1
|
Vogel K, Timmers I, Kumar V, Nickl-Jockschat T, Bastiani M, Roebroek A, Herpertz-Dahlmann B, Konrad K, Goebel R, Seitz J. White matter microstructural changes in adolescent anorexia nervosa including an exploratory longitudinal study. Neuroimage Clin 2016; 11:614-621. [PMID: 27182488 PMCID: PMC4857215 DOI: 10.1016/j.nicl.2016.04.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 03/12/2016] [Accepted: 04/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anorexia nervosa (AN) often begins in adolescence, however, the understanding of the underlying pathophysiology at this developmentally important age is scarce, impeding early interventions. We used diffusion tensor imaging (DTI) to investigate microstructural white matter (WM) brain changes including an experimental longitudinal follow-up. METHODS We acquired whole brain diffusion-weighted brain scans of 22 adolescent female hospitalized patients with AN at admission and nine patients longitudinally at discharge after weight rehabilitation. Patients (10-18 years) were compared to 21 typically developing controls (TD). Tract-based spatial statistics (TBSS) were applied to compare fractional anisotropy (FA) across groups and time points. Associations between average FA values of the global WM skeleton and weight as well as illness duration parameters were analyzed by multiple linear regression. RESULTS We observed increased FA in bilateral frontal, parietal and temporal areas in AN patients at admission compared to TD. Higher FA of the global WM skeleton at admission was associated with faster weight loss prior to admission. Exploratory longitudinal analysis showed this FA increase to be partially normalized after weight rehabilitation. CONCLUSIONS Our findings reveal a markedly different pattern of WM microstructural changes in adolescent AN compared to most previous results in adult AN. This could signify a different susceptibility and reaction to semi-starvation in the still developing brain of adolescents or a time-dependent pathomechanism differing with extend of chronicity. Higher FA at admission in adolescents with AN could point to WM fibers being packed together more closely.
Collapse
Affiliation(s)
- Katja Vogel
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Inge Timmers
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Vinod Kumar
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; JARA-Translational Brain Medicine (The Jülich Aachen Research Alliance), Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Thomas Nickl-Jockschat
- Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany; JARA-Translational Brain Medicine (The Jülich Aachen Research Alliance), Forschungszentrum Jülich GmbH, 52425 Jülich, Germany
| | - Matteo Bastiani
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands; Oxford Centre for Functional MRI of the Brain, John Radcliffe Hospital, Oxford OX3 9DU, United Kingdom
| | - Alard Roebroek
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Beate Herpertz-Dahlmann
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Kerstin Konrad
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany
| | - Rainer Goebel
- Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands
| | - Jochen Seitz
- Department of Child and Adolescent Psychiatry, Psychotherapy and Psychosomatics, University Hospital, RWTH Aachen University, Neuenhofer Weg 21, 52074 Aachen, Germany; Department of Cognitive Neuroscience, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD, Maastricht, The Netherlands.
| |
Collapse
|
2
|
van Noort BM, Kraus MKA, Pfeiffer E, Lehmkuhl U, Kappel V. Neuropsychological and Behavioural Short-Term Effects of Cognitive Remediation Therapy in Adolescent Anorexia Nervosa: A Pilot Study. EUROPEAN EATING DISORDERS REVIEW 2015; 24:69-74. [DOI: 10.1002/erv.2383] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 12/11/2014] [Accepted: 06/07/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Betteke Maria van Noort
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Manuela Klara Aurelia Kraus
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Ernst Pfeiffer
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Ulrike Lehmkuhl
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| | - Viola Kappel
- Department of Child and Adolescent Psychiatry, Psychosomatic Medicine and Psychotherapy; Charité-Universitätsmedizin Berlin; Berlin Germany
| |
Collapse
|
3
|
Torstveit MK, Aagedal-Mortensen K, Stea TH. More than half of high school students report disordered eating: a cross sectional study among Norwegian boys and girls. PLoS One 2015; 10:e0122681. [PMID: 25825877 PMCID: PMC4380422 DOI: 10.1371/journal.pone.0122681] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 02/24/2015] [Indexed: 11/18/2022] Open
Abstract
Disordered eating and eating disorders are of great concern due to their associations with physical and mental health risks. Even if adolescence has been identified as the most vulnerable time for developing disordered eating, few studies have used a broad spectrum of criteria to investigate the prevalence of disordered eating among high school students of both genders, in different programs of study, nor assessed correlates of disordered eating among this important target group. The purposes of this study were therefore to investigate the prevalence and correlates of disordered eating among both male and female high school students in sport-, general and vocational programs. A comprehensive questionnaire was completed by 2,451 students (98.7%), aged 15–17 years. The total prevalence of disordered eating was 54.9%, with 64.3% among girls and 45.0% among boys (p<0.001). The highest prevalence of disordered eating was found among vocational students (60.7%), followed by students in general programs (49.8%) and sport students (38.3%) (p<0.001). Female gender, school program (vocational and general), overweight/obesity and weight regulation were positively associated with disordered eating. The high prevalence indicates the importance of tailored prevention efforts directed at high school students, particularly in vocational programs. Furthermore, a smaller girls–boys ratio than expected indicates that the efforts to identify and manage disordered eating among high school students should include both genders.
