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Sæle RH, Ndetei DM, Mutiso VN, Mamah D. Epidemiology of DSM-5 psychiatric disorders in Kenyan Youth with Low and High Psychosis Risk. Compr Psychiatry 2024; 131:152473. [PMID: 38503003 DOI: 10.1016/j.comppsych.2024.152473] [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: 09/02/2023] [Revised: 01/30/2024] [Accepted: 03/10/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION There are few psychiatric epidemiology studies among Kenyan youth and fewer among those at high psychosis risk (HR). METHODS This study assessed the epidemiology of DSM-5 psychiatric disorders in HR and low-risk (LR) individuals to inform research and mental health services. 567 participants (aged 15-25) in HR (n = 246) and LR (n = 260) groups based on Washington Early Recognition Center Affectivity and Psychosis (WERCAP) Screen scores. Diagnostic Interview Schedule, version 5 (DIS-5) assessed DSM-5 psychiatric disorder prevalence. Diagnostic comorbidity and demographic relationships were investigated. RESULTS A higher prevalence was observed for all DSM-5 disorders in the HR group, significantly for gambling disorder (13% vs. 5.8%), major depressive disorder (9.8% vs. 3.8%), antisocial personality disorder (5.7% vs. 2.3%), general anxiety disorder (4.9% vs. 0.4%), oppositional defiant disorder (3.3% vs. 0.4%), panic disorder (2.8% vs. 0.8%), and anorexia nervosa (2.8% vs. 0%). Gambling disorder was the most prevalent and showed significant gender effects (males>females). DISCUSSION Psychiatric disorders occur at increased rates among HR compared to LR. Prevalence rates found are lower than in US studies, except for gambling disorder which was highly prevalent. Large-population-based epidemiology studies in Africa are needed to estimate rates, particularly of disorders such as schizophrenia, accurately.
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Affiliation(s)
- Rebekka H Sæle
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America.
| | - David M Ndetei
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya; Department of Psychiatry, University of Nairobi, Kenya
| | - Victoria N Mutiso
- Africa Mental Health Research and Training Foundation, Nairobi, Kenya
| | - Daniel Mamah
- Departments of Psychiatry, Washington University School of Medicine, St. Louis, MO, United States of America
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Laboe AA, McGinnis CG, Fennig M, Zucker K, Wu E, Shah J, Levitan J, Firebaugh ML, Bardone-Cone AM, Pike KM, Taylor CB, Wilfley DE, Fitzsimmons-Craft EE. Development and usability testing of a cognitive-behavioral therapy-guided self-help mobile app and social media group for the post-acute treatment of anorexia nervosa. Eat Behav 2024; 53:101865. [PMID: 38461772 DOI: 10.1016/j.eatbeh.2024.101865] [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: 11/07/2023] [Revised: 01/23/2024] [Accepted: 02/27/2024] [Indexed: 03/12/2024]
Abstract
OBJECTIVE Anorexia nervosa (AN) is often treated in the acute setting, but relapse after treatment is common. Cognitive-behavioral therapy (CBT) is useful in the post-acute period, but access to trained providers is limited. Social support is also critical during this period. This study utilized a user-centered design approach to develop and evaluate the usability of a CBT-based mobile app and social networking component for post-acute AN support. METHOD Participants (N = 19) were recently discharged from acute treatment for AN. Usability testing of the intervention was conducted over three cycles; assessments included the System Usability Scale (SUS), the Usefulness, Satisfaction, and Ease of Use Questionnaire (USE), the Mobile Application Rating Scale (MARS), a social media questionnaire, and a semi-structured interview. RESULTS Interview feedback detailed aspects of the app that participants enjoyed and those needing improvement. Feedback converged on three themes: Logistical App Feedback, boosting recovery, and Real-World App/Social Media Use. USE and MARS scores were above average and SUS scores were "good" to "excellent" across cycles. CONCLUSION This study provides evidence of feasibility and acceptability of an app and social networking feature for post-acute care of AN. The intervention has potential for offering scalable support for individuals with AN in the high-risk period following discharge from acute care.
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Affiliation(s)
- Agatha A Laboe
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA.
| | - Claire G McGinnis
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Molly Fennig
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Kianna Zucker
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Ellis Wu
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Jillian Shah
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Julie Levitan
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Marie-Laure Firebaugh
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
| | - Anna M Bardone-Cone
- Department of Psychology & Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kathleen M Pike
- Departments of Psychiatry, Epidemiology and Psychology, Columbia University, New York City, NY, USA
| | - C Barr Taylor
- Center for m2Health, Palo Alto University, Palo Alto, CA, USA; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA
| | - Denise E Wilfley
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO, USA
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Keegan E, Wade TD. The role of readiness and confidence to change in the treatment of atypical anorexia nervosa and bulimia nervosa. Int J Eat Disord 2024; 57:1020-1025. [PMID: 36840352 DOI: 10.1002/eat.23918] [Citation(s) in RCA: 2] [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: 11/14/2022] [Revised: 02/08/2023] [Accepted: 02/08/2023] [Indexed: 02/26/2023]
Abstract
OBJECTIVE Atypical anorexia nervosa (AN) is a serious eating disorder that is more common in the population than AN. Despite this, people with atypical AN are less likely to be referred or admitted for eating disorder treatment and there is evidence that they are less likely to complete or benefit from existing interventions. This study examined whether baseline readiness and/or confidence moderated outcomes from 10-session cognitive behavioral therapy among people with atypical AN and bulimia nervosa (BN), and whether the impact of these variables differed between diagnoses. METHODS Participants (n = 67; 33 with atypical AN) were a subset from an outpatient treatment study. Linear mixed model analyses were conducted to examine whether baseline readiness and/or confidence moderated outcomes. RESULTS People with BN who had higher levels of readiness or confidence at baseline had steeper decreases in eating disorder psychopathology over time. There was no evidence that readiness or confidence moderated outcomes for people with atypical AN. DISCUSSION This study suggests that the moderators that have been identified for other eating disorders may not apply for people with atypical AN and highlights a need for future work to routinely investigate whether theoretically or empirically driven variables moderate outcomes in this little-understood population. PUBLIC SIGNIFICANCE STATEMENT People with bulimia nervosa with higher readiness and confidence experienced greater decreases in eating disorder symptoms than people with lower readiness and confidence when treated with cognitive behavioral therapy. These findings did not apply to people with atypical anorexia nervosa. Results demonstrate that future work is urgently required to identify helpful treatments for people with atypical anorexia nervosa as well as the variables that have a positive impact on outcomes in treatment for these individuals.
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Affiliation(s)
- Ella Keegan
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
| | - Tracey D Wade
- Flinders Institute for Mental Health and Wellbeing, School of Psychology, Flinders University, Adelaide, South Australia, Australia
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Solmi M, Monaco F, Højlund M, Monteleone AM, Trott M, Firth J, Carfagno M, Eaton M, De Toffol M, Vergine M, Meneguzzo P, Collantoni E, Gallicchio D, Stubbs B, Girardi A, Busetto P, Favaro A, Carvalho AF, Steinhausen HC, Correll CU. Outcomes in people with eating disorders: a transdiagnostic and disorder-specific systematic review, meta-analysis and multivariable meta-regression analysis. World Psychiatry 2024; 23:124-138. [PMID: 38214616 PMCID: PMC10785991 DOI: 10.1002/wps.21182] [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] [Indexed: 01/13/2024] Open
Abstract
Eating disorders (EDs) are known to be associated with high mortality and often chronic and severe course, but a recent comprehensive systematic review of their outcomes is currently missing. In the present systematic review and meta-analysis, we examined cohort studies and clinical trials published between 1980 and 2021 that reported, for DSM/ICD-defined EDs, overall ED outcomes (i.e., recovery, improvement and relapse, all-cause and ED-related hospitalization, and chronicity); the same outcomes related to purging, binge eating and body weight status; as well as mortality. We included 415 studies (N=88,372, mean age: 25.7±6.9 years, females: 72.4%, mean follow-up: 38.3±76.5 months), conducted in persons with anorexia nervosa (AN), bulimia nervosa (BN), binge eating disorder (BED), other specified feeding and eating disorders (OSFED), and/or mixed EDs, from all continents except Africa. In all EDs pooled together, overall recovery occurred in 46% of patients (95% CI: 44-49, n=283, mean follow-up: 44.9±62.8 months, no significant ED-group difference). The recovery rate was 42% at <2 years, 43% at 2 to <4 years, 54% at 4 to <6 years, 59% at 6 to <8 years, 64% at 8 to <10 years, and 67% at ≥10 years. Overall chronicity occurred in 25% of patients (95% CI: 23-29, n=170, mean follow-up: 59.3±71.2 months, no significant ED-group difference). The chronicity rate was 33% at <2 years, 40% at 2 to <4 years, 23% at 4 to <6 years, 25% at 6 to <8 years, 12% at 8 to <10 years, and 18% at ≥10 years. Mortality occurred in 0.4% of patients (95% CI: 0.2-0.7, n=214, mean follow-up: 72.2±117.7 months, no significant ED-group difference). Considering observational studies, the mortality rate was 5.2 deaths/1,000 person-years (95% CI: 4.4-6.1, n=167, mean follow-up: 88.7±120.5 months; significant difference among EDs: p<0.01, range: from 8.2 for mixed ED to 3.4 for BN). Hospitalization occurred in 26% of patients (95% CI: 18-36, n=18, mean follow-up: 43.2±41.6 months; significant difference among EDs: p<0.001, range: from 32% for AN to 4% for BN). Regarding diagnostic migration, 8% of patients with AN migrated to BN and 16% to OSFED; 2% of patients with BN migrated to AN, 5% to BED, and 19% to OSFED; 9% of patients with BED migrated to BN and 19% to OSFED; 7% of patients with OSFED migrated to AN and 10% to BN. Children/adolescents had more favorable outcomes across and within EDs than adults. Self-injurious behaviors were associated with lower recovery rates in pooled EDs. A higher socio-demographic index moderated lower recovery and higher chronicity in AN across countries. Specific treatments associated with higher recovery rates were family-based therapy, cognitive-behavioral therapy (CBT), psychodynamic therapy, and nutritional interventions for AN; self-help, CBT, dialectical behavioral therapy (DBT), psychodynamic therapy, nutritional and pharmacological treatments for BN; CBT, nutritional and pharmacological interventions, and DBT for BED; and CBT and psychodynamic therapy for OSFED. In AN, pharmacological treatment was associated with lower recovery, and waiting list with higher mortality. These results should inform future research, clinical practice and health service organization for persons with EDs.
