Education, progressive muscle relaxation therapy, and exercise for the treatment of night eating syndrome. A pilot study

Effect of progressive muscle relaxation exercises on symptoms of premenstrual syndrome: A single-blind randomızed controlled trial

AIM

This study was carried out to determine the effect of progressive muscle relaxation exercises (PMR) on premenstrual syndrome (PMS) symptoms.

METHODS

The study was designed in a single-blind randomized controlled type. The study was conducted in a hospital in Western Türkiye. Seventy-nine single women who experienced PMS who met the inclusion criteria were randomly assigned to the experimental group in which PMR would be applied, and the control group to continue their routine coping habits regarding PMS. PMR were applied to the experimental group every day for 8 weeks. At the end of 8 weeks, the experimental and control groups were re-evaluated with the Premenstrual Syndrome Scale (PMSS).

RESULTS

At the beginning of the study, it was observed that the individual, health characteristics and PMSS mean scores of the women in the experimental and control groups were similar (p > 0.05). At the end of eight weeks, it was seen that the mean PMSS score of the experimental group was lower than that of the control group, and the difference was statistically significant (p < 0.001). When in-group comparisons were made at the end of the exercise program, no significant difference was found in the mean PMSS score of the control group compared to the beginning (p > 0.05). The PMSS score of the experimental group decreased significantly and the difference was statistically significant (p < 0.001).

CONCLUSION

In this study, it was seen that PMR were effective in improving PMS.

Prevalence and Correlates of Night Eating Syndrome, Insomnia, and Psychological Distress in Primary Care Patients with Obesity: A Cross-Sectional Study

INTRODUCTION

Management of obesity is challenging for both patients and healthcare workers. Considering the low success rate of current interventions, this study aimed to explore the prevalence and associated factors of night eating syndrome (NES), insomnia, and psychological distress among individuals with obesity in order to plan comprehensive obesity management interventions.

METHODS

A cross-sectional study on a convenient sample from five primary healthcare centers in Port Said, Egypt, was conducted from November 2020 to March 2021. Sociodemographic and clinical characteristics were collected in addition to the assessment of NES, insomnia, and psychological distress using the Arabic versions of the Night Eating Diagnostic Questionnaire (NEQ), the Insomnia Severity Index (ISI), and the Patient Health Questionnaire-4 (PHQ-4) scales, respectively. Associations of NES, insomnia, and psychological distress were assessed by multiple regression analysis. We performed Bonferroni adjustments for multiple comparisons.

RESULTS

We included 425 participants with obesity with a mean age of 45.52 ± 6.96 years. In all, 54.4% were females and the mean body mass index (BMI) was 35.20 ± 4.41 kg/m2. The prevalence rates of NES, insomnia, and psychological distress were 21.6% (95% CI: 17.7-25.6%), 15.3% (95% CI: 11.9-18.7%), and 18.8% (95% CI: 15.1-22.6%), respectively. NES was significantly associated with younger age (OR 0.974, p = 0.016), physical inactivity (OR 0.485, p = 0.010), insomnia (OR 2.227, p = 0.014), and psychological distress (OR 2.503, p = 0.002). Insomnia showed strong associations with NES (OR 2.255, p = 0.015) and psychological distress (OR 5.990, p < 0.001). Associated factors of psychological distress symptoms included insomnia (OR 6.098, p < 0.001) and NES (OR 2.463, p = 0.003).

CONCLUSION

The prevalence rates of NES, insomnia, and psychological distress were high among primary care patients with obesity, and these conditions were interrelated. Optimal obesity management necessitates individualized and targeted multidisciplinary care plans that take into consideration individual patients' mental, behavioral, and dietary habits needs.

Pharmacotherapy, alternative and adjunctive therapies for eating disorders: findings from a rapid review

BACKGROUND

The current review broadly summarises the evidence base for pharmacotherapies and adjunctive and alternative therapies in the treatment of eating disorders and disordered eating.

