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Maguire S, Kesby A, Brownlow R, Hunt GE, Kim M, McAulay C, Grisham JR, McGregor IS, Suraev A, Kevin RC, Russell J. A phase II randomised controlled trial of intranasal oxytocin in anorexia nervosa. Psychoneuroendocrinology 2024; 164:107032. [PMID: 38520886 DOI: 10.1016/j.psyneuen.2024.107032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 02/13/2024] [Accepted: 03/17/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Anorexia nervosa (AN) is an eating disorder (ED) with high mortality rates and limited response to existing treatments, prompting the need to identify effective agents and adjuncts. There is evidence for an emerging role for the neuropeptide oxytocin (OT) in the pathophysiology of AN, with studies showing a perturbed oxytocinergic system in patients with AN. Preliminary evidence has demonstrated that intranasal OT (IN-OT) can produce anxiolytic effects in AN, as well as reducing concern about eating, and dysfunctional attentional biases related to the disorder. IN-OT is a non-invasive treatment option for AN that requires investigation as an adjunct to nutritional rehabilitation. METHODS This multi-site study (Trial Registration:ACTRN1261000897460) sought to replicate and extend a previous randomised placebo-controlled pilot trial of repeated dose IN-OT in patients with AN hospitalised for nutritional rehabilitation. Patients with AN (N=61) received daily IN-OT (18 IU twice per day) or placebo for four weeks, whilst undergoing inpatient hospital treatment. Outcome measures included ED psychopathology (primary) as measured by the Eating Disorder Examination (EDE) and Body Mass Index (BMI; secondary). Participants were assessed pre- and post-treatment, and at six months following the intervention. The effects of the first and last doses of IN-OT on responses (anxiety ratings and salivary cortisol) to a high-energy snack were also examined. RESULTS Sixty-one female inpatients (Mage=24.36,SD=7.87) with an average BMI of 16.24 (range: 11.43-18.55), were recruited into the study. No significant differences were found between placebo and OT groups at any of the time points on the outcomes of interest, but significant improvements in almost all psychological parameters in both groups were evident over time. IN-OT did not significantly reduce anxiety nor salivary cortisol in response to a high-calorie snack. CONCLUSION This is the largest randomised placebo-controlled trial of repeated dose intranasal OT in people with AN, during refeeding. The therapeutically promising findings of the pilot study were not replicated. Limitations and reasons for the non-replication included relatively large variance, baseline psychopathology scores being higher in this patient group, potential ceiling effects in BMI and ED psychopathology as well as differing comorbidities.
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Affiliation(s)
- Sarah Maguire
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia.
| | - Alice Kesby
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia.
| | - Rachel Brownlow
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Glenn E Hunt
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia
| | - Marcellinus Kim
- Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
| | - Claire McAulay
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia
| | - Jessica R Grisham
- UNSW Sydney, Faculty of Science, School of Psychology, Anzac Parade, Randwick, NSW 2031, Australia
| | - Iain S McGregor
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Anastasia Suraev
- Faculty of Science, School of Psychology, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Richard C Kevin
- Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; University of Sydney, Brain and Mind Centre, Mallet St, Camperdown, NSW 2050, Australia; University of Sydney, Lambert Initiative for Cannabinoid Therapeutics, Brain Mind Centre, Mallet St, Camperdown, NSW 2050, Australia
| | - Janice Russell
- Inside Out Institute, Charles Perkins Building, University of Sydney, NSW 2006, Australia; Sydney Local Health District, Missenden Rd, Camperdown, NSW 2050, Australia; Faculty of Medicine & Health, University of Sydney, NSW 2006, Australia; Discipline of Psychiatry, University of Sydney, Sydney, NSW 2006, Australia; Professor Marie Bashir Centre, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia
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Russell J, Hunt GE. Oxytocin and eating disorders: Knowledge gaps and future directions. Psychoneuroendocrinology 2023; 154:106290. [PMID: 37178641 DOI: 10.1016/j.psyneuen.2023.106290] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/11/2023] [Accepted: 05/03/2023] [Indexed: 05/15/2023]
Abstract
Eating disorders continue to be a major public health issue and important cause of morbidity and premature mortality, particularly for young people. Yet in a concerning dialectic, this occurs in the context of an epidemic of obesity which, with its medical complications, constitutes another vexing public health challenge. While it is not an eating disorder per se obesity is often comorbid with eating disorders. Effective treatment for both eating disorders and obesity has proven to be elusive and in the search for novel therapeutic interventions, the prosocial, anxiolytic, brain plasticity and metabolic effects of oxytocin (OT) have been examined from this perspective. The availability of intranasal oxytocin (IN-OT) has led to a number of interventional treatment studies in anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), their atypical and subclinical forms and in medical and psychiatric conditions co-occurring or comorbid with these, obesity with BED would be included here. The aim of this mini review is to collate recent findings on OT as a novel therapeutic intervention in eating disorders and obesity and to identify and address some of the knowledge gaps in the use of IN-OT. The wider clinical perspective utilised here might better address some of the gaps and identify future directions of research. Clearly much remains to be done for OT to fulfil its therapeutic promise in eating disorders. OT might yet be of therapeutic promise and will be appreciated where treatment advances have been hard to come by and prevention challenging for these disorders.