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Affiliation(s)
- Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Regional Centre for Treatment of Eating Disorders, and On Track: Champlain First Episode Psychosis Program, Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| | - Francesco Monaco
- Department of Mental Health, Local Health Unit, Salerno, Italy
- European Biomedical Research Institute of Salerno, Salerno, Italy
| | - Mikkel Højlund
- Department of Psychiatry Aabenraa, Mental Health Services in the Region of Southern Denmark, Aabenraa, Denmark; Clinical Pharmacology, Pharmacy, and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | | | - Mike Trott
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
- Centre for Public Health, Queen's University, Belfast, UK
| | - Joseph Firth
- Division of Psychology and Mental Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Marco Carfagno
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Melissa Eaton
- NICM Health Research Institute, Western Sydney University, Sydney, NSW, Australia; School of Medicine, University of Wollongong, Wollongong, NSW, Australia
- School of Medical, Indigenous and Health Sciences Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Marco De Toffol
- Department of Mental Health, Local Health Unit, Lecce, Italy
| | | | - Paolo Meneguzzo
- Department of Neuroscience, University of Padua, Padua, Italy
| | | | | | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
- Faculty of Health, Social Care Medicine and Education, Anglia Ruskin University, Chelmsford, UK
| | - Anna Girardi
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Paolo Busetto
- Provincial Center for Eating Disorders, Local Health Unit, Treviso, Italy
| | - Angela Favaro
- Department of Neuroscience, University of Padua, Padua, Italy
| | - Andre F Carvalho
- Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, VIC, Australia
| | - Hans-Christoph Steinhausen
- Department of Child and Adolescent Psychiatry, Psychiatric University Clinic, Zurich, Switzerland
- Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
- Department of Child and Adolescent Psychiatry, University of Southern Denmark, Odense, Denmark
- Child and Adolescent Mental Health Centre, Capital Region Psychiatry, Copenhagen, Denmark
| | - Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
- Department of Psychiatry, Northwell Health, Zucker Hillside Hospital, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Center for Psychiatric Neuroscience, Feinstein Institutes for Medical Research, Manhasset, NY, USA
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Campos A, Marek T, Calderon G, Ghusn W, Cifuentes L, Sim LA, Camilleri M, Dayyeh BA, Port JD, Acosta A. Neurohormonal response patterns to hunger, satiation, and postprandial fullness in normal weight, anorexia nervosa, and obesity. Neurogastroenterol Motil 2024; 36:e14695. [PMID: 37926943 DOI: 10.1111/nmo.14695] [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: 06/12/2023] [Revised: 09/18/2023] [Accepted: 10/11/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Food intake is regulated by homeostatic and hedonic systems that interact in a complex neuro-hormonal network. Dysregulation in energy intake can lead to obesity (OB) or anorexia nervosa (AN). However, little is known about the neurohormonal response patterns to food intake in normal weight (NW), OB, and AN. MATERIAL & METHODS During an ad libitum nutrient drink (Ensure®) test (NDT), participants underwent three pseudo-continuous arterial spin labeling (pCASL) MRI scans. The first scan was performed before starting the NDT after a > 12 h overnight fast (Hunger), the second after reaching maximal fullness (Satiation), and the third 30-min after satiation (postprandial fullness). We measured blood levels of ghrelin, cholecystokinin (CCK), glucagon-like peptide (GLP-1), and peptide YY (PYY) with every pCASL-MRI scan. Semiquantitative cerebral blood flow (CBF) maps in mL/100 gr brain/min were calculated and normalized (nCBF) with the CBF in the frontoparietal white matter. The hypothalamus (HT), nucleus accumbens [NAc] and dorsal striatum [DS] were selected as regions of interest (ROIs). RESULTS A total of 53 participants, 7 with AN, 17 with NW (body-mass index [BMI] 18.5-24.9 kg/m2 ), and 29 with OB (BMI ≥30 kg/m2 ) completed the study. The NW group had a progressive decrease in all five ROIs during the three stages of food intake (hunger, satiation, and post-prandial fullness). In contrast, participants with OB showed a minimal change from hunger to postprandial fullness in all five ROIs. The AN group had a sustained nCBF in the HT and DS, from hunger to satiation, with a subsequent decrease in nCBF from satiation to postprandial fullness. All three groups had similar hormonal response patterns with a decrease in ghrelin, an increase in GLP-1 and PYY, and no change in CCK. CONCLUSION Conditions of regulated (NW) and dysregulated (OB and AN) energy intake are associated with distinctive neurohormonal activity patterns in response to hunger, satiation, and postprandial fullness.
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Affiliation(s)
- Alejandro Campos
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Tomas Marek
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Gerardo Calderon
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wissam Ghusn
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Lizeth Cifuentes
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Leslie A Sim
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michael Camilleri
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Barham Abu Dayyeh
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - John D Port
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA
- Department of Diagnostic Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Andres Acosta
- Precision Medicine for Obesity Program, Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Dahlgren CL, Reneflot A, Brunborg C, Wennersberg AL, Wisting L. Estimated prevalence of DSM-5 eating disorders in Norwegian adolescents: A community based two-phase study. Int J Eat Disord 2023; 56:2062-2073. [PMID: 37530417 DOI: 10.1002/eat.24032] [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: 03/13/2023] [Revised: 07/14/2023] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVE Little is known about the prevalence of DSM-5 eating disorders (EDs) in adolescents. In Norway, the most recent community-based prevalence study in adolescents was published more than 20 years ago. The aim of this study was to assess the prevalence of DSM-5 EDs in Norwegian adolescents using a two-phase design. METHOD A total of 1558 upper secondary school students (827 girls and 730 boys) (ages 16-19) were screened for at-risk ED pathology using the Eating Disorder Examination-Questionnaire short version (EDE-QS). A sub-sample of 99 adolescents (87 girls and 12 boys) subsequently participated in a clinical interview using the Eating Disorder Assessment for DSM-5 (EDA-5). RESULTS Eating pathology was common, with 19.9% of participants scoring at or above the applied EDE-QS cut-off. The estimated prevalence of any ED was 9.4% in the total sample, and 16.4% in girls. The number of boys who took part in the diagnostic interview was low, thus, diagnostic data from boys were not analyzed separately. Prevalence estimates of AN, BN, BED, and OSFED in girls were 2.7%, 1.1%, 1.9%, and 10.7%. Atypical AN was the most frequently assigned diagnosis in girls. DISCUSSION Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth. PUBLIC SIGNIFICANCE STATEMENT In this study, 1558 adolescents, aged 16-19, were screened for ED pathology. A subsample completed a diagnostic interview using DSM-5 criteria. Results showed that one in five adolescents displayed problematic eating behaviors and cognitions. The estimated prevalence rate of any ED was 9.4%. Sampling biases limit generalizability of results. Additional population-based studies are warranted to assess the prevalence of EDs in Norwegian youth.
