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Clifton E, Winder GS, Lentine KL, Zimbrean PC, Yadav A, Rubman S, Kalil R, Kumar V, Prashar R, Gan G, Deng Y, Joyce M, Holmes R, Laflen J, Bakhai D, Liapakis A, Doshi MD. Psychosocial Evaluation of Living Kidney Donors: A Survey of Current Practices in the United States. Transplantation 2024:00007890-990000000-00788. [PMID: 38867351 DOI: 10.1097/tp.0000000000005095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
BACKGROUND Best practices in psychosocial evaluation and care of living donor candidates and donors are not well established. METHODS We surveyed 195 living kidney donor (LKD) transplant centers in United States from October 2021 to April 2022 querying (1) composition of psychosocial teams, (2) evaluation processes including clinical tools and domains assessed, (3) selection criteria, and (4) psychosocial follow-up post-donation. RESULTS We received 161 responses from 104 programs, representing 53% of active LKD programs and 67% of LKD transplant volume in 2019. Most respondents (63%) were social workers/independent living donor advocates. Over 90% of respondents indicated donor candidates with known mental health or substance use disorders were initially evaluated by the psychosocial team. Validated psychometric or transplant-specific tools were rarely utilized but domains assessed were consistent. Active suicidality, self-harm, and psychosis were considered absolute contraindications in >90% of programs. Active depression was absolute contraindication in 50% of programs; active anxiety disorder was excluded 27%. Conditions not contraindicated to donation include those in remission: anxiety (56%), depression (53%), and posttraumatic stress disorder (41%). There was acceptance of donor candidates using alcohol, tobacco, or cannabis recreationally, but not if pattern met criteria for active use disorder. Seventy-one percent of programs conducted post-donation psychosocial assessment and use local resources to support donors. CONCLUSIONS There was variation in acceptance of donor candidates with mental health or substance use disorders. Although most programs conducted psychosocial screening post-donation, support is not standardized and unclear if adequate. Future studies are needed for consensus building among transplant centers to form guidelines for donor evaluation, acceptance, and support.
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Affiliation(s)
- Erin Clifton
- Department of Psychiatry, University of Michigan, Ann Arbor, MI
| | | | - Krista L Lentine
- Department of Internal Medicine, SSM Health Saint Louis University Hospital, St. Louis, MO
| | - Paula C Zimbrean
- Departments of Psychiatry and Surgery (Transplant), Yale School of Medicine, New Haven, CT
| | - Anju Yadav
- Division of Nephrology, Thomas Jefferson University, Philadelphia, PA
| | - Susan Rubman
- Department of Psychiatry, Yale School of Medicine, New Haven, CT
| | - Roberto Kalil
- Department of Medicine, University of Maryland, Baltimore, MD
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
| | | | - Geliang Gan
- Yale Center for Analytical Sciences, New Haven, CT
| | - Yanhong Deng
- Yale Center for Analytical Sciences, New Haven, CT
| | - Michael Joyce
- Department of Social Work, Yale New Haven Hospital, New Haven, CT
| | - Rachel Holmes
- Department of Psychiatry, Indiana University, Indianapolis, IN
| | - Jennie Laflen
- Department of Surgery, St. Louis University School of Medicine, St Louis, MO
| | - Darsh Bakhai
- Department of Social Work, University of Michigan, Ann Arbor, MI
| | | | - Mona D Doshi
- Department of Medicine, University of Michigan, Ann Arbor, MI
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Laliberte MM, Belisario K, Lucibello KM, Potechin MB, Potter S, Brassard S, Punia K, MacKillop J, Balodis I. Changing cannabis legislation in Canada and a longitudinal look at "regular" cannabis use in patients with eating disorders. Psychiatry Res 2024; 337:115933. [PMID: 38759416 DOI: 10.1016/j.psychres.2024.115933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 05/19/2024]
Abstract
Regular cannabis use (CU), defined as "weekly or more often", is associated with a number of negative mental health outcomes. In the last decade, Canada legalized first medical and then recreational CU. Despite higher prevalence in mental health populations, little research has documented changes in frequency of CU with progressive legalization of cannabis. This study examined rates of CU in a sample of 843 treatment-seeking patients with eating disorders (ED) in an outpatient setting between 2004 and 2020. Across ED diagnoses, segmented regression indicated a significant break-point in regular CU in 2014, commensurate with the relaxation of medical cannabis laws. Regular CU increased from 4.9 % to 23.7 % from 2014 to 2020; well above the stable 6 % found in the general population. No significant break-point was observed in either alcohol or illicit substance use over the same time period. Significant increases in regular CU were found in patients with anorexia nervosa and binge eating disorder, while regular use remained stable in patients with bulimia nervosa. Comorbid psychiatric diagnoses did not increase odds of regular CU. Findings suggest certain patient groups with mental illness may be at risk of engaging in high frequency use in the context of legislation implying medical benefits of cannabis.
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Affiliation(s)
- Michele M Laliberte
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Eating Disorders Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Kyla Belisario
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Kristen M Lucibello
- Department of Health Sciences, Brock University, St. Catharines, Ontario, Canada
| | | | - Sarah Potter
- Eating Disorders Clinic, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Brassard
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Kiran Punia
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychology, Neuroscience, & Behaviour, McMaster University, Hamilton, Ontario, Canada
| | - James MacKillop
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, Hamilton, Ontario, Canada
| | - Iris Balodis
- Peter Boris Centre for Addictions Research, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada; Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada; Michael G. DeGroote Centre for Medicinal Cannabis Research, Hamilton, Ontario, Canada.
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3
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Williams OC, Prasad S, Khan AA, Ayisire OE, Naseer H, Abdullah M, Nadeem M, Ashraf N, Zeeshan M. Tailoring parenting styles and family-based interventions cross-culturally as an effective prevention strategy for youth substance use: a scoping review. Ann Med Surg (Lond) 2024; 86:257-270. [PMID: 38222691 PMCID: PMC10783303 DOI: 10.1097/ms9.0000000000001387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/28/2023] [Indexed: 01/16/2024] Open
Abstract
Background The challenge of substance use among youth continues to be a highly concerning public health issue across the globe. The notion that parenting lifestyles and family-based intervention can help in the prevention of adolescent substance use have received robust attention from policy makers, researchers' clinicians and general public, nonetheless, there is scarcity of high quality evidence to support these concepts. Objective To review available literature which assessed the effects of parenting styles and family-based interventions on the prevention of adolescent substance use. Methods A scoping review of literature to identify studies published in English between 2012 and 2022 was conducted searching Scopus, MEDLINE, PsychInfo, and CINAHL databases focused on effects of parenting styles and family-based interventions in the prevention of adolescent substance use.Keywords of family-based intervention strategies and possible outcomes of parenting styles on youth substance use were coded from the results, discussion, or conclusion. Strategies were inductively categorized into themes according to the focus of the strategy. Results A total of 47 studies, published between 2012 and 2022 in English language included. Narrative synthesis illustrated that parental involvement, restriction of mature-rated content, parental monitoring, authoritative parenting styles, and parental support and knowledge can help in the prevention of adolescent substance use. On the contrary, poor parent-child bonding, overprotection, permissive parenting, parental frustrations, authoritarian and harsh parenting styles promoted adolescent substance use disorders. Proximal risk factors like peer influence, previous use of other substances, and risky behaviours had more effect than just parenting styles. Culturally tailored family-based intervention strategies such as "Preventive Parenting", "Parent Training", and "Parent Involvement", with focus on "Technology Assisted Intervention", particularly "SMART "(Substance Misuse among Adolescents in Residential Treatment) are found as effective family-based intervention strategies to mitigate substance use in youth. Conclusion Culturally tailored family-based behavioural strategies psychosocial intervention strategies can be considered of the most effective strategies to prevent substance use disorders in youth.
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Affiliation(s)
| | - Sakshi Prasad
- Department of Psychiatry National Pirogov Memorial Medical University, Vinnytsya, Ukraine
| | - Ahmed Ali Khan
- Department of Psychiatry, Shifa College of Medicine, Islamabad
| | | | | | | | | | | | - Muhammad Zeeshan
- Department of Psychiatry, Rutgers New Jersey Medical School, Newark, NJ
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4
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Soullane S, Israël M, Steiger H, Chadi N, Low N, Dewar R, Ayoub A, Auger N. Association of hospitalization for suicide attempts in adolescent girls with subsequent hospitalization for eating disorders. Int J Eat Disord 2023; 56:2223-2231. [PMID: 37646466 DOI: 10.1002/eat.24052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/10/2023] [Accepted: 08/11/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To determine the association between adolescent hospitalization for suicide attempts and the subsequent risk of eating disorder hospitalization. METHOD This was a cohort study of 162,398 adolescent girls in Quebec, Canada, including 7741 with suicide attempts before 20 years of age, matched to 154,657 adolescents with no attempt between 1989 and 2019. The main exposure measure was suicide attempt hospitalization. The main outcome measure was hospitalization for an eating disorder up to 31 years later, including anorexia nervosa, bulimia nervosa, and other eating disorders. We used adjusted Cox regression models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for the association between adolescent suicide attempts and eating disorder hospitalization. RESULTS Adolescent girls admitted for a suicide attempt had 5.55 times the risk of eating disorder hospitalization over time (95% CI 3.74-8.23), compared with matched controls. Suicide attempt was associated with anorexia nervosa (HR 3.57, 95% CI 1.78-7.17) and bulimia nervosa and other eating disorders (HR 8.55, 95% CI 5.48-13.32). Associations were pronounced in girls with repeated suicide attempts. Girls who attempted suicide through self-poisoning had an elevated risk of anorexia nervosa, whereas girls who used violent methods such as cutting or piercing had a greater risk of bulimia nervosa and other eating disorders. Suicide attempt was strongly associated with eating disorder hospitalization in the year following the attempt, but associations persisted throughout follow-up. DISCUSSION Suicide attempt admission is associated with the long-term risk of eating disorder hospitalization in adolescent girls. PUBLIC SIGNIFICANCE This study of adolescent girls suggests that suicide attempt admission is associated with the long-term risk of hospitalization for eating disorders. The risk is greatest in the year after the attempt, but persists over time. Adolescents who present with a suicide attempt may benefit from screening for eating disorders and long-term follow-up to help prevent the exacerbation or development of eating disorders.