METHODS

This paper forms part of a Rapid Review series examining the evidence base in the field of eating disorders. This was conducted to inform the Australian National Eating Disorder Research and Translation Strategy 2021-2030. ScienceDirect, PubMed and Ovid/Medline were searched for included studies published between 2009 and 2021 in English. High-level evidence such as meta-analyses, large population studies and randomised control trials were prioritised, and grey literature excluded. Data from included studies relating to pharmacotherapy, and to adjunctive and alternative therapies in eating disorders, were synthesised and disseminated in the current review.

RESULTS

A total of 121 studies were identified, relating to pharmacotherapy (n = 90), adjunctive therapies (n = 21) and alternative therapies (n = 22). Some of the identified studies involved combinations of the above (e.g. adjunctive pharmacotherapy). Evidence of efficacy of interventions across all three categories was very limited with few relevant high quality clinical trials. There was a particular scarcity of evidence around effective treatments for anorexia nervosa (AN). With treatment of bulimia nervosa (BN), fluoxetine has exhibited some efficacy leading to regulatory approval in some countries. With binge eating disorder (BED), recent evidence supports the use of lisdexamfetamine. Neurostimulation interventions show some emerging efficacy in the treatment of AN, BN and BED but some, such as deep brain stimulation can be highly invasive.

CONCLUSION

Despite widespread use of medications, this Rapid Review has identified a lack of effective medications and adjunctive and alternative therapies in the treatment of EDs. An intensification of high-quality clinical trial activity and drug discovery innovation are required to better assist patients suffering from EDs.

An Updated Review of Night Eating Syndrome: An Under-Represented Eating Disorder

PURPOSE OF REVIEW

Night eating syndrome (NES) is an eating disorder that has historically been under-studied. The current review aims to summarize the most up-to-date research on NES to support better awareness.

RECENT FINDINGS

Since NES was recently included as a formal diagnosis, research on the prevalence of NES is ever evolving. Current studies underscore the high comorbidity between NES and other eating disorders, with additional complexities for patient with comorbid eating disorders. Recent findings also support the association between NES and sleep correlates, a relationship that has remained during the COVID-19 pandemic. Emerging research confirms correlates of distress in NES across cultures. There remain mixed findings between NES and BMI. There is also debate around whether age is a risk factor. Bariatric surgery research has focused on the re-emergence of NES post-operatively. Our understanding of the correlates of NES is increasing. However, research on the treatment for NES remains particularly under-studied and requires further attention.

'In the night kitchen': A scoping review on the night eating syndrome

BACKGROUND

First described in 1955, night eating syndrome refers to an abnormal eating behavior clinically defined by the presence of evening hyperphagia (>25% of daily caloric intake) and/or nocturnal awaking with food ingestion occurring ⩾ 2 times per week.

AIMS

Although the syndrome is frequently comorbid with obesity, metabolic and psychiatric disorders, its etiopathogenesis, diagnosis, assessment and treatment still remain not fully understood.

METHODS

This review was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines; PubMed database was searched until 31 October 2020, using the key terms: 'Night Eating Syndrome' AND 'complications' OR 'diagnosis' OR 'drug therapy' OR 'epidemiology' OR 'etiology' OR 'physiology' OR 'physiopathology' OR 'psychology' OR 'therapy'.

RESULTS

From a total of 239 citations, 120 studies assessing night eating syndrome met the inclusion criteria to be included in the review.

CONCLUSION

The inclusion of night eating syndrome into the Diagnostic and Statistical Manual of Mental Disorders-5 'Other Specified Feeding or Eating Disorders' category should drive the attention of clinician and researchers toward this syndrome that is still defined by evolving diagnostic criteria. The correct identification and assessment of NES could facilitate the detection and the diagnosis of this disorder, whose bio-psycho-social roots support its multifactorial nature. The significant rates of comorbid illnesses associated with NES and the overlapping symptoms with other eating disorders require a focused clinical attention. Treatment options for night eating syndrome include both pharmacological (selective serotonin reuptake inhibitors, topiramate and melatonergic drugs) and non-pharmachological approaches; the combination of such strategies within a multidisciplinary approach should be addressed in future, well-sized and long-term studies.