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Affiliation(s)
- Camilla Lindvall Dahlgren
- Department of Psychology, Oslo New University College, Oslo, Norway
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål HF, Oslo, Norway
| | - Anne Reneflot
- Department of Mental Health and Suicide, Norwegian Institute of Public Health, Oslo, Norway
| | - Cathrine Brunborg
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Anne-Louise Wennersberg
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål HF, Oslo, Norway
| | - Line Wisting
- Regional Department for Eating Disorders, Oslo University Hospital, Ullevål HF, Oslo, Norway
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Birgegård A, Mantilla EF, Breithaupt LE, Borg S, Sanzari CM, Padalecki S, Hedlund E, Bulik CM. Proposal for increasing diagnostic clarity in research and clinical practice by renaming and reframing atypical anorexia nervosa as "Restrictive Eating Disorder" (RED). Eat Behav 2023; 50:101750. [PMID: 37263139 DOI: 10.1016/j.eatbeh.2023.101750] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 04/25/2023] [Accepted: 05/18/2023] [Indexed: 06/03/2023]
Abstract
Atypical anorexia nervosa (AAN) in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5), is characterized by meeting all criteria for anorexia nervosa (AN) except for weight being within or above the "normal" range despite significant weight loss. The current definition is plagued by several problems, resulting in widely heterogeneous operationalizations in research and clinical practice. As such, the poorly defined diagnosis of AAN negatively impacts affected individuals and frustrates research attempts to better understand the syndrome. We consider conceptual flaws in the AAN description and contend that the undefined weight range and nature of weight loss renders these two factors functionally inapplicable in research and practice. They also represent a departure from the originally intended use of the AAN category, i.e., arresting a negative weight trajectory likely to result in AN, making the target population, and the application of the label, unclear. We propose revised criteria and a new name, restrictive eating disorder (RED), intended to reduce stigma and encompass a wide but better-defined range of presentations. The RED criteria focus on clinically significant restrictive behavior that disrupts normal living (i.e., impairment), and cognitive symptoms of overevaluation, disturbed experience, and lack of recognition of illness seriousness. We believe that RED may enable more appropriate clinical application, but also inspire coordinated research toward a more valid psychiatric nosology in the eating disorders field.
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Affiliation(s)
- Andreas Birgegård
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
| | - Emma Forsén Mantilla
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Lauren E Breithaupt
- Eating Disorders Clinical and Research Program, Massachusetts General Hospital, Boston, MA, USA; Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Stina Borg
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christina M Sanzari
- Department of Psychology, University at Albany, State University of New York, Albany, NY, USA; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Sophie Padalecki
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Public Health, College of Arts and Sciences, Elon University, NC, USA
| | - Elin Hedlund
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Cynthia M Bulik
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Uziel O, Dickstein H, Beery E, Lewis Y, Loewenthal R, Uziel E, Shochat Z, Weizman A, Stein D. Differences in Telomere Length between Adolescent Females with Anorexia Nervosa Restricting Type and Anorexia Nervosa Binge-Purge Type. Nutrients 2023; 15:2596. [PMID: 37299559 PMCID: PMC10255620 DOI: 10.3390/nu15112596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 05/29/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023] Open
Abstract
Physiological and psychological distress may accelerate cellular aging, manifested by shortening of telomere length (TL). The present study focused on TL shortening in anorexia nervosa (AN), an illness combining physiological and psychological distress. For that purpose, we measured TL in 44 female adolescents with AN at admission to inpatient treatment, in a subset of 18 patients also at discharge, and in 22 controls. No differences in TL were found between patients with AN and controls. At admission, patients with AN-binge/purge type (AN-B/P; n = 18) showed shorter TL compared with patients with AN-restricting type (AN-R; n = 26). No change in TL was found from admission to discharge, despite an improvement in body mass index standard deviation score (BMI-SDS) following inpatient treatment. Older age was the only parameter assessed to be correlated with greater TL shortening. Several methodological changes have to be undertaken to better understand the putative association of shorter TL with B/P behaviors, including increasing the sample size and the assessment of the relevant pathological eating disorder (ED) and non-ED psychological correlates in the two AN subtypes.
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Affiliation(s)
- Orit Uziel
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
| | - Hadar Dickstein
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Einat Beery
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
| | - Yael Lewis
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Shalvatah Mental Health Center, Hod Hasahron 45100, Israel
| | - Ron Loewenthal
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
| | - Eran Uziel
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Zipi Shochat
- Research Unit, Geha Mental Health Center, Petah Tikva 49100, Israel
| | - Abraham Weizman
- Felsenstein Medical Research Center, Sackler School of Medicine, Tel Aviv University, Petah Tikva 69978, Israel; (O.U.)
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Statistical Service, Rabin Medical Center, Petah Tikva 49100, Israel
| | - Daniel Stein
- Sackler School of Medicine, Tel Aviv University, Tel Aviv 69978, Israel
- Safra Children’s Hospital, Sheba Medical Center, Ramat Gan 52621, Israel
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9
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Mirabella M, Muzi L, Franco A, Urgese A, Rugo MA, Mazzeschi C, Speranza AM, McWilliams N, Lingiardi V. From symptoms to subjective and bodily experiences: the contribution of the Psychodynamic Diagnostic Manual (PDM-2) to diagnosis and treatment monitoring in eating disorders. Eat Weight Disord 2023; 28:35. [PMID: 36997702 PMCID: PMC10063489 DOI: 10.1007/s40519-023-01562-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/17/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Atheoretical and descriptive conceptualizations of eating disorders (EDs) have faced substantial criticism due to their limited ability to assess patients' subjective characteristics and experiences, as needed to determine the most appropriate treatment options. The present article provides an overview of the clinical and empirical literature supporting the potential contribution of the Psychodynamic Diagnostic Manual (PDM-2) to both diagnostic assessment and treatment monitoring. METHODS Following a discussion of the most relevant shortcomings of current diagnostic models of EDs and a description of the rationale and structure of the PDM-2, evidence supporting the core PDM-2 dimensions of ED patients' subjective experiences (i.e., affective states, cognitive processes, relational patterns, somatic/bodily experiences and states) are examined, alongside their relevance to ED diagnosis and treatment. RESULTS Overall, the reviewed studies support the diagnostic importance of these patterns of subjective experiences in EDs, highlighting their potential role as either predisposing or maintaining factors to target in psychotherapy. A growing body of multidisciplinary evidence also shows that bodily and somatic experiences are central to the diagnosis and clinical management of ED patients. Moreover, there is evidence that a PDM-based assessment may enable closer monitoring of patient progress during treatment, with regard to both subjective experiences and symptom patterns. CONCLUSIONS The study suggests that current diagnostic frameworks for EDs would benefit from the addition of a person-centered perspective that considers not only symptoms, but also patients' full range of functioning-including their deep and surface-level emotional, cognitive, interpersonal, and social patterns-to improve patient-tailored interventions. LEVEL OF EVIDENCE Level V, narrative review.
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Affiliation(s)
- Marta Mirabella
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Laura Muzi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy.
| | - Anna Franco
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Alessia Urgese
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Michele A Rugo
- Eating Disorder Clinic "Residenza Gruber", Bologna, Italy
| | - Claudia Mazzeschi
- Department of Philosophy, Social Sciences, Humanities and Education, University of Perugia, Perugia, Italy
| | - Anna Maria Speranza
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | - Nancy McWilliams
- Graduate School of Applied and Professional Psychology, Rutgers University, Lambertville, NJ, USA
| | - Vittorio Lingiardi
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
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10
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Mattatia J, Gaha N, Cottin L, Mattatia D, Morelle Q, Truong R, Saussé-Corbière L, Yi MK. Anorexie mentale et médiations somatiques : évaluations croisées de l’ostéopathie et de la psychomotricité sur les préoccupations corporelles. ANNALES MÉDICO-PSYCHOLOGIQUES, REVUE PSYCHIATRIQUE 2023. [DOI: 10.1016/j.amp.2023.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/31/2023]
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11
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Abstract
PURPOSE OF REVIEW Eating disorders (anorexia nervosa, bulimia nervosa, binge eating disorder, and other eating disorders) affect young people worldwide. This narrative review summarizes key studies conducted on the prevalence of Diagnostic and Statistical Manual of Mental Disorders (DSM-5) eating disorders among young people in 2013-22. RECENT FINDINGS In Western settings, a substantial proportion of young people have reported an eating disorder. Overall, 5.5--17.9% of young women and 0.6-2.4% of young men have experienced a DSM-5 eating disorder by early adulthood. Lifetime DSM-5 anorexia nervosa was reported by 0.8-6.3% of women and 0.1-0.3% of men, bulimia nervosa by 0.8-2.6% of women and 0.1-0.2% of men, binge eating disorder by 0.6-6.1% of women and 0.3-0.7% of men, other specified feeding or eating disorders by 0.6-11.5% of women and 0.2-0.3% of men, and unspecified feeding or eating disorders 0.2-4.7% of women and 0-1.6% of men. Gender and sexual minorities were at particularly high risk. Emerging studies from Eastern Europe, Asia, and Latin America show similar high prevalences. During the COVID-19 pandemic, the incidence of eating disorders has still increased. SUMMARY Eating disorders are a global health concern among young people. Improved detection, management, and prevention methods are urgently needed.