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Affiliation(s)
- Safiya Soullane
- Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Mimi Israël
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Howard Steiger
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Nicholas Chadi
- Department of Pediatrics, Sainte-Justine University Hospital Centre, Montreal, Quebec, Canada
| | - Nancy Low
- Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Ron Dewar
- Cancer Care Program, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Aimina Ayoub
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
| | - Nathalie Auger
- University of Montreal Hospital Research Centre, Montreal, Quebec, Canada
- Institut national de santé publique du Québec, Montreal, Quebec, Canada
- Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada
- Department of Social and Preventive Medicine, School of Public Health, University of Montreal, Montreal, Quebec, Canada
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5
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Cadwallader JS, Orri M, Barry C, Falissard B, Hassler C, Huas C. Description of patients with eating disorders by general practitioners: a cohort study and focus on co-management with depression. J Eat Disord 2023; 11:185. [PMID: 37858179 PMCID: PMC10585727 DOI: 10.1186/s40337-023-00901-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 09/27/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND International guidelines often state that general practitioners (GPs) provide early management for most patients with eating disorders (EDs). GP management of EDs has not been studied in France. Depressive disorders are often a comorbidity of EDs. The aims of this study were to describe in France the characteristics of people with all subcategories of EDs (Anorexia Nervosa, Bulimia Nervosa, ED Not Otherwise Specified) managed by their GPs and to study the management temporality between depression and all subcategories of EDs. METHODS Retrospective cohort study of patients with EDs visiting French GPs. Data collected from 1994 through 2009 were extracted from the French society of general electronic health record. A descriptive analysis of the population focused on depression, medication such as antidepressants and anxiolytics, and the management temporality between depression and EDs. RESULTS 1310 patients aged 8 years or older were seen at least once for an ED by a GP participating in the database out of 355,848 patients, with a prevalence rate of 0.3%. They had a mean age of 35.19 years, 82.67% were women. 41.6% had anorexia nervosa, 26.4% bulimia nervosa, and 32% an ED not otherwise specified. Overall, 32.3% had been managed at least once for depression, and 18.4% had been prescribed an antidepressant of any type at least once. Benzodiazepines had been prescribed at least once for 73.9% of the patients treated for depression. Patients with an ED seen regularly by their GP ("during" profile) received care for depression more frequently than those with other profiles. 60.9% had a single visit with the participating GP for their ED Treatment and management for depression did not precede care for EDs. CONCLUSIONS Data extracted from the French society of general practice were the only one available in France in primary care about EDs and our study was the only one on this topic. The frequency of visits for EDs was very low in our general practice-based sample. Depressive disorders were a frequent comorbidity of EDs. GPs could manage common early signs of depression and EDs, especially if they improved their communication skills and developed collaborative professional management.
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Affiliation(s)
- Jean Sébastien Cadwallader
- School of Medicine, Department of General Practice, Sorbonne Université, Paris, France.
- INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Sorbonne Université, Paris, France.
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France.
| | - Massimiliano Orri
- McGill Group for Suicide Studies, Department of Psychiatry, Douglas Mental Health University Institute, McGill University, Montréal, QC, Canada
- Bordeaux Population Health Research Centre, INSERM U1219, University of Bordeaux, Bordeaux, France
| | - Caroline Barry
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Bruno Falissard
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Christine Hassler
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
| | - Caroline Huas
- INSERM, UMR 1018, Centre de Recherche en Épidémiologie et Santé des Populations (CESP), Paris-Saclay University, Paul Brousse Hospital, Villejuif Cedex, France
- Fondation Santé des Etudiants de France (FSEF), Service Hospitalo-Universitaire de Santé Mentale de l'Adolescent et du Jeune Adulte (SAMAJA), Paris, France
- Department of Family Medicine, Faculty of Health Sciences Simone Veil, University Versailles-Saint-Quentin-en-Yvelines (UVSQ), 78180, Montigny le Bretonneux, France
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6
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Ramsewak S, Moty N, Putteeraj M, Somanah J, Nirmala LP. Parenting style and its effect on eating disorders and substance abuse across the young population. DISCOVER PSYCHOLOGY 2022. [PMCID: PMC8802280 DOI: 10.1007/s44202-022-00025-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
This article attempts to examine the occurrence of two behavioural changes, namely, substance abuse and eating disorders in order of onset mediated by ineffective parenting styles during young age. The four parenting styles and their consequential behavioural adverse effects are taken as the focal point of this study and are synthesized to provide an outlook on the status of ineffective parenting and deviant offspring behaviours. A review of literature was primarily undertaken to examine the characteristic features of ineffective parenting. A causal relationship was then drawn between the onset of behavioural disorders with an emphasis on substance abuse and eating disorders, along the parenting spectrum. We probed into the order and directionality of the offspring behavioural changes against ineffective parenting. The current available data shows the superimposition of the parenting style spectrum on a bell-shaped distribution of behavioural outcomes as exemplified by authoritarian, permissive and neglectful parenting as a prime determinant of several disorders among the young age; parenting styles being at the extremities of the parenting spectrum. The sweet spot of parenting, mainly associated to the authoritative approach, bears the most positive effect on the growing child. The extreme ends of parenting as per the varying degree of responsiveness and demandingness, generally observed in authoritarian and neglectful parenting precipitate concomitant deviant behaviours cascading from one another; intricately linking substance abuse and eating disorders. A number of studies describe the isolated effects of ineffective parenting on the development of substance abuse and eating disorders during the adolescent period. However, the relationship between both eating disorders and substance abuse is underplayed and need to be stressed upon to tailor behaviour-specific targeted therapies and restore the normalcy of these altered behaviours. How the parenting style adopted can lead to a concurrent amalgam of disordered eating patterns and substance abuse. How disordered eating behaviours and substance abuse are initiated as coping strategies to deal with the consequences of poor parenting. Isolation of specific risk factors to deter the development of those deviant behaviours in addition to improvement of parenting methods.
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Affiliation(s)
- Shalina Ramsewak
- Psychiatry Department, A.G. Jeetoo Hospital, Port-Louis, Mauritius
| | - Numrata Moty
- Faculty of Law, University of Mauritius, Reduit, Mauritius
| | - Manish Putteeraj
- School of Health Sciences, University of Technology, Port-Louis, Mauritius
| | - Jhoti Somanah
- School of Health Sciences, University of Technology, Port-Louis, Mauritius
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Oberle CD, Marcell HS, Noebel NA. Orthorexia nervosa and substance use for the purposes of weight control, conformity, and emotional coping. Eat Weight Disord 2022; 27:553-561. [PMID: 33866529 DOI: 10.1007/s40519-021-01190-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/05/2021] [Indexed: 01/13/2023] Open
Abstract
PURPOSE Orthorexia nervosa (ON), characterized by extreme behaviors driven by the goal of eating only healthy and pure foods, could plausibly be associated with avoidance of nicotine, alcohol, and illicit drugs. However, findings from the limited research on these relationships are mixed, and other eating disorders are associated with greater substance abuse. METHOD An online survey was completed by 471 participants (86% women, mean age = 20) recruited from undergraduate courses and through an Instagram advertisement. The questionnaires assessed ON symptomatology; frequency of smoking, alcohol consumption, and illicit drug use; abuse of these substances; and motivations for using these substances. RESULTS ON scores were not significantly related to the level of use or abuse of nicotine, alcohol, or most illicit drugs. Yet, ON scores were positively correlated with frequency of using illicit depressant drugs. Further, among substance users, ON scores were positively associated with smoking or vaping for the purpose of weight control, and with consuming alcohol and using illicit drugs for the purposes of conformity and coping with such negative emotions as anxiety and depression. CONCLUSION Although people who are high in ON symptomatology may be at least partly driven by a strong desire to be as healthy as possible, they are not less likely to use potentially harmful drugs. Instead, many of them may even turn to certain drugs for the same weight control and emotional-coping motives that guide the behaviors of individuals with other eating disorders. LEVEL OF EVIDENCE Level V, descriptive cross-sectional study.
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Affiliation(s)
- Crystal D Oberle
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA.
| | - Haley S Marcell
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
| | - Natalie A Noebel
- Department of Psychology, Texas State University, 601 University Dr., San Marcos, TX, 78666, USA
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Mellentin AI, Skøt L, Guala MM, Støving RK, Ascone L, Stenager E, Mejldal A. Does receiving an eating disorder diagnosis increase the risk of a subsequent alcohol use disorder? A Danish nationwide register-based cohort study. Addiction 2022; 117:354-367. [PMID: 34251067 DOI: 10.1111/add.15639] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 12/01/2020] [Accepted: 06/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM No large-scale, longitudinal clinical study has examined whether patients with different types of eating disorders (ED) have an increased risk of a subsequent alcohol use disorder (AUD). This study aimed to assess the ongoing risk of receiving a diagnosis of AUD following a first-time diagnosis of anorexia nervosa (AN), bulimia nervosa (BN), or unspecified ED (USED). DESIGN Retrospective cohort study. SETTING Danish nationwide registries, January 1994 to December 2018. PARTICIPANTS A total of 20 759 ED patients and 83 036 controls were followed from the date of first ED diagnosis (index date) until the date of first AUD diagnosis, death, emigration, or the end of the study. Controls were selected in a 1:4 ratio and matched on month and year of birth, gender and ethnicity. MEASUREMENTS We obtained data on ED (AN, BN, USED; exposure) and AUD (abuse/dependence; outcome) diagnoses as well as sociodemographics and other psychiatric diagnoses. Time to AUD was generated from the index date. Risk of AUD after the index date was assessed among those without a prior AUD diagnosis while adjusting for sociodemographics and prior psychiatric diagnoses. FINDINGS Compared with controls, an increased relative risk of AUD after the index date was observed in AN patients throughout the study lasting 15 + years (adjusted hazard ratios [HRs] ranging from 2.49 [99% CI = 1.46, 4.25] to 6.83 [2.84, 16.41]), in BN patients during the first year of follow-up and from 2 years onward (2.72 [1.66, 4.44] to 17.44 [6.01, 50.63]), and in USED patients during the first year and 2-15 years of follow-up (2.52 [1.54, 4.14] to 14.17 [5.86, 34.27]). In all three groups, estimates were highest during the first year, particularly among BN patients. CONCLUSIONS Patients with anorexia nervosa, bulimia nervosa, or unspecified eating disorders appear to have an increased ongoing risk of receiving a diagnosis of alcohol use disorder following their first eating disorder diagnosis compared with controls.