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Affiliation(s)
- Janice Russell
- University of Sydney, Sydney, NSW, Australia; Marie Bashir Centre, Royal Prince Alfred Hospital, Sydney Local Area Health Service, Camperdown, NSW, Australia; Specialty of Psychiatry, University of Sydney, Australia.
| | - Glenn E Hunt
- University of Sydney, Sydney, NSW, Australia; Speciality of Psychiatry, University of Sydney, Concord Hospital, Concord, NSW, Australia
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Oxytocin and Bone: Review and Perspectives. Int J Mol Sci 2021; 22:ijms22168551. [PMID: 34445256 PMCID: PMC8395200 DOI: 10.3390/ijms22168551] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 12/27/2022] Open
Abstract
Recent data demonstrate the anabolic effect of oxytocin on bone. Bone cells express oxytocin receptors. Oxytocin promotes osteoblasts differentiation and function, leading to an increased bone formation with no effect on bone resorption and an improvement of bone microarchitecture. Oxytocin is synthetized by osteoblasts, and this synthesis is stimulated by estrogen. Animal studies demonstrate a direct action of oxytocin on bone, as the systemic administration of oxytocin prevents and reverses the bone loss induced by estrogen deficiency. Although oxytocin is involved in bone formation in both sexes during development, oxytocin treatment has no effect on male osteoporosis, underlining the importance of estrogen that amplifies its local autocrine and paracrine secretion. There are few human data showing a decrease in the oxytocin serum level in anorexia nervosa independently of estrogen and in amenorrheic women associated with impaired bone microarchitecture; in post-menopausal women a higher oxytocin serum level is associated with higher bone density, but not in osteoporotic men. Oxytocin displays many effects that may be beneficial in the management of osteoporosis, cardiovascular diseases, cognitive disorders, breast cancer, diabetes and body fat gain, all age-related diseases affecting elderly women, opening exciting therapeutic perspectives, although the issue is to find a single route, dosage and schedule able to reach all these targets.
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Plemeniti Tololeski B, Suhodolčan Grabner A, Kumperscak HG. Adolescents With Autism Spectrum Disorder and Anorexia Nervosa Comorbidity: Common Features and Treatment Possibilities With Cognitive Remediation Therapy and Oxytocin. Front Psychiatry 2021; 12:686030. [PMID: 34413796 PMCID: PMC8369034 DOI: 10.3389/fpsyt.2021.686030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/01/2021] [Indexed: 12/16/2022] Open
Abstract
Autistic traits or autism spectrum disorder (ASD) can be found in 4% to 52% of anorexic patients, which makes the treatment of these patients very challenging. In this review, possible ways to treat ASD and anorexia nervosa (AN) comorbidity in children and adolescents are summarized. Over recent years, the focus has shifted from searching for the evidence of connections between these two disorders, which have started with Gillberg's study in 1983, to searching for more effective and holistic treatment of this comorbidity. The latter is known to contribute to more severe courses and worse prognosis, which is probably related to the obstacles in both diagnosing and treating. Since AN usually starts in early adolescence and high-functioning ASD children seem to begin struggling with increased pressure in adolescence, while various comorbidities can occur, it is important to improve the treatment of this comorbidity in young patients and to tailor it specifically in terms of diagnosing. In this paper, a literature review is conducted on common features and promising treatment possibilities. We describe cognitive remediation therapy and the promising pharmacotherapeutic candidate oxytocin with a special focus on adolescents.
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Affiliation(s)
- Barbara Plemeniti Tololeski
- Centre for Mental Health, Unit for Adolescent Psychiatry, University Psychiatric Hospital Ljubljana, Ljubljana, Slovenia
| | | | - Hojka Gregoric Kumperscak
- Department for Child and Adolescent Psychiatry, University Medical Centre, Maribor, Slovenia.,Faculty for Medicine, University of Maribor, Maribor, Slovenia
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