Collapse
Affiliation(s)
| | | | - Tonje Holte Stea
- University of Agder, Faculty of Health and Sport Sciences, Kristiansand, Norway
| |
Collapse
|
4
|
Stuhldreher N, Wild B, König HH, Konnopka A, Zipfel S, Herzog W. Determinants of direct and indirect costs in anorexia nervosa. Int J Eat Disord 2015; 48:139-46. [PMID: 24634140 DOI: 10.1002/eat.22274] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 02/28/2014] [Accepted: 03/02/2014] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To estimate direct and indirect costs of anorexia nervosa (AN), and to identify cost determinants. METHODS In a subsample (n = 225) of the ANTOP trial (Anorexia Nervosa Treatment of OutPatients) health care utilization and productivity losses were assessed at baseline for the previous 3 months and monetarily valued. Included were females aged 18 years and older diagnosed with AN or subsyndromal AN, and a body mass index (BMI) between 15 and 18.5 kg/m(2) . To account for missing data multiple imputation was employed. Cost determinants were derived from generalized linear models with gamma distribution and log link function. RESULTS Mean 3-months costs per patient amounted to €5,866 (SE = €576). The largest share of costs (€3,374) resulted from hospitalizations. Determinants of direct costs were analyzed separately for those with hospitalizations for AN, and those without. In the group only treated as outpatients, participants with binge/purge subtype, and those diseased for more than 6 years had higher costs. Moreover, costs were increased in patients with a comorbid mental disorder. In the group with hospitalizations, direct costs increased with BMI. BMI was measured at the end of the observation period, indicating that longer duration of treatment yielded higher weight gain. Indirect costs were not significantly associated with any disease-related characteristic. DISCUSSION Costs resulting from health care utilization and productivity loss are substantial, although the sample studied had not received sufficient treatment. Future research should analyze the development of costs over time.
Collapse
Affiliation(s)
- Nina Stuhldreher
- Department of Health Economics and Health Services Research, Hamburg Center for Health Economics (HCHE), University Medical Center Hamburg-Eppendorf, Germany
| | | | | | | | | | | |
Collapse
|
5
|
van Noort BM, Pfeiffer E, Lehmkuhl U, Kappel V. [An international neuropsychological assessment tool for children, adolescents, and adults with anorexia nervosa – the German adaptation of the Ravello Profile]. ZEITSCHRIFT FUR KINDER-UND JUGENDPSYCHIATRIE UND PSYCHOTHERAPIE 2014; 41:371-81. [PMID: 24240493 DOI: 10.1024/1422-4917/a000253] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adults with anorexia nervosa (AN) show weaknesses in several cognitive functions before and after weight restoration. There is a great demand for standardized examinations of executive functioning in the field of child and adolescent AN. Previous studies exhibited methodological inconsistencies regarding test selection and operationalization of cognitive functions, making the interpretation of their findings difficult. In order to overcome these inconsistencies, a neuropsychological assessment tool, the "Ravello Profile," was developed, though previously not available in German. This paper presents a German adaptation of the Ravello Profile and illustrates its applicability in children and adolescents via three case descriptions. METHODS The Ravello Profile was adapted for the German-speaking area. The applicability of the Ravello Profile was evaluated in three children and adolescents with AN. RESULTS AND CONCLUSIONS The cases presented confirm the feasible implementation of this adaptation of the Ravello Profile, both in children and adolescents. Hence, it enables a methodologically consistent examination of executive functioning in German-speaking children, adolescents, and adults with AN. Using the Ravello Profile, the role of cognitive functions in the development of AN can be systematically examined over a broad age range.