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Affiliation(s)
- Angelina Isabella Mellentin
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Research Unit for Telepsychiatry and E-Mental Health, Center for Telepsychiatry, Region of Southern Denmark, Odense C, Denmark.,Brain Research-Inter-Disciplinary Guided Excellence (BRIDGE), Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lotte Skøt
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Maria Mercedes Guala
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Eating Disorders, Odense University Hospital, Odense C, Denmark
| | - René Klinkby Støving
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark.,Center for Eating Disorders, Odense University Hospital, Odense C, Denmark.,Research Unit for Medical Endocrinology, Institute of Clinical Research, University of South Denmark, Odense C, Denmark
| | - Leonie Ascone
- Neuroplasticity Research Group, Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Elsebeth Stenager
- Unit for Psychiatric Research, Department of Regional Health Services Research, University of Southern Denmark, 6200 Aabenraa, Denmark
| | - Anna Mejldal
- Unit for Psychiatric Research, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
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9
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Devoe DJ, Dimitropoulos G, Anderson A, Bahji A, Flanagan J, Soumbasis A, Patten SB, Lange T, Paslakis G. The prevalence of substance use disorders and substance use in anorexia nervosa: a systematic review and meta-analysis. J Eat Disord 2021; 9:161. [PMID: 34895358 PMCID: PMC8666057 DOI: 10.1186/s40337-021-00516-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/25/2021] [Indexed: 12/24/2022] Open
Abstract
AIM Individuals with anorexia nervosa (AN) often present with substance use and substance use disorders (SUDs). However, the prevalence of substance use and SUDs in AN has not been studied in-depth, especially the differences in the prevalence of SUDs between AN types [e.g., AN-R (restrictive type) and AN-BP (binge-eating/purge type]. Therefore, this systematic review and meta-analysis aimed to assess the prevalence of SUDs and substance use in AN samples. METHOD Systematic database searches of the peer-reviewed literature were conducted in the following online databases: MEDLINE, PsycINFO, Embase, and CINAHL from inception to January 2021. We restricted review eligibility to peer-reviewed research studies reporting the prevalence for either SUDs or substance use in individuals with AN. Random-effects meta-analyses using Freeman-Tukey double arcsine transformations were performed on eligible studies to estimate pooled proportions and 95% confidence intervals (CIs). RESULTS Fifty-two studies met the inclusion criteria, including 14,695 individuals identified as having AN (mean age: 22.82 years). Random pooled estimates showed that substance use disorders had a 16% prevalence in those with AN (AN-BP = 18% vs. AN-R = 7%). Drug abuse/dependence disorders had a prevalence of 7% in AN (AN-BP = 9% vs. AN-R = 5%). In studies that looked at specific abuse/dependence disorders, there was a 10% prevalence of alcohol abuse/dependence in AN (AN-BP = 15% vs. AN-R = 3%) and a 6% prevalence of cannabis abuse/dependence (AN-BP = 4% vs. AN-R = 0%). In addition, in terms of substance use, there was a 37% prevalence for caffeine use, 29% prevalence for alcohol use, 25% for tobacco use, and 14% for cannabis use in individuals with AN. CONCLUSION This is the most comprehensive meta-analysis on the comorbid prevalence of SUDs and substance use in persons with AN, with an overall pooled prevalence of 16%. Comorbid SUDs, including drugs, alcohol, and cannabis, were all more common in AN-BP compared to AN-R throughout. Therefore, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN. Finally, clinicians should consider screening for SUDs and integrating treatments that target SUDs in individuals with AN. Individuals with anorexia nervosa (AN) may also present with substance use or have a substance use disorder (SUDs). Thus, we conducted a systematic review and meta-analysis to determine the prevalence of substance use and substance use disorders in individuals with AN. We examined published studies that reported the prevalence of either substance use or SUDs in individuals with AN. We found that substance use disorders had a 16% prevalence and that drug abuse/dependence disorders had a prevalence of 7% in those with AN. These rates were much higher in individuals with binge-eating/purging type compared to the restrictive AN. However, many specific substance use disorders and substance use types were low in individuals with AN. Nonetheless, clinicians should be aware of the high prevalence of SUD comorbidity and substance use in individuals with AN.
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Affiliation(s)
- Daniel J Devoe
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Gina Dimitropoulos
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
- Faculty of Social Work, University of Calgary, Calgary, Canada
| | - Alida Anderson
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Anees Bahji
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Jordyn Flanagan
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Andrea Soumbasis
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Scott B Patten
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Tom Lange
- Department of Psychiatry, Cumming School of Medicine, Mathison Centre for Mental Health Research and Education, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada
| | - Georgios Paslakis
- Ruhr-University Bochum, University Clinic for Psychosomatic Medicine and Psychotherapy, Campus East-Westphalia, Lübbecke, Germany
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10
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Steinhausen H, Villumsen MD, Hørder K, Winkler LA, Bilenberg N, Støving RK. Comorbid mental disorders during long-term course in a nationwide cohort of patients with anorexia nervosa. Int J Eat Disord 2021; 54:1608-1618. [PMID: 34145619 PMCID: PMC8453938 DOI: 10.1002/eat.23570] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 06/14/2021] [Accepted: 06/14/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Comorbid mental disorders in anorexia nervosa during long-term course require detailed studies. METHOD This matched cohort study was based on nationwide Danish register data of all patients born 1961-2008 with a first-time ICD-10 diagnosis of anorexia nervosa (AN) between 1994 and 2018 at age 8-32 and matched controls taken from all individuals without an eating disorder (ED). For nine categories of non-eating mental disorders, time from date of first AN-diagnosis (inclusion date) to time of first diagnosis, accounting for censoring, was studied by use of time-stratified Cox models. RESULTS A total of 9,985 patients with AN (93.5% females) and 49,351 matched controls were followed for a median (IQR) of 9.0 (4.4-15.7) years. For patients, there was about 25% and 55% risk of receiving any non-ED disorder during the first 2 years and two decades after inclusion, respectively. A hazard ratio (HR) of seven for any non-ED was found for the first 12 months after inclusion, a ratio that reduced to two at five or more years after inclusion. During the first years, large HRs ranging in 6-9 were found for affective, autism spectrum, personality, and obsessive-compulsive disorders with the latter displaying the highest continuous increased risk. The HR at 12 months after inclusion was highest for any non-ED disorder and affective disorders in patients aged 8-13 at diagnosis. DISCUSSION Comorbid mental disorders in AN are most frequently diagnosed in the first years after diagnosis of AN and on longer terms imply a double immediate risk.
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Affiliation(s)
- Hans‐Christoph Steinhausen
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark,Child and Adolescent Mental Health CentreCapital Region PsychiatryCopenhagenDenmark,Department of Child and Adolescent PsychiatryPsychiatric University Hospital of ZurichSwitzerland,Clinical Psychology and Epidemiology, Institute of PsychologyUniversity of BaselSwitzerland
| | - Martin Dalgaard Villumsen
- Department of Epidemiology, Biostatistics, and Biodemography, Institute of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Kirsten Hørder
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark
| | - Laura Al‐Dakhiel Winkler
- Center for Eating DisordersOdense University HospitalOdenseDenmark,OPEN – Open Patient Data Explorative NetworkOdense University HospitalDenmark,Psychiatric Services in the Region of Southern DenmarkOdenseDenmark
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health Odense, Mental Health Services in the Region of Southern DenmarkUniversity of Southern DenmarkOdenseDenmark,Psychiatric Services in the Region of Southern DenmarkOdenseDenmark
| | - René Klinkby Støving
- Center for Eating DisordersOdense University HospitalOdenseDenmark,OPEN – Open Patient Data Explorative NetworkOdense University HospitalDenmark,Psychiatric Services in the Region of Southern DenmarkOdenseDenmark,Endocrine Research UnitOdense University HospitalDenmark
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11
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Williams H, Moxley K, Macharia M, Kidd M, Jordaan GP. Eating disorders and substance use at a South African tertiary hospital over a 21-year period. S Afr J Psychiatr 2020; 26:1421. [PMID: 32670633 PMCID: PMC7343936 DOI: 10.4102/sajpsychiatry.v26i0.1421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 03/05/2020] [Indexed: 11/24/2022] Open
Abstract
Background Eating disorders (EDs) and substance-related disorders pose a challenge when they co-occur and have implications for patient management. Clinical information on EDs and substance-related disorders as independent disorders is fairly well established in South Africa, but our understanding of the coexistence of these disorders is limited. Aim To determine the prevalence, the concurrent nature and the possible trends of substance use among patients diagnosed with EDs at a South African tertiary hospital over a 21-year period. Setting The ED unit at Tygerberg Hospital, Cape Town, South Africa. Methods We performed a retrospective chart review of 162 patients who were treated for EDs between January 1993 and December 2014. Results The prevalence of ED subtypes was 40.1% bulimia nervosa (BN), 33.3% EDs not otherwise specified (EDNOS) and 26.5% anorexia nervosa. Most participants (71.0%) used at least one substance. Alcohol was the most prevalent substance of choice (54.8%). Most patients had an additional psychiatric disorder (62.3%), of which major depressive disorder was the most prevalent (46.3%). Apart from the use of alcohol and cannabis, which remained consistent, the use of most other substances as well as the prevalence of BN declined during the study period. Conclusion Understanding the prevalence and trends of EDs and the corresponding patterns of substance misuse is essential to improve service provision. This study emphasises the need to better understand the ongoing and changing behavioural trends in EDs to improve patient management.
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Affiliation(s)
- Hannelie Williams
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Karis Moxley
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Muiruri Macharia
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Martin Kidd
- Centre for Statistical Consultation, Department of Statistics and Actuarial Sciences, Stellenbosch University, Cape Town, South Africa
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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12
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Lozano-Madrid M, Clark Bryan D, Granero R, Sánchez I, Riesco N, Mallorquí-Bagué N, Jiménez-Murcia S, Treasure J, Fernández-Aranda F. Impulsivity, Emotional Dysregulation and Executive Function Deficits Could Be Associated with Alcohol and Drug Abuse in Eating Disorders. J Clin Med 2020; 9:jcm9061936. [PMID: 32575816 PMCID: PMC7355820 DOI: 10.3390/jcm9061936] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 06/17/2020] [Accepted: 06/18/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Empirical data suggests a high comorbid occurrence of eating disorders (EDs) and substance use disorders (SUDs), as well as neurological and psychological shared characteristics. However, no prior study has identified the neuropsychological features of this subgroup. This study examines the prevalence of alcohol and/or drug abuse (A/DA) symptoms in ED patients. It also compares the clinical features and neuropsychological performance of ED patients with and without A/DA symptoms. Methods: 145 participants (74.5% females) with various forms of diagnosed EDs underwent a comprehensive clinical (TCI-R, SCL-90-R and EDI-2) and neuropsychological assessment (Stroop, WCST and IGT). Results: Approximately 19% of ED patients (across ED subtypes) had A/DA symptoms. Those with A/DA symptoms showed more impulsive behaviours and higher levels of interoceptive awareness (EDI-2), somatisation (SCL-90-R) and novelty seeking (TCI-R). This group also had a lower score in the Stroop-words measure, made more perseverative errors in the WCST and showed a weaker learning trajectory in the IGT. Conclusions: ED patients with A/DA symptoms display a specific phenotype characterised by greater impulsive personality, emotional dysregulation and problems with executive control. Patients with these temperamental traits may be at high risk of developing a SUD.
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Affiliation(s)
- María Lozano-Madrid
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.L.-M.); (I.S.); (N.R.); (S.J.-M.)
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
| | - Danielle Clark Bryan
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (D.C.B.); (J.T.)
| | - Roser Granero
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
- Departament de Psicobiologia i Metodologia. Universitat Autònoma de Barcelona, 08035 Barcelona, Spain
| | - Isabel Sánchez
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.L.-M.); (I.S.); (N.R.); (S.J.-M.)
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
| | - Nadine Riesco
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.L.-M.); (I.S.); (N.R.); (S.J.-M.)
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
| | - Núria Mallorquí-Bagué
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
- Department of Psychiatry, Addictive Behavior Unit, Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau, 08001 Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.L.-M.); (I.S.); (N.R.); (S.J.-M.)
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
| | - Janet Treasure
- Department of Psychological Medicine, Section of Eating Disorders, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, SE5 8AF London, UK; (D.C.B.); (J.T.)
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain; (M.L.-M.); (I.S.); (N.R.); (S.J.-M.)
- Psychiatry and Mental Health Group, Neuroscience Program, Institut d’Investigació Biomèdica de Bellvitge—IDIBELL, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Ciber Fisiopatologia Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, 28029 Madrid, Spain; (R.G.); (N.M.-B.)