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Affiliation(s)
- Yasmina Silén
- Department of Public Health, University of Helsinki, Finland
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12
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Morgan GSK, Mata Y, Urbano BC, Suárez de Puga RP, Guirao PC, Gotti S, Sànchez HP. Influence of early maternal separation on susceptibility to the activity-based anorexia model in male and female Sprague Dawley rats. Neurosci Res 2022; 184:54-61. [PMID: 35948154 DOI: 10.1016/j.neures.2022.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 08/01/2022] [Accepted: 08/04/2022] [Indexed: 10/31/2022]
Abstract
A principal animal paradigm employed in Anorexia Nervosa (AN) study is the activity-based anorexia (ABA) model. The model's efficacy in recapitulating the core features of AN in humans allows for the study of the parameters involved in the disorder. The current study examined the susceptibility to the ABA protocol in the presence of a significant stressor (maternal separation) in male and female Sprague Dawley rats. More importantly, we analysed the sex-differences on activity levels during different periods of the ABA protocol to determine the period(s) influencing the most pathological weight loss. Both components of the ABA protocol contributed to the subjects' bodyweight loss. Stress in the first two weeks of development conferred a protective effect in males. Time spent and activity levels on the running wheel were higher in females compared to males. Hyperactivity in ABA subjects was observed during the food-anticipatory activity (FAA) and postprandial activity in males and during the FAA and nocturnal activity periods in females. This study aids in understanding the effect of intensity of activity during specific periods on the pathological weight loss in ABA rats. These observations are informative for therapies aimed at ameliorating body mass index in AN patients.
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Affiliation(s)
- Godstime Stephen Kojo Morgan
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, Orbassano 10043, Torino, Italy; Department of Neuroscience Rita Levi Montalcini, University of Torino, Via Cherasco 15, 10125 Torino, Italy; Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Yolanda Mata
- Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Beatriz Carrillo Urbano
- Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Ricardo Pellón Suárez de Puga
- Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Paloma Collado Guirao
- Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
| | - Stefano Gotti
- Neuroscience Institute Cavalieri Ottolenghi (NICO), Regione Gonzole 10, Orbassano 10043, Torino, Italy; Department of Neuroscience Rita Levi Montalcini, University of Torino, Via Cherasco 15, 10125 Torino, Italy.
| | - Helena Pinos Sànchez
- Department of Psychobiology, Universidad Nacional de Educación a Distancia (UNED), C/ Juan del Rosal 10, 28040 Madrid, Spain.
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13
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Dauty M, Menu P, Jolly B, Lambert S, Rocher B, Le Bras M, Jirka A, Guillot P, Pretagut S, Fouasson-Chailloux A. Inpatient Rehabilitation during Intensive Refeeding in Severe Anorexia Nervosa. Nutrients 2022; 14:nu14142951. [PMID: 35889908 PMCID: PMC9322979 DOI: 10.3390/nu14142951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 02/01/2023] Open
Abstract
Severe forms of anorexia nervosa are responsible for weight loss and life-threatening consequences. Refeeding represents a real psychiatric and somatic challenge. Physical activities are usually not recommended during intensive refeeding in order to avoid energy expenditure. This study assessed the interest in an early return to controlled physical activities, during a hospitalization in a Physical Medicine and Rehabilitation (PMR) department, including continuous nasogastric refeeding and psychiatric care. A total of 37 subjects aged 32 ± 11 years old performed inpatient physical activities during nasogastric refeeding initiated after intensive care. The physical activity program was adapted according to the hyperactivity of the patients. Evaluation parameters were weight, body mass index (BMI), body composition (fat, lean, and bone masses), and function (strength, balance, walking, ventilation). Patient satisfaction, re-hospitalizations, and physical activities continuation were assessed at 12 months of follow-up. Weight, BMI, and body fat increased significantly (+2.7 ± 1.7 kg; +1.0 ± 0.6 kg/m2; +1.7 ± 2.5 kg, respectively). Muscle strength increased even if the lean mass did not. Walking distance, balance, and respiratory function were significantly improved. Weight and fat mass gains did not differ according to the presence or absence of hyperactivity. At 12 months, 46% of the patients continued to be physically active, but 21% of the patients had been re-hospitalized. The early return to controlled physical activities in PMR hospitalization does not compromise the efficiency of intensive refeeding in severe anorexia nervosa patients.
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Affiliation(s)
- Marc Dauty
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Pierre Menu
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
| | - Baptiste Jolly
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
| | - Sylvain Lambert
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Bruno Rocher
- Psychiatrie et Santé Mentale, UIC 18, CHU Nantes, Nantes Université, 44000 Nantes, France; (S.L.); (B.R.)
| | - Maëlle Le Bras
- Service d’Endocrinologie, Diabétologie et Nutrition, Institut du Thorax, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Adam Jirka
- Equipe Transversale D’assistance Nutritionnelle, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Pascale Guillot
- Service de Rhumatologie, CHU Nantes, Nantes Université, 44000 Nantes, France;
| | - Stéphane Pretagut
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
| | - Alban Fouasson-Chailloux
- Service de Médecine Physique et Réadaptation Locomotrice et Respiratoire, CHU Nantes, Nantes Université, 44093 Nantes, France; (M.D.); (P.M.); (B.J.)
- Service de Médecine du Sport, CHU Nantes, Nantes Université, 44093 Nantes, France;
- IRMS, Institut Régional de Médecine du Sport, 44093 Nantes, France
- Inserm UMR 1229, Regenerative Medicine and Skeleton, RMeS, Nantes Université, ONIRIS, 44042 Nantes, France
- Correspondence:
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14
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Waples L, Giombini L, Wiseman M, Nesbitt S. Psychological changes in young people with anorexia nervosa during an inpatient treatment: exploration of optimal length of stay predictors. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2022; 36:19-27. [PMID: 33871834 DOI: 10.1007/s40211-021-00390-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 03/16/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE The current study aimed to monitor psychological changes in young people (YP) with anorexia nervosa (AN) during a specialist inpatient treatment in order to explore possible predictors of an optimal length of stay. Outcome measures were analysed to determine if significant changes occur earlier or later on during the treatment. METHODS Eating Disorder Examination Questionnaire (EDE-Q), Children's Depression Inventory (CDI), State-Trait Anxiety Inventory (STAI) and Compulsive Exercise Test (CET) measures administered to YP (n = 42) at three time points-admission, 85% ideal body weight (IBW) and discharge-were analysed using linear mixed effects model and regression analysis to determine change between the time points and possible predictors in length of stay. RESULTS Significant improvements occurred between admission and the mid time point of 85% IBW in the eating disorder (ED) symptomology outcome measures of EDE‑Q (mean difference [MD] = 1.066 ± 0.259) and CET (MD = 1.743 ± 0.627). A significant improvement occurred in the CDI (MD = 7.714 ± 2.343), and STAI (MD = 5.292 ± 2.121) measures between admission and discharge. CONCLUSIONS Psychological changes occur at different stages of treatment. Although it was difficult to determine what factors may predict the length of stay from the variables explored, it was observed that a lower weight at admission impacted negatively on the improvement of ED and anxiety symptoms, which may lead to stay in treatment for longer. Also, higher levels of compulsive exercise and depression were associated to worse outcomes. LEVEL IV Evidence obtained from multiple time series with or without the intervention, such as case studies. Dramatic results in uncontrolled trials might also be regarded as this type of evidence.