Night Eating Syndrome in Patients With Obesity and Binge Eating Disorder: A Systematic Review

Night eating syndrome (NES) is currently classified as an Other Specified Feeding or Eating Disorder (OSFED) under the Diagnostic Statistical Manual-5 (DSM-5). This systematic review aims to consolidate the studies that describe the sociodemographic, clinical and psychological features of NES in a population of patients with eating disorders (ED), obesity, or those undergoing bariatric surgery, and were published after the publication of the DSM-5. A further aim was to compare, where possible, NES with BED on the aforementioned variables. Lastly, we aimed to appraise the quality of the studies being included in the review. We conducted a systematic search on three databases (MEDLINE, PubMed and Embase) which resulted in the selection of 22 studies for the review. We included the articles that studied patients with NES and their sociodemographic, clinical and psychological features in a clinical (i.e., ED, obese or bariatric surgery) population, through a quantitative study design. Articles were excluded if the NES patients included in the study had a comorbid psychological disorder, and/or the sample was collected from a university/non-clinical population, and/or the study design was qualitative, and/or NES features were compared with any other disorder, except BED. Our study found that no conclusions about the link between any sociodemographic feature (such as, age, gender, income, etc.) and an NES diagnosis could be made. Further, NES patients presented with elevated ED pathology (including emotional eating and loss of control eating) and higher occurrence of depressive symptoms than controls. Contrary to the literature suggesting that NES and Binge Eating Disorder (BED; an ED subtype which is also comorbid with obesity) patients often report overlapping features, questioning the validity of NES as an ED diagnosis, we found that BED can be differentiated from NES by the higher occurrence of emotional eating, body related concerns and abnormal eating episodes. The review also suggested an overlap between NES and Sleep-Related Eating Disorder. We recommend that it is essential to study NES as an independent disorder to further develop its diagnostic criteria and treatment options, thereby, increasing the quality of life of the patients suffering from this syndrome.

Night-Eating Syndrome and Depressive Symptoms in College Freshmen: Fitness Improvement Tactics in Youths (FITYou) Project

Background

Emerging evidence has shown that night-eating syndrome is correlated to depressive symptoms. However, these studies were mainly small-scale investigations.

Purpose

This study aimed to examine the association of night-eating syndrome with depressive symptoms among college students using a large-scale sample.

Methods

A cross-sectional study, which was a part of the Fitness Improvement Tactics in Youth Project, was conducted in 2017. The current study included 3278 college freshmen from Shenyang, China. They completed self-administered questionnaires and provided their sociodemographic and lifestyle information. Night-eating syndrome was assessed using the night-eating questionnaire (NEQ). Depressive symptoms were measured using the Self-rating Depression Scale (SDS).

Results

Of participants, 5.4% had night-eating syndrome (NEQ score ≥30), and 21.3% had depressive symptoms (SDS score ≥53). Prevalence of night-eating syndrome was higher in male than female students (p = 0.006). Logistic regression analysis indicated that students with night-eating syndrome had a higher prevalence of depressive symptoms than those without the syndrome after adjusting covariates (odds ratios [95% CI]: 3.28 [2.40, 4.48], p < 0.001). Consistent results were found when night-eating syndrome was defined as NEQ score ≥25. In addition, analysis of covariance showed a significant association between NEQ quartiles and SDS score (mean [95% CI]: Q1, 44.4 [43.8, 45.0]; Q2, 43.4 [42.7, 44.0]; Q3, 44.4 [43.7, 45.1]; Q4, 47.5 [46.9, 48.2], p < 0.001 for linear and quadratic trend).

Conclusion

This study showed an association between night-eating syndrome and depressive symptoms among Chinese college freshmen.

Progressive muscle relaxation for patients with chronic schizophrenia: A randomized controlled study

PURPOSE

To evaluate progressive muscle relaxation (PMR) as an intervention for anxiety, psychotic symptoms, and quality of life (QOL) in patients with chronic schizophrenia.

DESIGN AND METHODS

Eighty patients were recruited from a Taiwanese psychiatry ward. The intervention group received group PMR; control group received treatment-as-usual.