- Department of Clinical Sciences, School of Medicine and Health Sciences, University of Barcelona, 08907 L’Hospitalet de Llobregat, Barcelona, Spain
- Correspondence: ; Tel.: +34-93-2607227; Fax: +34-93-2607193
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13
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Mousavi A, Askari N, Vaez-Mahdavi MR. Augmentation of morphine-conditioned place preference by food restriction is associated with alterations in the oxytocin/oxytocin receptor in rat models. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2020; 46:304-315. [PMID: 31609135 DOI: 10.1080/00952990.2019.1648483] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Studies indicate that food restriction (FR) reinforces the effects of morphine. The exact mechanisms by which FR influences the reward circuitry of morphine have not yet been determined. OBJECTIVES We hypothesized that the effects of FR on the oxytocin (OXT) system and HPA axis can be associated with substance abuse disorders. In this study, the serum levels of OXT and corticosterone, and the expression of OXT/OXT receptor (OXTR), glucocorticoid receptor (GR), and brain-derived neurotrophic factor (BDNF) in the hippocampus, prefrontal cortex, and nucleus accumbens were investigated in an FR model. METHODS First, the male rats (n = 8 per group) were subjected to FR for 3 weeks. Then, morphine-induced conditioned place preference (CPP) was observed using two doses of morphine (3 and 5 mg/kg). The serum concentrations of corticosterone and OXT were determined by ELISA and the expression of genes was examined by qPCR. RESULTS FR induced an enhanced preference in the animals for the 5 mg/kg dose of morphine compared to the controls. Serum corticosterone levels increased after FR but OXT levels decreased. Meanwhile, FR actuated downregulation of GR, BDNF, and OXT genes, while inducing the overexpression of OXTR. CONCLUSION We propose the inclusion of OXT and OXTR alterations in the enhancement of morphine-induced CPP and addiction vulnerability following FR. Moreover, we conclude that altered BDNF levels and HPA axis activity may be the mechanisms involved in the effects of FR on morphine-induced behavior.
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Affiliation(s)
- Ali Mousavi
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman , Kerman, I.R. Iran
| | - Nayere Askari
- Department of Biology, Faculty of Sciences, Shahid Bahonar University of Kerman , Kerman, I.R. Iran.,Immunoregulation Research Center, Shahed University , Tehran, I.R. Iran
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14
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Sebastiani G, Andreu-Fernández V, Herranz Barbero A, Aldecoa-Bilbao V, Miracle X, Meler Barrabes E, Balada Ibañez A, Astals-Vizcaino M, Ferrero-Martínez S, Gómez-Roig MD, García-Algar O. Eating Disorders During Gestation: Implications for Mother's Health, Fetal Outcomes, and Epigenetic Changes. Front Pediatr 2020; 8:587. [PMID: 33042925 PMCID: PMC7527592 DOI: 10.3389/fped.2020.00587] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022] Open
Abstract
Introduction: Eating disorders (EDs) have increased globally in women of childbearing age, related to the concern for body shape promoted in industrialized countries. Pregnancy may exacerbate a previous ED or conversely may be a chance for improving eating patterns due to the mother's concern for the unborn baby. EDs may impact pregnancy evolution and increase the risk of adverse outcomes such as miscarriage, preterm delivery, poor fetal growth, or malformations, but the knowledge on this topic is limited. Methods: We performed a systematic review of studies on humans in order to clarify the mechanisms underpinning the adverse pregnancy outcomes in patients with EDs. Results: Although unfavorable fetal development could be multifactorial, maternal malnutrition, altered hormonal pathways, low pre-pregnancy body mass index, and poor gestational weight gain, combined with maternal psychopathology and stress, may impair the evolution of pregnancy. Environmental factors such as malnutrition or substance of abuse may also induce epigenetic changes in the fetal epigenome, which mark lifelong health concerns in offspring. Conclusions: The precocious detection of dysfunctional eating behaviors in the pre-pregnancy period and an early multidisciplinary approach comprised of nutritional support, psychotherapeutic techniques, and the use of psychotropics if necessary, would prevent lifelong morbidity for both mother and fetus. Further prospective studies with large sample sizes are needed in order to design a structured intervention during every stage of pregnancy and in the postpartum period.
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Affiliation(s)
- Giorgia Sebastiani
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Vicente Andreu-Fernández
- Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Valencian International University (VIU), Valencia, Spain
| | - Ana Herranz Barbero
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Victoria Aldecoa-Bilbao
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Xavier Miracle
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Eva Meler Barrabes
- Fetal i+D Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Déu), IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Arantxa Balada Ibañez
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Marta Astals-Vizcaino
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Silvia Ferrero-Martínez
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - María Dolores Gómez-Roig
- Hospital Sant Joan de Déu, Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain
| | - Oscar García-Algar
- Neonatal Unit, Hospital Clinic-Maternitat, Institut Clinic de Ginecologia, Obstetricia i Neonatologia (ICGON), Barcelona Center for Maternal Fetal and Neonatal Medicine (BCNatal), Barcelona, Spain.,Grup de Recerca Infancia i Entorn (GRIE), Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
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15
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Abstract
BACKGROUND: Eating disorders seriously affect both physical health and psychosocial functioning. Breaking the confines of an eating disorder requires engagement in a multifaceted recovery process. OBJECTIVE: This article provides a synthesis of 12 qualitative research studies with various eating disordered populations (anorexia nervosa, bulimia nervosa, binge eating disorder, eating disorder not otherwise specified, and other specified feeding and eating disorders) to elucidate the recovery process from the perspective of those who have overcome the disease. METHOD: A metasynthesis of qualitative studies was conducted using Noblit and Hare's metaethnographic methodology. RESULTS: Five overarching themes emerged from the data: (1) the eating disorder as a life jacket, (2) drowning: recognizing consequences, (3) treading the surface: contemplating recovery, (4) swimming: the path toward recovery, and (5) reaching recovery: a sense of freedom. CONCLUSIONS: Eating disorder treatment often entails a cycle of transitions before recovery occurs. Synthesizing the experiences from the perspective of individuals who have overcome an eating disorder presents a unique understanding of the treatment and recovery process.
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Affiliation(s)
- Carrie Morgan Eaton
- Carrie Morgan Eaton, PhD, MSN, RNC-OB, C-EFM, CHSE, University of Connecticut, Storrs, CT, USA
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16
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Himmerich H, Hotopf M, Shetty H, Schmidt U, Treasure J, Hayes RD, Stewart R, Chang CK. Psychiatric comorbidity as a risk factor for mortality in people with anorexia nervosa. Eur Arch Psychiatry Clin Neurosci 2019; 269:351-359. [PMID: 30120534 DOI: 10.1007/s00406-018-0937-8] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 08/09/2018] [Indexed: 12/27/2022]
Abstract
Anorexia nervosa (AN) is found associated with increased mortality. Frequent comorbidities of AN include substance use disorders (SUD), affective disorders (AD) and personality disorders (PD). We investigated the influence of these psychiatric comorbidities on all-cause mortality with demographic and socioeconomic factors considered as confounders in the observation window between January 2007 and March 2016 for 1970 people with AN, using data from the case register of the South London and Maudsley (SLaM) NHS Foundation Trust, an almost monopoly-secondary mental healthcare service provider in southeast London. We retrieved data from its Clinical Records Interactive Search (CRIS) system as data source. Mortality was ascertained through nationwide tracing by the UK Office for National Statistics (ONS) linked to CRIS database on a monthly basis. A total of 43 people with AN died during the observation period. Standardized Mortality Ratio (SMR) with England and Wales population in 2012 as standard population for our study cohort was 5.21 (95% CI 3.77, 7.02). In univariate analyses, the comorbidity of SUD or PD was found to significantly increase the relative risks of mortality (HRs = 3.10, 95% CI 1.21, 7.92; and 2.58, 95% CI 1.23, 5.40, respectively). After adjustment for demographic and socioeconomic covariates as confounders, moderately but not significantly elevated risks were identified for SUD (adjusted HR = 1.39, 95% CI 0.53, 3.65) and PD (adjusted HR = 1.58, 95% CI 0.70, 3.56). These results suggest an elevated mortality in people with AN, which might be, at least partially, explained by the existence of the comorbidities SUD or PD.
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Affiliation(s)
- Hubertus Himmerich
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Matthew Hotopf
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Hitesh Shetty
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ulrike Schmidt
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Janet Treasure
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Richard D Hayes
- Department of Psychological Medicine, King's College London, London, UK
| | - Robert Stewart
- Department of Psychological Medicine, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Chin-Kuo Chang
- Department of Psychological Medicine, King's College London, London, UK. .,South London and Maudsley NHS Foundation Trust, London, UK. .,Department of Health and Welfare, University of Taipei, No. 101, Sec. 2, Jhongcheng Rd, Shilin District, Taipei, 111, Taiwan.
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17
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Scolnick B. Hypothesis: Clues From Mammalian Hibernation for Treating Patients With Anorexia Nervosa. Front Psychol 2018; 9:2159. [PMID: 30483182 PMCID: PMC6240652 DOI: 10.3389/fpsyg.2018.02159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 10/19/2018] [Indexed: 12/30/2022] Open
Abstract
This hypothesis is that anorexia nervosa (AN) is a biologically driven disorder, and mammalian hibernation may offer clues to its pathogenesis. Using this approach, this hypothesis offers suggestions for employing heart rate variability as an early diagnostic test for AN; employing the ketogenic diet for refeeding patients, attending to omega 3:6 ratio of polyunsaturated fatty acids (PUFAs) in the refeeding diet; and exploring clinical trials of the endocannabinoid-like agent, palmitoylethanolamde for patients with AN. This hypothesis also explores the role of lipids and autoimmune phenomena in AN, and suggest a lipodomics study to search for antibodies in the serum on patients with AN.
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Affiliation(s)
- Barbara Scolnick
- Psychology and Brain Science, Boston University, Boston, MA, United States
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18
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Flores-Fresco MJ, Blanco-Gandía MDC, Rodríguez-Arias M. Alteraciones de la Conducta Alimentaria en Pacientes con Trastorno por Abuso de Sustancias. CLINICA Y SALUD 2018. [DOI: 10.5093/clysa2018a18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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19
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Which Comes First? An Examination of Associations and Shared Risk Factors for Eating Disorders and Suicidality. Curr Psychiatry Rep 2018; 20:77. [PMID: 30094518 DOI: 10.1007/s11920-018-0931-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW This narrative review evaluates recent literature on the associations between eating disorders and suicidality and discusses potential shared mechanisms that may account for these relationships. Additionally, the review highlights shortcomings with the literature to date and suggests avenues for future research. RECENT FINDINGS Individuals with anorexia nervosa, bulimia nervosa, and binge eating disorder experience elevated rates of suicidality compared to the general population. Suicide risk is higher when eating disorders occur with other psychological conditions. Additionally, genetic factors, emotion dysregulation, trauma, stressful life events, and lack of body regard may have roles in the development of both eating disorders and suicidality. Much of the risk for suicidality in eating disorders appears to be driven by comorbid psychopathology and genetic factors. However, the lack of longitudinal research makes it difficult to draw conclusions about the directionality or temporality of these relations; thus, novel methods are needed.