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Affiliation(s)
| | - Lucia Giombini
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Malcolm Wiseman
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK
| | - Sophie Nesbitt
- Eating Disorders Service for Children and Adolescents, Elysium Healthcare, Rhodes Wood Hospital, London, UK
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15
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Anorexia Nervosa and Autism Spectrum Disorder: A Systematic Review. Psychiatry Res 2021; 306:114271. [PMID: 34798485 DOI: 10.1016/j.psychres.2021.114271] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 09/20/2021] [Accepted: 11/01/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Recent research has shown a growing interest in exploring the relationship between anorexia nervosa (AN) and autism spectrum disorder (ASD). Both conditions seem to share areas of cognitive, social and behavioural impairment, leading to relevant implications on treatment, especially when they are in comorbidity. This literature review aims to synthesise the latest studies on this topic to investigate the co-occurrence of AN and ASD, suggest future research directions and consider implications for treatment. METHOD Records were systematically (PRISMA guidelines) identified through PubMed, EBSCOhost, Scopus and Web of Science searching. RESULTS Thirteen studies met the eligibility criteria and were therefore included in the review. Results seem to confirm an overrepresentation of ASD symptoms in AN. Only few studies investigated the AN-ASD comorbidity in young people and report slightly lower rates than those conducted with adults. CONCLUSIONS Analysed studies suggest that while the comorbidity seems to exacerbate the severity of the condition, autistic traits appear to be rather stable over time and not related to body weight. Thus, future longitudinal studies and gender- specific assessment tools can help clarify the relationship between the two disorders, examine the onset of ASD symptoms and develop structured guidelines for treatment.
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16
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Westwater ML, Mancini F, Shapleske J, Serfontein J, Ernst M, Ziauddeen H, Fletcher PC. Dissociable hormonal profiles for psychopathology and stress in anorexia and bulimia nervosa. Psychol Med 2021; 51:2814-2824. [PMID: 32460904 PMCID: PMC8640366 DOI: 10.1017/s0033291720001440] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/13/2020] [Accepted: 05/05/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND Anorexia nervosa (AN) and bulimia nervosa (BN) are complex psychiatric conditions, in which both psychological and metabolic factors have been implicated. Critically, the experience of stress can precipitate loss-of-control eating in both conditions, suggesting an interplay between mental state and metabolic signaling. However, associations between psychological states, symptoms and metabolic processes in AN and BN have not been examined. METHODS Eighty-five women (n = 22 AN binge/purge subtype, n = 33 BN, n = 30 controls) underwent remote salivary cortisol sampling and a 2-day, inpatient study session to examine the effect of stress on cortisol, gut hormones [acyl-ghrelin, peptide tyrosine tyrosine (PYY) and glucagon-like peptide-1] and food consumption. Participants were randomized to either an acute stress induction or control task on each day, and plasma hormones were serially measured before a naturalistic, ad libitum meal. RESULTS Cortisol-awakening response was augmented in AN but not in BN relative to controls, with body mass index explaining the most variance in post-awakening cortisol (36%). Acute stress increased acyl-ghrelin and PYY in AN compared to controls; however, stress did not alter gut hormone profiles in BN. Instead, a group-by-stress interaction showed nominally reduced cortisol reactivity in BN, but not in AN, compared to controls. Ad libitum consumption was lower in both patient groups and unaffected by stress. CONCLUSIONS Findings extend previous reports of metabolic dysfunction in binge-eating disorders, identifying unique associations across disorders and under stress. Moreover, we observed disrupted homeostatic signaling in AN following psychological stress, which may explain, in part, the maintenance of dysregulated eating in this serious illness.
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Affiliation(s)
- Margaret L. Westwater
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
| | - Flavia Mancini
- Department of Engineering, Computational and Biological Learning Laboratory, University of Cambridge, CambridgeCB2 1PZ, UK
| | - Jane Shapleske
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Jaco Serfontein
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
| | - Monique Ernst
- National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | - Hisham Ziauddeen
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
| | - Paul C. Fletcher
- Department of Psychiatry, University of Cambridge, Herchel Smith Building, Addenbrooke's Hospital, CambridgeCB2 0SZ, UK
- Adult Eating Disorders Service, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, CB21 5EF, UK
- Wellcome Trust MRC Institute of Metabolic Science, University of Cambridge, Cambridge Biomedical Campus, CambridgeCB2 0QQ, UK
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17
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Perkins NM, Ortiz SN, Smith AR, Brausch AM. Suicidal Ideation and Eating Disorder Symptoms in Adolescents: The Role of Interoceptive Deficits. Behav Ther 2021; 52:1093-1104. [PMID: 34452664 PMCID: PMC8403232 DOI: 10.1016/j.beth.2021.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 01/19/2021] [Accepted: 03/07/2021] [Indexed: 01/11/2023]
Abstract
Eating disorder symptoms and suicidal ideation are relatively common, and often begin to emerge in adolescence. Interoceptive deficits, or the inability to perceive and accurately identify the physiological condition of the body, is an established risk factor for both eating disorders and suicidal thoughts and behaviors. Despite this, longitudinal research examining the temporal dynamics between these variables is scarce, especially within adolescent samples. Using a three-wave longitudinal design, the present study tested bidirectional relationships between interoceptive deficits, eating disorder symptoms, and suicidal ideation to examine whether interoceptive deficits predicted eating disorder symptoms and suicidal ideation over the course of a year among a sample of adolescents. Participants were 436 community adolescents recruited from local middle- and high-schools. Data were collected at baseline, 6-month follow-up, and 12-month follow-up. Study measures assessed current suicidal ideation, eating disorder symptom severity, and interoceptive deficits. Autoregressive cross-lagged modeling was conducted in MPlus. We found baseline eating disorder symptoms significantly predicted suicidal ideation at 6-month follow-up when controlling for baseline suicidal ideation. Baseline interoceptive deficits significantly predicted eating disorder symptoms 6-months later, while 6-month follow-up interoceptive deficits significantly predicted 12-month follow-up suicidal ideation. Our findings highlight the need for early and regular assessment of suicidal ideation and eating disorder symptoms in adolescents. Given that interoceptive deficits was a shared risk factor for both conditions within this sample, these results underscore the need for targeted interventions aimed at improving interoception.
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Affiliation(s)
- Natalie M. Perkins
- Department of Psychology, Miami University, 90 N. Patterson Avenue, Oxford, OH, 45056,Correspondence concerning this article should addressed to Natalie M. Perkins,
| | - Shelby N. Ortiz
- Department of Psychology, Miami University, 90 N. Patterson Avenue, Oxford, OH, 45056
| | - April R. Smith
- Department of Psychology, Miami University, 90 N. Patterson Avenue, Oxford, OH, 45056
| | - Amy M. Brausch
- Department of Psychological Science, Western Kentucky University, 1906 College Heights Boulevard, Bowling Green, KY
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18
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Pepin G. What is the efficacy of family approaches in the treatment of people with anorexia nervosa?: A Cochrane Review summary with commentary. Aust Occup Ther J 2021; 68:472-474. [PMID: 34292597 DOI: 10.1111/1440-1630.12754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Genevieve Pepin
- Occupational Science and Therapy, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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19
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Abstract
Pathological exercise behavior is pervasive in eating disorder psychopathology, yet minimal treatment guidance exists for extinguishing it as little is known about how to differentiate pathological from healthy exercise. The purpose of this study was to characterize pathological exercise in terms of motivation to increase the specificity with which both pathological and healthy exercise is described and to inform treatment interventions. Latent profile analysis characterized homogenous groups based on exercise motivation in two samples: college women (n = 200) and women with eating psychopathology (n = 211). These profiles were compared on levels of eating and general psychopathology and emotion dysregulation. Three profiles emerged describing sedentary, pathological exercise, and athlete groups in the first sample, and five profiles describing neutral, sedentary, weight loss, athlete, and pathological exercise groups emerged in the second sample. Findings indicate that motivation style is salient in defining pathological exercise and may, therefore, be a clinically useful treatment target.
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20
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Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. Detection, treatment, and course of eating disorders in Finland: A population-based study of adolescent and young adult females and males. EUROPEAN EATING DISORDERS REVIEW 2021; 29:720-732. [PMID: 34008267 PMCID: PMC8349843 DOI: 10.1002/erv.2838] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 03/22/2021] [Accepted: 04/26/2021] [Indexed: 11/17/2022]
Abstract
Objective: We assessed the detection, treatment and outcomes of DSM-5 eating disorders in a nationwide community setting. Method: The FinnTwin12 cohort comprises twins born in 1983–1987 in Finland (n = 5,600), with follow-up starting at age 12. We outline treatment and outcomes of the 127 females and 15 males diagnosed with a lifetime DSM-5 eating disorder in interviews conducted for a subsample (n = 1,347) in their early 20s. Results: Only 45 (32%) of those diagnosed with eating disorder in the interviews had their condition detected in healthcare, and even fewer received treatment (30% of females, 13% of males). Anorexia nervosa (AN), bulimia nervosa, and atypical AN were detected and treated more often than other eating disorders. Five years after disease onset, 41% of those diagnosed had recovered. There were no statistically significant differences in the course of different eating disorders (log-rank p = 0.66) but the outcome was more favourable among males (log-rank p = 0.008). The likelihood of 5-year recovery did not differ between those who had and who had not received treatment (41.1% vs. 40.5%, log-rank p = 0.66). Conclusion: Although eating disorders are common and symptoms are persistent for many, they remain under-diagnosed and under-treated. In real-world settings, effectiveness of provided treatments may be limited.
