Date of registration: 23 July 2015.
Collapse
Affiliation(s)
- Savani Bartholdy
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jessica McClelland
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Maria Kekic
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Owen G O'Daly
- Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK. o.o'
| | - Iain C Campbell
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Jessica Werthmann
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Samantha J Rennalls
- Centre for Neuroimaging Sciences, Department of Neuroimaging, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Katya Rubia
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | - Anthony S David
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
| | | | - Nikola Kern
- South London and Maudsley NHS Foundation Trust, London, UK.
| | - Ulrike Schmidt
- Section of Eating Disorders, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK.
- South London and Maudsley NHS Foundation Trust, London, UK.
| |
Collapse
|