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del Pino-Gutiérrez A, Jiménez-Murcia S, Fernández-Aranda F, Agüera Z, Granero R, Hakansson A, Fagundo AB, Bolao F, Valdepérez A, Mestre-Bach G, Steward T, Penelo E, Moragas L, Aymamí N, Gómez-Peña M, Rigol-Cuadras A, Martín-Romera V, Menchón JM. The relevance of personality traits in impulsivity-related disorders: From substance use disorders and gambling disorder to bulimia nervosa. J Behav Addict 2017; 6:396-405. [PMID: 28838248 PMCID: PMC5700725 DOI: 10.1556/2006.6.2017.051] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background and aims The main aim of this study was to analyze and describe the clinical characteristics and shared personality traits in different impulsivity-compulsivity spectrum disorders: substance use disorders (SUD), gambling disorder (GD), and bulimia nervosa (BN). The specific aims were to compare personality differences among individuals with pure SUD, BN with and without SUD, and GD with and without SUD. In addition, we assessed the differential predictive capacity of clinical and personality variables in relation to diagnostic subtype. Methods The sample comprised 998 subjects diagnosed according to DSM-IV-TR criteria: 101 patients were diagnosed with SUD, 482 with GD, 359 with BN, 11 with GD + SUD, and 45 patients with BN + SUD. Various assessment instruments were administered, as well as other clinical measures, to evaluate their predictive capacity. Results Marked differences in personality traits were observed between groups. Novelty seeking, harm avoidance, self-directedness, cooperation, and self-transcendence best differentiated the groups. Notably, novelty seeking was significantly higher in the two dual pathology subgroups. Patients with dual pathology showed the most dysfunctional personality profiles. Discussion and conclusion Our results indicate the existence of shared dysfunctional personality traits among the groups studied, especially in novelty seeking and self-directedness.
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Affiliation(s)
- Amparo del Pino-Gutiérrez
- Department of Nursing in Public Health, Mental Health, and Maternal and Child Health, School of Nursing, University of Barcelona, Barcelona, Spain,Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Susana Jiménez-Murcia
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Corresponding authors: Susana Jiménez-Murcia, PhD; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/Feixa Llarga s/n, L’Hospitalet de Llobregat, Barcelona 08907, Spain; Phone: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mail: ; Fernando Fernández-Aranda, PhD; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/Feixa Llarga s/n, L’Hospitalet de Llobregat, Barcelona 08907, Spain; Phone: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mail:
| | - Fernando Fernández-Aranda
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,Corresponding authors: Susana Jiménez-Murcia, PhD; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/Feixa Llarga s/n, L’Hospitalet de Llobregat, Barcelona 08907, Spain; Phone: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mail: ; Fernando Fernández-Aranda, PhD; Department of Psychiatry, Bellvitge University Hospital-IDIBELL, c/Feixa Llarga s/n, L’Hospitalet de Llobregat, Barcelona 08907, Spain; Phone: +34 93 260 79 88; Fax: +34 93 260 76 58; E-mail:
| | - Zaida Agüera
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Roser Granero
- Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain,Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Anders Hakansson
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Ana B. Fagundo
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Ferran Bolao
- Department of Internal Medicine, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Ana Valdepérez
- Department of Psychiatry, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Gemma Mestre-Bach
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Trevor Steward
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Ciber Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto de Salud Carlos III, Barcelona, Spain
| | - Eva Penelo
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laura Moragas
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Neus Aymamí
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Mónica Gómez-Peña
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain
| | - Assumpta Rigol-Cuadras
- Department of Nursing in Public Health, Mental Health, and Maternal and Child Health, School of Nursing, University of Barcelona, Barcelona, Spain
| | - Virginia Martín-Romera
- Departament de Psicobiologia i Metodologia, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - José M. Menchón
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, Barcelona, Spain,Departament of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain,CIBER Salud Mental (CIBERSAM), Instituto Carlos III, Barcelona, Spain
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21
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Wiss DA, Brewerton TD. Incorporating food addiction into disordered eating: the disordered eating food addiction nutrition guide (DEFANG). Eat Weight Disord 2017; 22:49-59. [PMID: 27943202 PMCID: PMC5334442 DOI: 10.1007/s40519-016-0344-y] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 11/16/2016] [Indexed: 12/18/2022] Open
Abstract
Although not formally recognized by the DSM-5, food addiction (FA) has been well described in the scientific literature. FA has emerged as a clinical entity that is recognized within the spectrum of disordered eating, particularly in patients with bulimia nervosa, binge-eating disorder and/or co-occurring addictive disorders and obesity. Integrating the concept of FA into the scope of disordered eating has been challenging for ED treatment professionals, since there is no well-accepted treatment model. The confusion surrounding the implications of FA, as well as the impact of the contemporary Westernized diet, may contribute to poor treatment outcomes. The purpose of this review is twofold. The first is to briefly explore the relationships between EDs and addictions, and the second is to propose a new model of conceptualizing and treating EDs that incorporates recent data on FA. Since treatment for EDs should vary based on individual assessment and diagnosis, the Disordered Eating Food Addiction Nutrition Guide (DEFANG) is presented as a tool for framing treatment goals and helping patients achieve sustainable recovery.
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Affiliation(s)
- David A Wiss
- Nutrition in Recovery LLC, 8549 Wilshire Blvd. #646, Beverly Hills, CA, 90211, USA.
| | - Timothy D Brewerton
- Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, 29425, USA
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22
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Ouyang J, Carcea I, Schiavo JK, Jones KT, Rabinowitsch A, Kolaric R, Cabeza de Vaca S, Froemke RC, Carr KD. Food restriction induces synaptic incorporation of calcium-permeable AMPA receptors in nucleus accumbens. Eur J Neurosci 2017; 45:826-836. [PMID: 28112453 PMCID: PMC5359088 DOI: 10.1111/ejn.13528] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 01/14/2017] [Accepted: 01/17/2017] [Indexed: 12/25/2022]
Abstract
Chronic food restriction potentiates behavioral and cellular responses to drugs of abuse and D-1 dopamine receptor agonists administered systemically or locally in the nucleus accumbens (NAc). However, the alterations in NAc synaptic transmission underlying these effects are incompletely understood. AMPA receptor trafficking is a major mechanism for regulating synaptic strength, and previous studies have shown that both sucrose and d-amphetamine rapidly alter the abundance of AMPA receptor subunits in the NAc postsynaptic density (PSD) in a manner that differs between food-restricted and ad libitum fed rats. In this study we examined whether food restriction, in the absence of reward stimulus challenge, alters AMPAR subunit abundance in the NAc PSD. Food restriction was found to increase surface expression and, specifically, PSD abundance, of GluA1 but not GluA2, suggesting synaptic incorporation of GluA2-lacking Ca2+-permeable AMPARs (CP-AMPARs). Naspm, an antagonist of CP-AMPARs, decreased the amplitude of evoked EPSCs in NAc shell, and blocked the enhanced locomotor response to local microinjection of the D-1 receptor agonist, SKF-82958, in food-restricted, but not ad libitum fed, subjects. Although microinjection of the D-2 receptor agonist, quinpirole, also induced greater locomotor activation in food-restricted than ad libitum fed rats, this effect was not decreased by Naspm. Taken together, the present findings are consistent with the synaptic incorporation of CP-AMPARs in D-1 receptor-expressing medium spiny neurons in NAc as a mechanistic underpinning of the enhanced responsiveness of food-restricted rats to natural rewards and drugs of abuse.
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Affiliation(s)
- Jiangyong Ouyang
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Ioana Carcea
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Otolaryngology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Neuroscience/Physiology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Jennifer K. Schiavo
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Otolaryngology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Neuroscience/Physiology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Kymry T. Jones
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Ariana Rabinowitsch
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Rhonda Kolaric
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Soledad Cabeza de Vaca
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Robert C. Froemke
- Skirball Institute of Biomolecular Medicine, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Otolaryngology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Neuroscience/Physiology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
| | - Kenneth D. Carr
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, New York 10016
- Department of Biochemistry and Molecular Pharmacology, New York University School of Medicine, 550 First Avenue, New York, New York 10016
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23
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Miller RJH, Chew D. Re-feeding syndrome and alcoholic cardiomyopathy: A case of interacting diagnoses. J Cardiol Cases 2016; 14:90-93. [PMID: 30546674 DOI: 10.1016/j.jccase.2016.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Revised: 04/14/2016] [Accepted: 04/29/2016] [Indexed: 11/19/2022] Open
Abstract
Re-feeding syndrome is an uncommon clinical entity of fluid and electrolyte disorders that typically occurs after re-initiation of enteral nutrition following prolonged fasting. This disorder can be complicated by left ventricular (LV) dysfunction, arrhythmias, and death. Alcohol abuse and anorexia nervosa are independently associated with similar complications. The interaction between these diagnoses can result in significant, but reversible, LV dysfunction. We present the case of a 69-year-old woman with a history of significant alcohol abuse and anorexia nervosa. The patient was admitted to hospital for the management of re-feeding syndrome, which was complicated by significant LV dysfunction. Her LV function normalized following a combination of electrolyte replacement, re-institution of feeding, and abstinence from alcohol. Re-feeding syndrome, anorexia nervosa, and alcohol abuse are conditions that commonly co-exist. These conditions may have a synergistic relationship, potentially resulting in a profound cardiomyopathy. Careful monitoring and aggressive electrolyte replacement may be helpful in identifying this complication and minimizing its potential harm. <Learning objective: Re-feeding syndrome can be complicated by significant myocardial dysfunction, particularly in patients with a history of alcohol abuse or anorexia nervosa, which independently cause cardiac dysfunction. Physicians should be aware of the risk of new cardiomyopathy in patients with these overlapping diagnoses. We review the case of a patient with these conditions who developed a significant reversible cardiomyopathy managed with re-institution of feeding and electrolyte replacement.>.
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Affiliation(s)
- Robert J H Miller
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Derek Chew
- Libin Cardiovascular Institute of Alberta, Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
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24
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Elmquist J, Shorey RC, Anderson SE, Temple JR, Stuart GL. The Relationship Between Eating Disorder Symptoms and Treatment Rejection among Young Adult Men in Residential Substance Use Treatment. SUBSTANCE ABUSE-RESEARCH AND TREATMENT 2016; 10:39-44. [PMID: 27257382 PMCID: PMC4877080 DOI: 10.4137/sart.s33396] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Revised: 03/29/2016] [Accepted: 03/29/2016] [Indexed: 11/05/2022]
Abstract
Research has demonstrated that individuals with substance use disorders (SUDs) and comorbid mental health problems evidence heightened negative consequences, including poorer treatment outcomes, a higher risk for relapse, and mortality compared to individuals with a single disorder. In this study, we focus on the comorbidity between SUDs and eating disorder (ED) symptomatology, as EDs are similarly associated with high rates of relapse, morbidity, and mortality. Of particular importance is research examining treatment rejection among individuals in treatment for SUDs with cooccurring ED symptomatology. This study seeks to add to the literature by examining treatment rejection among young adult men in residential treatment for SUDs (N = 68) with cooccurring ED symptomatology. Results from hierarchical regression analyses indicated that ED symptoms were significantly associated with treatment rejection after controlling for alcohol and drug use and problems and depression symptoms. Although this is a preliminary study, the results add to a growing body of research examining the comorbidity between SUDs and ED symptomatology. Future research examining this relationship is needed to further elucidate the treatment patterns among individuals with comorbid ED symptoms and substance use diagnoses.