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Affiliation(s)
- Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Linda Mustelin
- Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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21
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de Borja C, Holtzman B, McCall LM, Carson TL, Moretti LJ, Farnsworth N, Ackerman KE. Specific dietary practices in female athletes and their association with positive screening for disordered eating. J Eat Disord 2021; 9:50. [PMID: 33865448 PMCID: PMC8052728 DOI: 10.1186/s40337-021-00407-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 04/07/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND To determine if following specific diets was associated with reporting behaviors that are consistent with disordered eating compared to non-diet-adherent athletes. We hypothesized that athletes adhering to specific diets were more likely to report disordered eating than those not following a diet. METHODS One thousand female athletes (15-30 years) completed a comprehensive survey about athletic health and wellness. Athletes were asked to specify their diet and completed 3 eating disorder screening tools: the Brief Eating Disorder in Athletes Questionnaire, the Eating Disorder Screen for Primary Care, and self-reported current or past history of eating disorder or disordered eating. Descriptive statistics were calculated for all study measures and chi-squared tests assessed relationships between athletes' dietary practices and their responses to eating disorder screening tools. Statistical significance was defined as p < 0.05. RESULTS Two hundred thirty-four of 1000 female athletes reported adherence to specific diets. 69 of the 234 diet-adhering athletes (29.5%) were excluded due to medically-indicated dietary practices or vague dietary descriptions. Of the 165 diet-adherent athletes, 113 (68.5%) screened positively to ≥1 of the 3 eating disorder screening tools. Specifically, athletes practicing a low-carbohydrate diet were more likely to report disordered eating vs. athletes without dietary restrictions (80% vs. 41.8%; p < 0.0001). CONCLUSION Specific diet adherence in female athletes may be associated with reporting behaviors that are consistent with disordered eating. Health practitioners should consider further questioning of athletes reporting specific diet adherence in order to enhance nutritional knowledge and help treat and prevent eating disorders or disordered eating.
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Affiliation(s)
- Celina de Borja
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA
| | - Bryan Holtzman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Lauren M McCall
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Traci L Carson
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Laura J Moretti
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Nicole Farnsworth
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA
| | - Kathryn E Ackerman
- Female Athlete Program, Division of Sports Medicine, Boston Children's Hospital, 319 Longwood Avenue - 6th Floor, Boston, MA, 02115, USA.
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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22
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Fornaro M, Daray FM, Hunter F, Anastasia A, Stubbs B, De Berardis D, Shin JI, Husain MI, Dragioti E, Fusar-Poli P, Solmi M, Berk M, Vieta E, Carvalho AF. The prevalence, odds and predictors of lifespan comorbid eating disorder among people with a primary diagnosis of bipolar disorders, and vice-versa: Systematic review and meta-analysis. J Affect Disord 2021; 280:409-431. [PMID: 33227671 DOI: 10.1016/j.jad.2020.11.015] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 09/16/2020] [Accepted: 11/07/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND There are scarce and discrepant data about the prevalence and correlates of co-occurring eating disorders (EDs) among people with a primary diagnosis of bipolar disorder (BD), and vice-versa, compelling a systematic review and meta-analysis on the matter. METHODS MEDLINE/PsycINFO databases were systematically searched for original studies documenting BD⇌ED comorbidity across the lifespan, from inception up until April 20th, 2020. Random-effects meta-analysis and meta-regression analyses were conducted, accounting for multiple moderators. RESULTS Thirty-six studies involved 15,084 primary BD patients. Eleven studies encompassed 15,146 people with primary EDs. Binge eating disorder (BED) occurred in 12.5% (95%C.I.=9.4-16.6%, I2=93.48%) of BDs, while 9.1% (95%C.I.=3.3-22.6%) of BEDs endorsed BD. Bulimia Nervosa (BN) occurred in 7.4% (95%C.I.=6-10%) of people with BD, whereas 6.7% (95%C.I.=12-29.2%) of subjects with BN had a diagnosis of BD. Anorexia Nervosa (AN) occurred in 3.8% (95%C.I.=2-6%) of people with BDs; 2% (95%C.I.=1-2%) of BD patients had a diagnosis of AN. Overall, BD patients with EDs had higher odds of being female vs. non-ED controls. Several moderators yielded statistically significant differences both within- and between different types of BDs and EDs. LIMITATIONS Scant longitudinal studies, especially across different EDs and pediatric samples. High heterogeneity despite subgroup comparisons. Limited discrimination of the quality of the evidence. CONCLUSIONS The rates of BD⇌ED comorbidity vary across different diagnostic groups, more than they do according to the "direction" of BD⇌ED. Further primary studies should focus on the risks, chronology, clinical impact, and management of the onset of intertwined BD⇌ED across different ages, promoting a continuum approach.
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Affiliation(s)
- Michele Fornaro
- Department of Psychiatry, Federico II University, Naples, Italy; Polyedra Research Foundation, Teramo, Italy.
| | - Federico Manuel Daray
- The University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina.
| | - Fernando Hunter
- The University of Buenos Aires, School of Medicine, Institute of Pharmacology, Argentina
| | | | - Brendon Stubbs
- Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK; Health Service and Population Research Department and the Department of Psychological, London, UK
| | | | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Muhammad Ishrat Husain
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
| | - Elena Dragioti
- Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden University, Linköping, Sweden; Department of Hygiene and Epidemiology, School of Medicine, University of Ioannina, University Campus, Ioannina, Greece
| | - Paolo Fusar-Poli
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Marco Solmi
- Early Psychosis: Interventions and Clinical-Detection Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, UK; Neurosciences Department, University of Padua, Italy; Padua Neuroscience Center, University of Padua, Italy
| | - Michael Berk
- Department of Psychiatry, the University of Melbourne, Parkville, VIC, Australia; Deakin University, IMPACT - the Institute for Mental and Physical Health and Clinical Translation, School of Medicine, Barwon Health, Geelong, Australia; Orygen Youth Health Research Centre, Centre for Youth Mental Health, the University of Melbourne, Parkville, VIC, Australia; The Florey Institute for Neuroscience and Mental Health, the University of Melbourne, Parkville, VIC, Australia
| | - Eduard Vieta
- Bipolar and Depressive Disorders Unit, Institute of Neuroscience, Hospital Clinic, University of Barcelona, IDIBAPS, CIBERSAM, 170 Villarroel st, 12-0, 08036 Barcelona, Catalonia, Spain
| | - André Ferrer Carvalho
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Centre for Addiction & Mental Health (CAMH), Toronto, ON, Canada
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23
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Modan-Moses D, Yaroslavsky A, Pinhas-Hamiel O, Levy-Shraga Y, Kochavi B, Iron-Segev S, Enoch-Levy A, Toledano A, Stein D. Prospective Longitudinal Assessment of Linear Growth and Adult Height in Female Adolescents With Anorexia Nervosa. J Clin Endocrinol Metab 2021; 106:e1-e10. [PMID: 32816013 DOI: 10.1210/clinem/dgaa510] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 08/03/2020] [Indexed: 02/08/2023]
Abstract
CONTEXT Growth retardation is an established complication of anorexia nervosa (AN); however, findings concerning the adult height of AN patients are inconsistent. OBJECTIVE The objective of this work was to assess linear growth and adult height in female adolescents with AN. DESIGN AND SETTING A prospective observational study was conducted in a tertiary university hospital. PARTICIPANTS Participants included all 255 female adolescent AN patients hospitalized in the pediatric psychosomatic department between January 1, 2000 and May 31, 2015. INTERVENTIONS Height and weight were assessed at admission and during hospitalization. Patients were subsequently invited for measurement of adult height. Additional data collected included premorbid height data, menstrual history, skeletal age, pertinent laboratory studies, and parental heights. MAIN OUTCOME MEASURE The main outcome measure of this study was adult height. RESULTS Mean age at admission was 15.4 ± 1.75 years, mean body mass index (BMI) was 15.7 ± 1.8 kg/m2 (BMI SDS = -2.3 ± 1.45 kg/m2). Premorbid height SD scores (SDS) were not significantly different from those expected in normal adolescents (0.005 ± 0.96). However, height SDS at admission (-0.36 ± 0.99), discharge (-0.34 ± 0.96), and at adult height (-0.29 ± 0.95), were significantly (P < .001) lower than expected. Furthermore, adult height was significantly (P = .006) shorter compared to the midparental target height. Stepwise forward linear regression analysis identified age (r = 0.32, P = .002) and bone age (r = -0.29, P = .006) on admission, linear growth during hospitalization (r = 0.47, P < .001), and change in luteinizing hormone during hospitalization (r = -0.265, P = .021) as independent predictors of improvement in height SDS from the time of admission to adult height. CONCLUSIONS Whereas the premorbid height of female adolescent AN patients is normal, linear growth retardation is a prominent feature of their illness. Weight restoration is associated with catch-up growth, but complete catch-up is often not achieved.