Collapse
Affiliation(s)
- Betteke Maria van Noort
- Klinik für Psychiatrie, Psychosomatik und Psychotherapie des Kindes- und Jugendalters, Charité-Universitätsmedizin Berlin
| | | | | | | |
Collapse
|
6
|
Kohlboeck G, Romanos M, Tiesler C, Koletzko S, Kratzsch J, Thiery J, Bauer CP, von Berg A, Berdel D, Hoffmann B, Schaaf B, Lehmann I, Herbarth O, Heinrich J. Peer problems are associated with elevated serum leptin levels in children. Psychol Med 2014; 44:255-265. [PMID: 23561045 DOI: 10.1017/s003329171300069x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Leptin is thought to act as an important mediator in stress reactions. To date, no study has examined the association between psychological stress and leptin levels in children. This study aimed to assess the association between emotional symptoms and peer problems and serum leptin levels in children aged 10 years of the two population-based GINI-plus and LISA-plus birth cohorts. METHOD Cross-sectional data from 2827 children aged 10 years were assessed with regard to leptin concentrations in serum and behavioral problems using the parent-reported Strengths and Difficulties Questionnaire (SDQ). Linear regression modeling was applied to determine the likelihood of elevated leptin levels in children with emotional symptoms and peer problems, controlling for socio-economic status (SES), body mass index (BMI), fasting serum leptin levels, pubertal development and sex hormones. RESULTS We found that increases in emotional symptoms (exp β adj = 1.03, s.e. = 0.02, p < 0.04) and peer problems (exp β adj = 1.05, s.e. = 0.01, p = 0.0001) were significantly associated with higher serum leptin levels controlled for BMI and sociodemographic factors. Similar results were found when the fasting serum leptin sample was examined (exp β adj = 1.08, s.e. = 0.04, p = 0.0294). Gender-stratified analyses showed a significant relationship between serum leptin and peer problems in girls (exp β adj = 1.05, s.e. = 0.02, p = 0.03), and a borderline significant association in boys (exp β adj = 1.04, s.e. = 0.02, p = 0.05). CONCLUSIONS Children with peer problems have higher stress and eat more, acquire a higher body fat mass and thus, through increased leptin resistance, exhibit higher leptin levels.
Collapse
Affiliation(s)
- G Kohlboeck
- Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - M Romanos
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Hospital Wuerzburg, Germany
| | - C Tiesler
- Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| | - S Koletzko
- Dr von Hauner Children's Hospital, Ludwig-Maximilians-University of Munich, Germany
| | - J Kratzsch
- University Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Germany
| | - J Thiery
- University Leipzig, Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, Germany
| | - C-P Bauer
- Department of Pediatrics, Technical University of Munich, Germany
| | - A von Berg
- Department of Pediatrics, Marien-Hospital Wesel, Germany
| | - D Berdel
- Department of Pediatrics, Marien-Hospital Wesel, Germany
| | - B Hoffmann
- Leibniz Research Institute for Environmental Medicine, University of Düsseldorf, Germany
| | - B Schaaf
- Medical Practice for Pediatrics, Bad Honnef, Germany
| | - I Lehmann
- UFZ-Center for Environmental Research, Leipzig, Germany
| | - O Herbarth
- University Leipzig, Faculty of Medicine, Environmental Medicine and Hygiene, Leipzig, Germany
| | - J Heinrich
- Helmholtz Zentrum Muenchen, German Research Center for Environmental Health, Institute of Epidemiology I, Neuherberg, Germany
| |
Collapse
|
7
|
Voderholzer U, Cuntz U, Schlegl S. [Eating disorders: state of the art research and future challenges]. DER NERVENARZT 2012; 83:1458-67. [PMID: 23104604 DOI: 10.1007/s00115-012-3686-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Eating disorders are a common mental disorder during adolescence and young adulthood. While prevalence rates of eating disorders dramatically increased during the second half of the last century, these rates have remained relatively stable over the last 20 years. According to ICD-10 eating disorders are diagnostically categorized as anorexia nervosa, bulimia nervosa and atypical eating disorders or eating disorders not otherwise specified. Concerning the etiology, genetic factors are involved, especially in anorexia nervosa, as well as psychological and sociocultural factors. Evidence-based recommendations are available for the treatment of bulimia nervosa and binge eating disorder and in this context cognitive behavioral therapy is seen as the first choice. In contrast, the state of knowledge concerning the treatment of anorexia nervosa is still limited, especially concerning effective treatments for adults. Recent data only provide evidence for the effectiveness of family therapy for adolescents. Due to the lack of high quality studies, research on therapy for anorexia nervosa is a future challenge.
Collapse
Affiliation(s)
- U Voderholzer
- Schön Klinik Roseneck, Am Roseneck 6, 83209, Prien am Chiemsee, Deutschland.
| | | | | |
Collapse
|