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Affiliation(s)
- JoAnna Elmquist
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, TN, USA
| | - Ryan C Shorey
- Department of Psychology, Ohio University, Athens, OH, USA
| | | | - Jeff R Temple
- Department of OB/GYN, University of Texas Medical Branch Health, Galveston, TX, USA
| | - Gregory L Stuart
- Department of Psychology, The University of Tennessee, Knoxville, Knoxville, TN, USA
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25
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Gibbs EL, Kass AE, Eichen DM, Fitzsimmons-Craft EE, Trockel M, Wilfley DE, Taylor CB. Attention-deficit/hyperactivity disorder-specific stimulant misuse, mood, anxiety, and stress in college-age women at high risk for or with eating disorders. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2016; 64:300-308. [PMID: 26822019 PMCID: PMC4904716 DOI: 10.1080/07448481.2016.1138477] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To examine the misuse of attention-deficit/hyperactivity disorder (ADHD)-specific stimulants in a college population at high risk for or with clinical or subclinical eating disorders. PARTICIPANTS Four hundred forty-eight college-age women aged 18-25 at high risk for or with a clinical or subclinical eating disorder. METHODS Participants completed assessments of stimulant misuse and psychopathology from September 2009 to June 2010. RESULTS Greater eating disorder pathology, objective binge eating, purging, eating disorder-related clinical impairment, depressive symptoms, perceived stress, and trait anxiety were associated with an increased likelihood of stimulant misuse. Subjective binge eating, excessive exercise, and dietary restraint were not associated with stimulant misuse. CONCLUSIONS ADHD-specific stimulant misuse is associated with eating disorder and comorbid pathology among individuals at high risk for or with clinical or subclinical eating disorders. Screening for stimulant misuse and eating disorder pathology may improve identification of college-age women who may be engaging in maladaptive behaviors and inform prevention efforts.
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Affiliation(s)
| | - Andrea E. Kass
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Dawn M. Eichen
- Department of Pediatrics, University of California, San Diego, San Diego, CA, USA
| | | | - Mickey Trockel
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | | | - C. Barr Taylor
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
- The mHealth Institute, Palo Alto University, Palo Alto, CA, USA
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26
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Abstract
Eating disorders, especially anorexia nervosa and bulimia nervosa have been classically described in young females in Western population. Recent research shows that they are also seen in developing countries including India. The classification of eating disorders has been expanded to include recently described conditions like binge eating disorder. Eating disorders have a multifactorial etiology. Genetic factor appear to play a major role. Recent advances in neurobiology have improved our understanding of these conditions and may possibly help us develop more effective treatments in future. Premorbid personality appears to play an important role, with differential predisposition for individual disorders. The role of cultural factors in the etiology of these conditions is debated. Culture may have a pathoplastic effect leading to non-conforming presentations like the non fat-phobic form of anorexia nervosa, which are commonly reported in developing countries. With rapid cultural transformation, the classical forms of these conditions are being described throughout the world. Diagnostic criteria have been modified to accommodate for these myriad presentations. Treatment of eating disorders can be quite challenging, given the dearth of established treatments and poor motivation/insight in these conditions. Nutritional rehabilitation and psychotherapy remains the mainstay of treatment, while pharmacotherapy may be helpful in specific situations.
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Affiliation(s)
- Pratap Sharan
- Department of Psychiatry, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India
| | - A Shyam Sundar
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bangalore, Karnataka, India
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27
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Elmquist J, Shorey RC, Anderson S, Stuart GL. Eating Disorder Symptoms and Length of Stay in Residential Treatment for Substance Use: A Brief Report. J Dual Diagn 2015; 11:233-7. [PMID: 26457661 PMCID: PMC4724169 DOI: 10.1080/15504263.2015.1104480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE Treatment dropout is common both among people in treatment for eating disorders and for substance use disorders. Because of the high rates of co-occurrence and mortality associated with these disorders, the purpose of the current study was to examine the relationship among eating disorder symptoms, length of stay, and decisions to leave against medical advice among individuals in substance use treatment. METHODS We analyzed de-identified medical record data for 122 adult women enrolled in residential treatment for substance use disorders over a 12-month period. Routine treatment intake included standardized assessments of eating disorders, depression, and substance use. RESULTS Participants averaged 43.1 years of age (SD = 10.7) and were primarily non-Hispanic Caucasian (n = 118, 96.7%). Approximately 8 (6.6%) patients met criteria for a probable eating disorder and 79 (64.8%) for a probable alcohol use disorder. Mean length of stay was 28.1 days (SD = 6.6) and 21 (17%) patients left against medical advice. Logistic regression analysis showed that eating disorder symptoms were significantly associated with decisions to leave treatment against medical advice after controlling for age, years of education, depression symptoms, alcohol problems, and drug problems: χ(2) = 14.88, df = 6, p =.02. This model accounted for 19.1% (Nagelkerke R(2)) of the variance in discharge type. Eating disorder symptoms were not associated with length of treatment. CONCLUSIONS Our findings suggest the importance of assessing and monitoring eating disorder symptoms among individuals in treatment for substance use disorders.
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Affiliation(s)
- JoAnna Elmquist
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
| | - Ryan C Shorey
- b Department of Psychology , Ohio University , Athens , Ohio , USA
| | - Scott Anderson
- c Cornerstone of Recovery , Louisville , Tennessee , USA
| | - Gregory L Stuart
- a University of Tennessee-Knoxville , Knoxville , Tennessee , USA
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28
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Peng XX, Cabeza de Vaca S, Ziff EB, Carr KD. Involvement of nucleus accumbens AMPA receptor trafficking in augmentation of D- amphetamine reward in food-restricted rats. Psychopharmacology (Berl) 2014; 231:3055-63. [PMID: 24535653 PMCID: PMC4102651 DOI: 10.1007/s00213-014-3476-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 01/29/2014] [Indexed: 11/28/2022]
Abstract
RATIONALE Chronic food restriction (FR) increases behavioral responsiveness to drugs of abuse and associated environments. Pre- and postsynaptic neuroadaptations have been identified in the mesoaccumbens dopamine pathway of FR subjects but the mechanistic basis of increased drug reward magnitude remains unclear. OBJECTIVES Effects of FR on basal and D-amphetamine-induced trafficking of AMPA receptor subunits to the nucleus accumbens (NAc) postsynaptic density (PSD) were examined, and AMPA receptor involvement in augmentation of D-amphetamine reward was tested. MATERIALS AND METHODS FR and ad libitum fed (AL) rats were injected with D-amphetamine (2.5 mg/kg, i.p.) or vehicle. Brains were harvested and subcellular fractionation and Western analyses were used to assess AMPA receptor abundance in NAc homogenate and PSD fractions. A follow-up experiment used a curve-shift protocol of intracranial self-stimulation to assess the effect of 1-naphthylacetyl spermine (1-NASPM), a blocker of Ca(2+)-permeable AMPA receptors, on rewarding effects of D-amphetamine microinjected in NAc shell. RESULTS FR increased GluA1 in the PSD, and D-amphetamine increased p-Ser845-GluA1, GluA1, GluA2, but not GluA3, with a greater effect in FR than AL rats. D-amphetamine lowered reward thresholds, with greater effects in FR than AL rats, and 1-NASPM selectively reversed the enhancing effect of FR. CONCLUSIONS Results suggest that FR leads to increased synaptic incorporation of GluA1 homomers to potentiate rewarding effects of appetitive stimuli and, as a maladaptive byproduct, D-amphetamine. The D-amphetamine-induced increase in synaptic p-Ser845-GluA1, GluA1, and GluA2 may contribute to the rewarding effect of D-amphetamine, but may also be a mechanism of synaptic strengthening and behavior modification.
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Affiliation(s)
- Xing-Xiang Peng
- Department of Psychiatry, New York University School of Medicine, 550 First Avenue, New York, NY, 10016, USA
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29
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De Young KP, Lavender JM, Steffen K, Wonderlich SA, Engel SG, Mitchell JE, Crow SJ, Peterson CB, Le Grange D, Wonderlich J, Crosby RD. Restrictive eating behaviors are a nonweight-based marker of severity in anorexia nervosa. Int J Eat Disord 2013; 46:849-54. [PMID: 23868197 PMCID: PMC4001723 DOI: 10.1002/eat.22163] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Revised: 06/10/2013] [Accepted: 06/10/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the type and frequency of restrictive eating behaviors across the two subtypes of anorexia nervosa (AN; restricting [ANr] and binge eating/purging [ANbp]) using ecological momentary assessment (EMA) and to determine whether subtype differences in restrictive eating behaviors were attributable to severity of the disorder or the frequency of binge eating. METHOD Participants (N = 118) were women at least 18 years of age with full (n = 59) or subthreshold (n = 59) AN who participated in a two week (EMA) protocol. RESULTS General estimating equations revealed that individuals with ANbp generally reported more frequent restrictive eating behaviors than individuals with ANr. These differences were mostly accounted for by greater severity of eating psychopathology, indicating that the presence and frequency of restrictive eating behaviors in AN may be nonweight-based markers of severity. Binge eating frequency did not account for these findings. DISCUSSION The present findings are especially interesting in light of the weight-based severity rating in the DSM-5.