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Affiliation(s)
- Dalit Modan-Moses
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Amit Yaroslavsky
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Yael Levy-Shraga
- Pediatric Endocrinology and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Brigitte Kochavi
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Sharon Iron-Segev
- Institute of Biochemistry, Food Science and Nutrition, Robert H. Smith Faculty of Agriculture, Food and Environment, The Hebrew University of Jerusalem, Rehovot, Israel
- School of Nutrition, Peres Academic Center, Rehovot, Israel
| | - Adi Enoch-Levy
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Anat Toledano
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Stein
- Pediatric Psychosomatic Department, Division of Child and Adolescent Psychiatry, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel Hashomer, Ramat-Gan, Israel
- The Sackler Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
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24
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Støving RK, Larsen PV, Winkler LA, Bilenberg N, Røder ME, Steinhausen H. Time trends in treatment modes of anorexia nervosa in a nationwide cohort with free and equal access to treatment. Int J Eat Disord 2020; 53:1952-1959. [PMID: 32893903 PMCID: PMC7754480 DOI: 10.1002/eat.23378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 08/15/2020] [Accepted: 08/18/2020] [Indexed: 12/02/2022]
Abstract
BACKGROUND Treating patients with anorexia nervosa (AN) remains a major challenge. The choice between an inpatient or an outpatient care setting is an essential issue for the patients and for their relatives with major health economic implications. However, health services-related studies are lacking. The present study was a descriptive exploration of time-trends in treatment modes of patients with free and equal access to health services. METHODS The study was based on a nationwide cohort of patients diagnosed for the first time with AN, each followed for 5 years in the registers covering the years 1994-2018. The per patient number of hospital admissions, cumulated number of days of hospitalization and number of outpatient visits during the first 5 years after initial diagnosis were considered. RESULTS The cohort of patients with AN with at least 5 years of follow-up amounted to N = 7,505. A clear trend was observed in the per patient five-year cumulated number of inpatient days, decreasing by 6% per year after adjustment for age at diagnosis, parental mental diagnosis, and family income. The five-year number of hospital admissions after initial diagnosis decreased by 2% per year, while no trend was observed for outpatient visits. CONCLUSIONS The per patient number of hospitalizations and cumulated days of hospitalization during 5 years after diagnosis were reduced for patients initially diagnosed with AN while there was no change in the number of outpatient visits. The factors contributing to these changes of treatment modes over time are in need of further study.
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Affiliation(s)
- René Klinkby Støving
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Research Unit for Medical EndocrinologyOdense University HospitalOdenseDenmark,Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark,Open Patient data Explorative Network (OPEN)Clinical Institute, University of Southern DenmarkOdenseDenmark
| | - Pia Veldt Larsen
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | - Laura Al‐Dakhiel Winkler
- Center for Eating DisordersOdense University HospitalOdenseDenmark,Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | - Niels Bilenberg
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark
| | | | - Hans‐Christoph Steinhausen
- Department of Child and Adolescent Mental Health OdenseMental Health Services in the Region of Southern DenmarkOdenseDenmark,Denmark Child and Adolescent Mental Health CentreCapital Region PsychiatryCopenhagenDenmark,Department of Child and Adolescent PsychiatryPsychiatric University Hospital of ZurichZurichSwitzerland,Clinical Psychology and EpidemiologyInstitute of Psychology, University of BaselBaselSwitzerland
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25
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Bowen M, Lovell A, Waller R. Stigma: the representation of anorexia nervosa in UK newspaper Twitter feeds. J Ment Health 2020; 31:131-138. [PMID: 32667238 DOI: 10.1080/09638237.2020.1793128] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND There is evidence that the representation of mental health in newspapers has an influence on readers' attitudes, however, relatively little is known about how the industry presents accounts of anorexia nervosa. Further, the industry increasingly uses Twitter as a medium for reaching readers and this remains an under-examined area of research. AIMS To explore the representation of anorexia nervosa in the UK national press' Twitter feeds. METHOD Frame analysis was used to examine the manner in which anorexia nervosa was represented in the Twitter feeds of all national UK newspapers between 2009 and 2019 (n = 332). This qualitative approach used Braun and Clarke's stages of thematic analysis, while drawing on Van Gorp's use of a frame matrix to support the definition of the news frames. RESULTS The analysis identified four news frames: social model, illness model, stress-recovery model and clickbait model. CONCLUSIONS The newspapers drew on a range of perspectives in their representation of anorexia nervosa, which typically were not stigmatising in their accounts. However, there was a pattern of using sensationalistic images in some of the tweets, which may encourage readers to view people with anorexia nervosa as Other, and as a consequence contribute to stigmatisation.
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Affiliation(s)
- Matt Bowen
- Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Andy Lovell
- Faculty of Health and Social Care, University of Chester, Chester, UK
| | - Rhian Waller
- School of Arts and Media, University of Chester, Chester, UK
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26
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Silén Y, Sipilä PN, Raevuori A, Mustelin L, Marttunen M, Kaprio J, Keski-Rahkonen A. DSM-5 eating disorders among adolescents and young adults in Finland: A public health concern. Int J Eat Disord 2020; 53:520-531. [PMID: 31999001 DOI: 10.1002/eat.23236] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 01/16/2020] [Accepted: 01/17/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE We aimed to assess the lifetime prevalence, 10-year incidence, and peak periods of onset for eating disorders as defined by the Fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-5) among adolescents and young adults born in the 1980s in Finland. METHOD Virtually all Finnish twins born in 1983-1987 (n = 5,600) were followed prospectively from the age of 12 years. A subsample of participants (n = 1,347) was interviewed using a semi-structured diagnostic interview in their early twenties. RESULTS The prevalence of lifetime DSM-5 eating disorders was 17.9% for females and 2.4% for males (pooled across genders, 10.5%). The estimated lifetime prevalences for females and males, respectively, were 6.2 and 0.3% for anorexia nervosa (AN), 2.4 and 0.16% for bulimia nervosa (BN), 0.6 and 0.3% for binge-eating disorder (BED), 4.5 and 0.16% for other specified feeding or eating disorder (OSFED), and 4.5 and 1.6% for unspecified feeding or eating disorder (UFED). Among females, the prevalence of OSFED subcategories was as follows: atypical AN 2.1%, purging disorder 1.3%, BED of low frequency/limited duration 0.7%, and BN of low frequency/limited duration 0.4%. The 10-year incidence rate of eating disorders was 1,700 per 100,000 person-years among females (peak age of onset 16-19 years) and 220 per 100,000 person-years among males. DISCUSSION Eating disorders are a common public health concern among youth and young adults, affecting one in six females and one in 40 males. Adequate screening efforts, prevention, and interventions are urgently needed.