RESULTS

The results indicated that PMR might have a short-term effect on reducing anxiety, improving psychotic syndromes, and QOL among patients with chronic schizophrenia; however, the effectiveness at the 3-month follow-up was not evident.

PRACTICE IMPLICATIONS

Both the psychiatric patients and the health institutions may be able to list PMR as a clinical routine care, and then become a mental health practice strategy for mental patients to improve the quality of mental care.

IMPLICATIONS FOR NURSING PRACTICE

Our studies suggest that prevention of severe mental illness among patients with schizophrenia requires PMR interventions. PMR had an immediate effect, and it is possible that a shorter intervention period using this approach would also be successful.

The Frequency of Night-Eating Syndrome in People Aged 18-65 Who Admitted to a Family Medicine Clinic of a Tertiary Hospital

Aim: Night Eating Syndrome is thought to pose a risk for the development of cardiovascular system, endocrinological and psychiatric diseases. The aim of our study was to investigate the frequency of night-eating syndrome and risk factors related to night eating syndrome. Methods: This cross-sectional, descriptive study was carried out among 525 people who admitted to the Family Medicine Clinic of a tertiary hospital between 01 October and 30 November 2018. The night-eating questionnaire was applied to the partcipants using face-to-face interview. Persons with a psychiatric disorder, who have a history of chronic medication or disease, who have alcohol and drug addiction and who are working on the night shift were excluded from the study. p values < 0.05 were considered as statistically significant. Results: Fifty-one (9.7%) of the 525 patients admitted to our clinic met the criteria of Night Eating Syndrome. In our study, there were statistically significant difference between night eating syndrome and non-night eating syndrome groups with respect to smoking status and body mass index. Conclusion: Night eating syndrome is a hidden public health problem which is related to cardiovascular system diseases, diabetes mellitus and psychiatric disorders besides obesity. Because of the presence of serious health problems associated with night eating syndrome, it is very important to determine night eating syndrome in primary care.

Night eating syndrome: a psychiatric disease, a sleep disorder, a delayed circadian eating rhythm, and/or a metabolic condition?

Introduction: Night Eating Syndrome (NES) refers to an abnormal eating behavior which presents as evening hyperphagia consuming >25% calorie intake and/or nocturnal awaking with food ingestion which occurs ≥2 times per week. Although the syndrome has been described more than seven decades ago, the literature has been growing slowly on its etiology, diagnosis, and treatment. Areas covered: The proposed treatment options for NES are all at a case-study level. Moreover, our understanding of its etiology, comorbidities, and diagnosis is still premature. We performed a literature review in Medline/PubMed to identify all the studies proposing a management plan for NES and summarized all the existing data on its diagnosis and treatment. Expert opinion: To date, none of the proposed treatment options for NES have been promising and long-term data on its efficacy is lacking. The slow growth of evidence on this debilitating but underreported condition may be due to unawareness among clinicians, under-reporting by patients, and unrecognized diagnostic criteria. Objective screening of symptoms during office visits especially for patients at a high-risk for NES will identify more patients suffering from the syndrome.

Disordered eating and obesity: associations between binge-eating disorder, night-eating syndrome, and weight-related comorbidities

Binge-eating disorder (BED) and night-eating syndrome (NES) are two forms of disordered eating associated with overweight and obesity. While these disorders also occur in nonobese persons, they seem to be associated with weight gain over time and higher risk of diabetes and other metabolic dysfunction. BED and NES are also associated with higher risk of psychopathology, including mood, anxiety, and sleep problems, than those of similar weight status without disordered eating. Treatments are available, including cognitive behavior therapy (CBT), interpersonal psychotherapy, lisdexamfetamine, and selective serotonin reuptake inhibitors (SSRIs) for BED; and CBT, SSRIs, progressive muscle relaxation, and bright light therapy for NES.

Night eating syndrome: How to treat it?