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Affiliation(s)
- Kyle P. De Young
- University of North Dakota, Department of Psychology, Grand Forks, North Dakota,Corresponding Author: Kyle P. De Young, Ph.D., Assistant Professor, Department of Psychology, University of North Dakota, 319 Harvard St., Stop 8380, Grand Forks, ND 58202; Ph: (701)777-5671; Fax: (701)777-3454;
| | | | - Kristine Steffen
- Neuropsychiatric Research Institute, Fargo, North Dakota,North Dakota State University, Fargo, North Dakota, Department of Pharmaceutical Sciences
| | - Stephen A. Wonderlich
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - Scott G. Engel
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - James E. Mitchell
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
| | - Scott J. Crow
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | - Carol B. Peterson
- University of Minnesota, Department of Psychiatry, Minneapolis, Minnesota
| | - Daniel Le Grange
- The University of Chicago, Department of Psychiatry and Behavioral Neuroscience
| | | | - Ross D. Crosby
- Neuropsychiatric Research Institute, Fargo, North Dakota,University of North Dakota School of Medicine and Heath Sciences, Department of Clinical Neuroscience, Fargo, North Dakota
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30
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Gregorowski C, Seedat S, Jordaan GP. A clinical approach to the assessment and management of co-morbid eating disorders and substance use disorders. BMC Psychiatry 2013; 13:289. [PMID: 24200300 PMCID: PMC4226257 DOI: 10.1186/1471-244x-13-289] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2013] [Accepted: 07/31/2013] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Research has shown that eating disorder (ED) patients who abuse substances demonstrate worse ED symptomatology and poorer outcomes than those with EDs alone, including increased general medical complications and psychopathology, longer recovery times, poorer functional outcomes and higher relapse rates. This article provides a broad overview of the prevalence, aetiology, assessment and management of co-morbid EDs and substance use disorders (SUDs). REVIEW The co-occurrence of EDs and SUDs is high. The functional relationship between EDs and SUDs vary within and across ED subtypes, depends on the class of substance, and needs to be carefully assessed for each patient. Substances such as caffeine, tobacco, insulin, thyroid medications, stimulants or over the counter medications (laxatives, diuretics) may be used to aid weight loss and/or provide energy, and alcohol or psychoactive substances could be used for emotional regulation or as part of a pattern of impulsive behaviour. A key message conveyed in the current literature is the importance of screening and assessment for co-morbid SUDs and EDs in patients presenting with either disorder. There is a paucity of treatment studies on the management of co-occurring EDs and SUDs. Overall, the literature indicates that the ED and SUD should be addressed simultaneously using a multi-disciplinary approach. The need for medical stabilization, hospitalization or inpatient treatment needs to be assessed based on general medical and psychiatric considerations. Common features across therapeutic interventions include psycho-education about the aetiological commonalities, risks and sequelae of concurrent ED behaviours and substance abuse, dietary education and planning, cognitive challenging of eating disordered attitudes and beliefs, building of skills and coping mechanisms, addressing obstacles to improvement and the prevention of relapse. Emphasis should be placed on building a collaborative therapeutic relationship and avoiding power struggles. Cognitive behavioural therapy has been frequently used in the treatment of co-morbid EDs and SUDs, however there are no randomized controlled trials. More recently evidence has been found for the efficacy of dialectical behavioural therapy in reducing both ED and substance use behaviours. CONCLUSION Future research would benefit from a meta-analysis of the current research in order to better understand the relationships between these two commonly co-occurring disorders.
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Affiliation(s)
- Claire Gregorowski
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Soraya Seedat
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
| | - Gerhard P Jordaan
- Department of Psychiatry, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa
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Effects of time of feeding on psychostimulant reward, conditioned place preference, metabolic hormone levels, and nucleus accumbens biochemical measures in food-restricted rats. Psychopharmacology (Berl) 2013; 227:307-20. [PMID: 23354537 PMCID: PMC3637844 DOI: 10.1007/s00213-013-2981-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 12/17/2012] [Indexed: 10/27/2022]
Abstract
RATIONALE Chronic food restriction (FR) increases rewarding effects of abused drugs and persistence of a cocaine-conditioned place preference (CPP). When there is a single daily meal, circadian rhythms are correspondingly entrained, and pre- and postprandial periods are accompanied by different circulating levels of metabolic hormones that modulate brain dopamine function. OBJECTIVES The present study assessed whether rewarding effects of d-amphetamine, cocaine, and persistence of cocaine-CPP differ between FR subjects tested in the pre- and postprandial periods. MATERIALS AND METHODS Rats were stereotaxically implanted with intracerebral microinjection cannulae and an electrode in lateral hypothalamus. Rewarding effects of d-amphetamine and cocaine were assessed using electrical self-stimulation in rats tested 1-4 or 18-21 h after the daily meal. Nonimplanted subjects acquired a cocaine-CPP while ad libitum fed and then were switched to FR and tested for CPP at these same times. RESULTS Rewarding effects of intranucleus accumbens (NAc) d-amphetamine, intraventricular cocaine, and persistence of cocaine-CPP did not differ between rats tested 18-21 h food-deprived, when ghrelin and insulin levels were at peak and nadir, respectively, and those tested 1-4 h after feeding. Rats that expressed a persistent CPP had elevated levels of p-ERK1, GluA1, and p-Ser845-GluA1 in NAc core, and the latter correlated with CPP expression. CONCLUSIONS Psychostimulant reward and persistence of CPP in FR rats are unaffected by time of testing relative to the daily meal. Further, NAc biochemical responses previously associated with enhanced drug responsiveness in FR rats are associated with persistent CPP expression.
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Baker JH, Thornton LM, Strober M, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Jones I, Kaplan AS, Klump KL, Mitchell JE, Treasure J, Woodside DB, Berrettini WH, Kaye WH, Bulik CM. Temporal sequence of comorbid alcohol use disorder and anorexia nervosa. Addict Behav 2013; 38:1704-9. [PMID: 23254222 DOI: 10.1016/j.addbeh.2012.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 08/14/2012] [Accepted: 10/03/2012] [Indexed: 11/16/2022]
Abstract
Women with eating disorders have a significantly higher prevalence of substance use disorders than the general population. The goal of the current study was to assess the temporal pattern of comorbid anorexia nervosa (AN) and alcohol use disorder (AUD) and the impact this ordering has on symptomatology and associated features. Women were placed into one of three groups based on the presence or absence of comorbid AUD and the order of AN and AUD onset in those with both disorders: (1) AN Only, (2) AN First, and (3) AUD First. The groups were compared on psychological symptoms and personality characteristics often associated with AN, AUD, or both using general linear models. Twenty-one percent of women (n=161) with AN reported a history of AUD with 115 reporting AN onset first and 35 reporting AUD onset first. Women with binge-eating and/or purging type AN were significantly more likely to have AUD. In general, differences were found only between women with AN Only and women with AN and AUD regardless of order of emergence. Women with AN and AUD had higher impulsivity scores and higher prevalence of depression and borderline personality disorder than women with AN Only. Women with AN First scored higher on traits commonly associated with AN, whereas women with comorbid AN and AUD displayed elevations in traits more commonly associated with AUD. Results do not indicate a distinct pattern of symptomatology in comorbid AN and AUD based on the temporal sequence of the disorders.
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Affiliation(s)
- Jessica H Baker
- 101 Manning Drive, CB #7160, Department of Psychiatry, University of North Carolina, Chapel Hill, NC 27599, United States
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Effects of protein kinase A inhibitor and activator on rewarding effects of SKF-82958 microinjected into nucleus accumbens shell of ad libitum fed and food-restricted rats. Psychopharmacology (Berl) 2012; 221:589-99. [PMID: 22143580 PMCID: PMC3310955 DOI: 10.1007/s00213-011-2602-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2011] [Accepted: 11/27/2011] [Indexed: 10/14/2022]
Abstract
RATIONALE Previous studies indicate that the rewarding effect of D-1 dopamine receptor stimulation in nucleus accumbens (NAc) shell is greater in food-restricted (FR) than in ad libitum fed (AL) rats. The D-1 receptor is positively coupled to adenylyl cyclase and activates protein kinase A (PKA). OBJECTIVES The purpose of this study was to determine whether PKA is involved in the rewarding effect of D-1 receptor stimulation and, if so, whether it is involved in the enhanced response of FR rats. MATERIALS AND METHODS Rats were stereotaxically implanted with microinjection cannulae in NAc shell and a stimulating electrode in lateral hypothalamus. The rewarding effects of SKF-82958 (1.5 or 3.0 μg, bilaterally) in the presence and absence of PKA inhibitor, Rp-cAMPS (8.9 μg), and PKA activator, Sp-cAMPS (8.9 μg), were assessed using the curve-shift method of intracranial self-stimulation (ICSS). Basal NAc levels of DARPP-32 phosphorylated on Thr34 and Thr75 were measured. RESULTS Rp-cAMPS increased the rewarding effect of SKF-82958 in AL but not FR rats, doubling the ICSS threshold-lowering effect of the 3.0-μg dose. Sp-cAMPS decreased the rewarding effect of SKF-82958 in FR but not AL rats. Levels of phospho-DARPP-32 (Thr75), which inhibits PKA, were higher in FR than AL rats. CONCLUSIONS Results indicate that inhibition of PKA enhances the unconditioned rewarding effect of D-1 receptor stimulation and that decreased PKA may be involved in the effect of FR on drug reward. Evidence for involvement of D-2 receptor-expressing neurons in the enhancing effect of PKA inhibition is discussed.
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Hoffman ER, Gagne DA, Thornton LM, Klump KL, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Jones I, Kaplan AS, Mitchell JE, Strober M, Treasure J, Woodside DB, Berrettini WH, Kaye WH, Bulik CM. Understanding the association of impulsivity, obsessions, and compulsions with binge eating and purging behaviours in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 20:e129-36. [PMID: 22351620 PMCID: PMC3443865 DOI: 10.1002/erv.2161] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2011] [Revised: 12/04/2011] [Accepted: 12/06/2011] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To further refine our understanding of impulsivity, obsessions, and compulsions in anorexia nervosa (AN) by isolating which behaviours--binge eating, purging, or both--are associated with these features. METHODS We conducted regression analyses with binge eating, purging, and the interaction of binge eating with purging as individual predictors of scores for impulsivity, obsessions, and compulsions in two samples of women with AN (n = 1373). RESULTS Purging, but not binge eating, was associated with higher scores on impulsivity, obsessions, and compulsions. Purging was also associated with worst eating rituals and with worst eating preoccupations. CONCLUSION Our results suggest that purging, compared with binge eating, may be a stronger correlate of impulsivity, obsessions, and compulsions in AN.
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Affiliation(s)
- Elizabeth R Hoffman
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, USA
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Barbarich-Marsteller NC, Foltin RW, Walsh BT. Does anorexia nervosa resemble an addiction? ACTA ACUST UNITED AC 2012; 4:197-200. [PMID: 21999694 DOI: 10.2174/1874473711104030197] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 06/14/2011] [Accepted: 07/30/2011] [Indexed: 01/16/2023]
Abstract
Anorexia nervosa is a severe psychiatric disorder characterized by unrelenting self-starvation and life-threatening weight loss. The relentlessness with which individuals with anorexia nervosa pursue starvation and in some cases exercise despite the negative physical, emotional, and social consequences parallels features of addictive disorders. From a clinical perspective, individuals with anorexia nervosa behave similarly to individuals with substance abuse by narrowing their behavioral repertoire so that weight loss, restricting food intake, and excessive exercise interfere with other activities in much the same way that substance abuse does. However, fundamental differences exist between anorexia nervosa and substance abuse that suggest anorexia nervosa is not an addiction in and of itself.
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Dellava JE, Trace SE, Strober M, Thornton LM, Klump KL, Brandt H, Crawford S, Fichter MM, Halmi KA, Johnson C, Kaplan AS, Mitchell JE, Treasure J, Woodside DB, Berrettini WH, Kaye WH, Bulik CM. Retrospective maternal report of early eating behaviours in anorexia nervosa. EUROPEAN EATING DISORDERS REVIEW 2012; 20:111-5. [PMID: 21830261 PMCID: PMC3391535 DOI: 10.1002/erv.1153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2011] [Revised: 06/30/2011] [Accepted: 07/10/2011] [Indexed: 11/07/2022]
Abstract
This exploratory study assessed whether maternal recall of childhood feeding and eating practices differed across anorexia nervosa (AN) subtypes. Participants were 325 women from the Genetics of Anorexia Nervosa study whose mothers completed a childhood feeding and eating questionnaire. Multinomial logistic regression analyses were used to predict AN subtype from measures related to childhood eating: (i) infant feeding (breastfed, feeding schedule, age of solid food introduction), (ii) childhood picky eating (picky eating before age 1 year and between ages one and five) and (iii) infant gastrointestinal problems (vomiting and colic). Results revealed no significant differences in retrospective maternal report of childhood feeding and eating practices among AN subtypes.