Summary Night eating syndrome (NES) is characterized by caloric intake ≥ 25% of total daily after dinner and/or by two or more weekly nocturnal awakenings accompanied by food ingestion. Causes of NES are not entirely clear and seem to involve a desynchronization between the circadian rhythms of food ingestion and sleep, resulting in a delayed pattern of food intake. Estimates of the prevalence of NES in the general population are around 1.5%, and although much higher frequencies have been described in obese individuals, a causal relationship between NES and obesity is not clearly established. Since the first NES reports, several treatment modalities have been proposed, although, in many cases, the evidence is still insufficient and there is no consensus on the ideal approach. In order to conduct a critical review of proposed treatments for NES since its original description, a systematic search of articles published in journals indexed in Medline/Pubmed database in the period 1955-2015 was performed. Seventeen articles addressing non-pharmacological and pharmacological therapies met the selection criteria. Based on the articles analyzed, we conclude that serotonergic agents and psychological interventions, particularly cognitive behavioral therapy, have been shown to be effective for the treatment of NES. A combination of non-pharmacological and pharmacological therapies must be considered in future studies on the treatment of these patients.

Sleep and Eating Disorders

Insomnia is related to an increased risk of eating disorders, while eating disorders are related to more disrupted sleep. Insomnia is also linked to poorer treatment outcomes for eating disorders. However, over the last decade, studies examining sleep and eating disorders have relied on surveys, with no objective measures of sleep for anorexia nervosa or bulimia nervosa, and only actigraphy data for binge eating disorder. Sleep disturbance is better defined for night eating syndrome, where sleep efficiency is reduced and melatonin release is delayed. Studies that include objectively measured sleep and metabolic parameters combined with psychiatric comorbidity data would help identify under what circumstances eating disorders and sleep disturbance produce an additive effect for symptom severity and for whom poor sleep would increase risk for an eating disorder. Cognitive behavior therapy for insomnia may be a helpful addition to treatment of those with both eating disorder and insomnia.

Chronobesity: role of the circadian system in the obesity epidemic

Although obesity is considered to result from an imbalance between energy uptake and energy expenditure, the strategy of dietary changes and physical exercise has failed to tackle the global obesity epidemic. In search of alternative and more adequate treatment options, research has aimed at further unravelling the mechanisms underlying this excessive weight gain. While numerous studies are focusing on the neuroendocrine alterations that occur after bariatric Roux-en-Y gastric bypass surgery, an increasing amount of chronobiological studies have started to raise awareness concerning the pivotal role of the circadian system in the development and exacerbation of obesity. This internal timekeeping mechanism rhythmically regulates metabolic and physiological processes in order to meet the fluctuating demands in energy use and supply throughout the 24-h day. This review elaborates on the extensive bidirectional interaction between the circadian system and metabolism and explains how disruption of body clocks by means of shift work, frequent time zone travelling or non-stop consumption of calorie-dense foods can evoke detrimental metabolic alterations that contribute to obesity. Altering the body's circadian rhythms by means of time-related dietary approaches (chrononutrition) or pharmacological substances (chronobiotics) may therefore represent a novel and interesting way to prevent or treat obesity and associated comorbidities.

Optimal management of night eating syndrome: challenges and solutions

Night Eating Syndrome (NES) is a unique disorder characterized by a delayed pattern of food intake in which recurrent episodes of nocturnal eating and/or excessive food consumption occur after the evening meal. NES is a clinically important disorder due to its relationship to obesity, its association with other psychiatric disorders, and problems concerning sleep. However, NES often goes unrecognized by both health professionals and patients. The lack of knowledge regarding NES in clinical settings may lead to inadequate diagnoses and inappropriate treatment approaches. Therefore, the proper diagnosis of NES is the most important issue when identifying NES and providing treatment for this disorder. Clinical assessment tools such as the Night Eating Questionnaire may help health professionals working with populations vulnerable to NES. Although NES treatment studies are still in their infancy, antidepressant treatments and psychological therapies can be used for optimal management of patients with NES. Other treatment options such as melatonergic medications, light therapy, and the anticonvulsant topiramate also hold promise as future treatment options. The purpose of this review is to provide a summary of NES, including its diagnosis, comorbidities, and treatment approaches. Possible challenges addressing patients with NES and management options are also discussed.