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Affiliation(s)
- Jocilyn E Dellava
- Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University, Richmond, VA, USA
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Zheng D, Cabeza de Vaca S, Carr KD. Food restriction increases acquisition, persistence and drug prime-induced expression of a cocaine-conditioned place preference in rats. Pharmacol Biochem Behav 2011; 100:538-44. [PMID: 22074687 DOI: 10.1016/j.pbb.2011.10.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2011] [Revised: 09/30/2011] [Accepted: 10/23/2011] [Indexed: 01/01/2023]
Abstract
Cocaine conditioned place preference (CPP) is more persistent in food-restricted than ad libitum fed rats. This study assessed whether food restriction acts during conditioning and/or expression to increase persistence. In Experiment 1, rats were food-restricted during conditioning with a 7.0 mg/kg (i.p.) dose of cocaine. After the first CPP test, half of the rats were switched to ad libitum feeding for three weeks, half remained on food restriction, and this was followed by CPP testing. Rats tested under the ad libitum feeding condition displayed extinction by the fifth test. Their CPP did not reinstate in response to overnight food deprivation or a cocaine prime. Rats maintained on food restriction displayed a persistent CPP. In Experiment 2, rats were ad libitum fed during conditioning with the 7.0 mg/kg dose. In the first test only a trend toward CPP was displayed. Rats maintained under the ad libitum feeding condition did not display a CPP during subsequent testing and did not respond to a cocaine prime. Rats tested under food-restriction also did not display a CPP, but expressed a CPP following a cocaine prime. In Experiment 3, rats were ad libitum fed during conditioning with a 12.0 mg/kg dose. After the first test, half of the rats were switched to food restriction for three weeks. Rats that were maintained under the ad libitum condition displayed extinction by the fourth test. Their CPP was not reinstated by a cocaine prime. Rats tested under food-restriction displayed a persistent CPP. These results indicate that food restriction lowers the threshold dose for cocaine CPP and interacts with a previously acquired CPP to increase its persistence. In so far as CPP models Pavlovian conditioning that contributes to addiction, these results suggest the importance of diet and the physiology of energy balance as modulatory factors.
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Affiliation(s)
- Danielle Zheng
- Department of Psychiatry, New York University School of Medicine, New York, New York 10016, USA
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Karačić M, Wales JA, Arcelus J, Palmer RL, Cooper Z, Fairburn CG. Changes in alcohol intake in response to transdiagnostic cognitive behaviour therapy for eating disorders. Behav Res Ther 2011; 49:573-7. [PMID: 21704306 PMCID: PMC3387552 DOI: 10.1016/j.brat.2011.05.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2011] [Revised: 05/25/2011] [Accepted: 05/31/2011] [Indexed: 01/27/2023]
Abstract
OBJECTIVE The aim of this study was to examine how alcohol intake changes during and after transdiagnostic cognitive behaviour therapy for eating disorders (CBT-E). Additionally, the paper considers the relationship between alcohol consumption, eating disorder diagnosis and current major depressive episode at the time of first assessment. METHOD One hundred and forty nine outpatients with an eating disorder (body mass index over 17.5) were divided into high or low alcohol intake groups (HIG and LIG) according to their intake at pre-treatment assessment. Their alcohol intake and eating disorder psychopathology were examined over the course of treatment and follow-up. RESULTS There was no difference between the groups on response of the eating disorder to treatment. The HIG significantly reduced their alcohol intake following treatment whilst the intake of the LIG remained stable over the course of treatment and follow-up. There were no group differences in major depression and overall severity of eating disorder at baseline. CONCLUSIONS The response to CBT-E was not influenced by baseline level of alcohol use. The mean alcohol intake of the heavy drinking subjects decreased without being specifically addressed by the treatment.
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Affiliation(s)
- Matislava Karačić
- Eating Disorders Service, Brandon Unit, Leicester General Hospital, Leicester LE5 4PW, UK
- Schön Klinik Roseneck, Am Roseneck 6, 83209 Prien am Chiemsee, Germany
| | - Jackie A. Wales
- Eating Disorders Service, Brandon Unit, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Jon Arcelus
- Eating Disorders Service, Brandon Unit, Leicester General Hospital, Leicester LE5 4PW, UK
- Loughborough University Centre for Research into Eating Disorders, Loughborough University, Loughborough, Leicestershire LE11 3TU, UK
| | - Robert L. Palmer
- Eating Disorders Service, Brandon Unit, Leicester General Hospital, Leicester LE5 4PW, UK
| | - Zafra Cooper
- Department of Psychiatry, Oxford University, Warneford Hospital, Oxford OX3 7JX, UK
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Liu S, Zheng D, Peng XX, Cabeza de Vaca S, Carr KD. Enhanced cocaine-conditioned place preference and associated brain regional levels of BDNF, p-ERK1/2 and p-Ser845-GluA1 in food-restricted rats. Brain Res 2011; 1400:31-41. [PMID: 21640333 DOI: 10.1016/j.brainres.2011.05.028] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/11/2011] [Accepted: 05/13/2011] [Indexed: 12/18/2022]
Abstract
Previously, a learning-free measure was used to demonstrate that chronic food restriction (FR) increases the reward magnitude of a wide range of abused drugs. Moreover, a variety of striatal neuroadaptations were detected in FR subjects, some of which are known to be involved in synaptic plasticity but have been ruled out as modulators of acute drug reward magnitude. Little is known about effects of FR on drug-conditioned place preference (CPP) and brain regional mechanisms that may enhance CPP in FR subjects. The purpose of the present study was to compare the expression and persistence of a conditioned place preference (CPP) induced by a relatively low dose of cocaine (7.0mg/kg, i.p.) in ad libitum fed (AL) and FR rats and take several brain regional biochemical measures following the first CPP conditioning session to probe candidate mechanisms that may underlie the more robust CPP observed in FR subjects. Behaviorally, AL subjects displayed a CPP upon initial testing which extinguished rapidly over the course of subsequent test sessions while CPP in FR subjects persisted. Despite previous reports of elevated BDNF protein in forebrain regions of FR rats, the FR protocol used in the present study did not alter BDNF levels in dorsal hippocampus, nucleus accumbens or medial prefrontal cortex. On the other hand, FR rats, whether injected with cocaine or vehicle, displayed elevated p-ERK1/2 and p-Ser845-GluA1 in dorsal hippocampus. FR rats also displayed elevated p-ERK1/2 in medial prefrontal cortex and elevated p-ERK1 in nucleus accumbens, with further increases produced by cocaine. The one effect observed exclusively in cocaine-treated FR rats was increased p-Ser845-GluA1 in nucleus accumbens. These findings suggest a number of avenues for continuing investigation with potential translational significance.
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Affiliation(s)
- Shan Liu
- Department of Psychiatry, New York University School of Medicine, USA
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Glasner-Edwards S, Mooney LJ, Marinelli-Casey P, Hillhouse M, Ang A, Rawson R. Bulimia nervosa among methamphetamine dependent adults: association with outcomes three years after treatment. Eat Disord 2011; 19:259-69. [PMID: 21516550 PMCID: PMC3159413 DOI: 10.1080/10640266.2011.566149] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Although weight loss is among the most commonly cited reasons for using methamphetamine (MA), little is known about the association between eating disorders and treatment outcomes in this population. This study examined psychiatric, substance use, and functional outcomes of MA users (N = 526) with bulimia nervosa 3 years after treatment for MA dependence. Bulimia nervosa was observed among 2.4% (N = 13) of the participants and was associated with poorer MA use outcomes, increased health service utilization, and higher levels of functional impairment. Addressing MA use among adults with eating disorders may be helpful as a means of improving treatment outcomes.
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Affiliation(s)
- Suzette Glasner-Edwards
- Integrated Substance Abuse Programs, Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California 90024, USA.
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Killeen TK, Greenfield SF, Bride BE, Cohen L, Gordon SM, Roman PM. Assessment and treatment of co-occurring eating disorders in privately funded addiction treatment programs. Am J Addict 2011; 20:205-11. [PMID: 21477048 PMCID: PMC3076120 DOI: 10.1111/j.1521-0391.2011.00122.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Privately funded addiction treatment programs were surveyed to increase understanding of assessment and current treatment options for patients with co-occurring substance use and eating disorders. Data were collected from face-to-face interviews with program administrators of a nationally representative sample of 345 private addiction treatment programs. Although the majority of programs reported screening for eating disorders, programs varied in screening instruments used. Sixty-seven percent reported admitting cases of low severity. Twenty-one percent of programs attempt to treat eating disorders. These results highlight the need for education of addiction treatment professionals in assessment, referral, and treatment of eating disorders.
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Affiliation(s)
- Therese K Killeen
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 67 President St., Charleston, SC 29425, USA.
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Root TL, Pisetsky EM, Thornton L, Lichtenstein P, Pedersen NL, Bulik CM. Patterns of co-morbidity of eating disorders and substance use in Swedish females. Psychol Med 2010; 40:105-115. [PMID: 19379530 PMCID: PMC2788663 DOI: 10.1017/s0033291709005662] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Little is known about the association of eating disorder subtypes across multiple categories of substance use in population-based samples. We examined the association between eating disorders and substance use in a large population-based sample. METHOD Female participants (n=13 297) were from the Swedish Twin Registry [Lichtenstein et al., Twin Research and Human Genetics (2006) 9, 875-882]. Substance use was examined in four defined groups - (1) anorexia nervosa (AN); (2) bulimia nervosa (BN); (3) AN and BN (ANBN); and (4) binge eating disorder (BED) as well as a referent group without eating disorder (no ED). Secondary analyses examined differences between restricting AN (RAN) and binge and/or purge AN (ANBP). RESULTS In general, eating disorders were associated with greater substance use relative to the referent. The AN group had significantly increased odds for all illicit drugs. Significant differences emerged across the RAN and ANBP groups for alcohol abuse/dependence, diet pills, stimulants, and polysubstance use with greater use in the ANBP group. Across eating disorder groups, (1) the BN and ANBN groups were more likely to report alcohol abuse/dependence relative to the AN group, (2) the ANBN group was more likely to report diet pill use relative to the AN, BN and BED groups, and (3) the BN group was more likely to report diet pill use relative to the no ED, AN and BED groups. CONCLUSIONS Eating disorders are associated with a range of substance use behaviors. Improved understanding of how they mutually influence risk could enhance understanding of etiology and prevention.
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Affiliation(s)
- T L Root
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7160, USA
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Calero-Elvira A, Krug I, Davis K, López C, Fernández-Aranda F, Treasure J. Meta-analysis on drugs in people with eating disorders. EUROPEAN EATING DISORDERS REVIEW 2009; 17:243-59. [DOI: 10.1002/erv.936] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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