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Affiliation(s)
- Yasmina Silén
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Pyry N Sipilä
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
| | - Anu Raevuori
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland.,Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Linda Mustelin
- Department of Public Health & Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Mauri Marttunen
- Department of Adolescent Psychiatry, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - Jaakko Kaprio
- Department of Public Health & Institute for Molecular Medicine Finland (FIMM), University of Helsinki, Helsinki, Finland
| | - Anna Keski-Rahkonen
- Clinicum, Department of Public Health, University of Helsinki, Helsinki, Finland
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27
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Karageorgiou V, Furukawa TA, Tsigkaropoulou E, Karavia A, Gournellis R, Soureti A, Bellos I, Douzenis A, Michopoulos I. Adipokines in anorexia nervosa: A systematic review and meta-analysis. Psychoneuroendocrinology 2020; 112:104485. [PMID: 31805456 DOI: 10.1016/j.psyneuen.2019.104485] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 10/15/2019] [Accepted: 10/15/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The association between adipokine dysregulation and weight loss of patients with anorexia nervosa (AN) has been long investigated, in search of a causal relationship. We sought to: a) synthesize the available evidence on potential differences between AN patients and controls with regards to adipokine measurements (namely, leptin, adiponectin, resistin, soluble leptin receptor, visfatin, vaspin and omentin), b) estimate the potential differences between constitutionally thin (CT) subjects and AN patients, and c) present the available evidence with regards to biomarker efficacy of adipokines in AN. METHODS A structured literature search, last updated in 2/2019, was conducted in the following databases: MEDLINE, clinicaltrials.gov, PsycINFO, PSYNDEX and WHO Registry Network. The primary outcome was the standardized mean difference of each adipokine between AN patients and controls of normal BMI. Secondary outcomes included the correlation of leptin with BMI and bone mineral density among AN patients. The study protocol is published in PROSPERO (CRD42018116767). RESULTS In a total of 622 screened studies, after exclusion of non-relevant articles and duplicates, 84 reports on leptin, 31 reports on adiponectin, 12 on resistin, 10 on soluble leptin receptor, 5 on visfatin, 3 on vaspin and omentin were finally included in the meta-analysis. Publication bias assessment underlined the possibility of non-significant studies being underrepresented; still, significant heterogeneity renders this statement inconclusive. Leptin [ELISA: SMD (95% CI): -3.03 (-4, -2.06)], radioimmunoassay [RIA: -3.84 (-4.71, -2.98)] and resistin [-1.67 (-2.85, -0.48)] were significantly lower in patients with AN compared with controls, whereas visfatin decrease did not reach significance (-2.03 (-4.38, 0.3). Mean adiponectin, vaspin and soluble leptin receptor levels were significantly higher. In subgroup analysis, a significantly attenuated SMD was reported in ELISA studies compared with RIA studies. Leptin was significantly lower in AN patients compared to CT subjects and BMI marginally did not appear to confound the result. In all analyses, except for the correlation of leptin with BMI in AN patients, high heterogeneity was present. Meta-regression analysis indicated a potential confounding action of controls' BMI and age on leptin SMD and between-assay differences. Publication bias assessment underlined the possibility of nonsignificant studies being underrepresented; still, further investigation did not corroborate this and significant heterogeneity renders this statement inconclusive. CONCLUSION A distinct profile of adipokine dysregulation is apparent in AN patients, following the anticipated pattern of low BMI. A precise estimation of the magnitude is hindered by heterogeneity, partly caused by varying assays and methodologies. Interestingly, while mean leptin levels are lower in AN subjects compared with constitutionally thin women, there is an overlap in individual levels between the two groups and therefore, they cannot be used to differentiate between these states.
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Affiliation(s)
- Vasilios Karageorgiou
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Toshiaki A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine, School of Public Health, Kyoto, Japan
| | - Evdoxia Tsigkaropoulou
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Anna Karavia
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Rossetos Gournellis
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Anastasia Soureti
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Ioannis Bellos
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Athanasios Douzenis
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece
| | - Ioannis Michopoulos
- Eating Disorders Unit, 2nd Department of Psychiatry, Medical School, National and Kapodistrian University of Athens, 'Attikon' University Hospital, Athens, Greece.
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28
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Deficits in response inhibition on varied levels of demand load in anorexia nervosa: an event-related potentials study. Eat Weight Disord 2020; 25:231-240. [PMID: 30168032 PMCID: PMC6997249 DOI: 10.1007/s40519-018-0558-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2017] [Accepted: 07/30/2018] [Indexed: 10/28/2022] Open
Abstract
PURPOSE The aim of the present study was to investigate the executive function of inhibitory control in anorexia nervosa (AN), which is considered as an underlying pathophysiology of restricting eating. METHODS In this work, we examined the function of response inhibition in 27 unmedicated AN patients and 30 healthy controls (HC) using stop-signal tasks with different demand loads. Two event-related potentials (ERP) during the stop-signal tasks, N2 and P300, were compared between the AN and HC groups. RESULTS We found attenuated P300 amplitudes and delayed N2 latencies in AN patients across all three demand loads compared to HCs. We also found significant interaction between group and level of demand load. N2 latencies were prolonged when the inhibitory demand was lower in the AN group, whereas no differences in N2 latencies were found across different demand loads in HCs. CONCLUSIONS Taken together, altered P300 amplitudes and N2 latencies may be associated with impaired response inhibition in AN patients. In particular, alterations of fronto-central N2 activations were demand-related, which might contribute to an aberrant inhibitory control process in AN. LEVEL OF EVIDENCE Level II, controlled trial without randomization.
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29
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Ortiz SN, Smith A. A longitudinal examination of the relationship between eating disorder symptoms and suicidal ideation. Int J Eat Disord 2020; 53:69-78. [PMID: 31479165 DOI: 10.1002/eat.23162] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 08/15/2019] [Accepted: 08/18/2019] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Cross-sectional research demonstrates significant correlations between eating disorders (EDs) and suicidal thoughts and behaviors. Although suicide ideation (SI) is a risk factor for suicidal behavior, longitudinal research investigating SI among EDs is limited. Thus, the aim of this study was to offer insight into the dynamic relationship between EDs and SI by investigating if these variables predicted one another at weekly time points. METHOD Autoregressive cross-lagged modeling was used to test bidirectional relationships between ED symptoms and suicidal ideation among an ED patient sample (n = 92). Participants completed a measure of suicidal ideation and the Eating Disorder Examination-Questionnaire (EDE-Q) weekly for 5 weeks. RESULTS SI and ED symptoms were correlated with each other at each time point. Unexpectedly, the majority of cross-lagged pathways were nonsignificant. However, SI at Week 4 predicted ED symptoms at Week 5, while controlling for Week 4 ED symptoms. This pattern of results was found when the shape concerns, weight concerns, and eating concerns subscales of the EDE-Q were entered into the model. Moreover, Week 2 shape concerns predicted Week 3 SI and Week 3 eating concerns predicted Week 4 SI. No significant cross-lagged pathways were found with the dietary restraint subscale. DISCUSSION Nonsignificant cross-lagged pathways may indicate that third variables better explain the relations between certain ED symptoms and SI over time. However, there were instances where ED symptoms and SI predicted one another. Given this, targeting suicidal thoughts in therapy may help to reduce eating pathology and vice versa.
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Affiliation(s)
- Shelby N Ortiz
- Department of Psychology, Miami University, Oxford, Ohio
| | - April Smith
- Department of Psychology, Miami University, Oxford, Ohio
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The Importance of Restoring Body Fat Mass in the Treatment of Anorexia Nervosa: An Expert Commentary. JOURNAL OF POPULATION THERAPEUTICS AND CLINICAL PHARMACOLOGY 2019; 26:e9-e13. [PMID: 31904201 DOI: 10.15586/jptcp.v26i3.629] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 08/20/2019] [Indexed: 11/18/2022]
Abstract
Anorexia nervosa is a severe mental disorder that is characterised by dietary restriction, low weight and widespread endocrine abnormalities. Whilst the importance of weight restoration has been recognised in recent guidelines, the significance of normalising body fat mass has received less attention. A recent systematic review and meta-analysis found that a minimum of 20.5% body fat mass is necessary for regular menses in women with anorexia nervosa of reproductive age. This has significant implications for both treatment and research. It is important to help the patient and carers understand that a certain level of body fat percentage is essential for optimal health, such as the return of menstruation. Further research is needed into how best to use this information to help motivation to change as part of treatment. The benefit of the return of menstruation goes beyond improved fertility: it signals the normalisation of sexual hormones, which have a widespread impact on the body and multiple pathways in the brain. Given the complex functions of adipocytes in various organs of the body, the metabolic effects of the normal body fat tissue should not be underestimated. Further research is needed to elucidate the mechanisms behind the link between minimum body fat mass, menstruation, bone and brain health in anorexia nervosa.
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Manzato E. Eating disorders and disordered eating behaviors in males: a challenging topic. Eat Weight Disord 2019; 24:651-652. [PMID: 31104271 DOI: 10.1007/s40519-019-00711-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 05/08/2019] [Indexed: 11/29/2022] Open
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Genis-Mendoza AD, Ruiz-Ramos D, López-Narvaez ML, Tovilla-Zárate CA, Rosa García A, Cortes Meda G, Martinez-Magaña JJ, González-Castro TB, Juárez-Rojop IE, Nicolini H. Genetic association analysis of 5-HTR2A gene variants in eating disorders in a Mexican population. Brain Behav 2019; 9:e01286. [PMID: 31199591 PMCID: PMC6625474 DOI: 10.1002/brb3.1286] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 03/06/2019] [Accepted: 03/15/2019] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION The 5-HTR2A gene has been implicated as candidate gene for eating disorders. The aim of the present study was to analyze the association of rs6311 and rs6313 polymorphisms of 5-HTR2A gene with eating disorders in Mexican population, and to evaluate if the polymorphisms of 5-HTR2A gene were associated with comorbidities in eating behavior. METHODS We conducted a case-control analysis with 460 subjects. We included 168 patients with eating disorders and 292 controls; two polymorphisms of 5-HTR2A gene were genotyped. We assessed the association by allele, genotype, and inheritance models. Psychiatric comorbidities were analyzed by genotype in patients with eating disorders. RESULTS We found an association between rs6311 and eating disorders in a Mexican population by allele (OR = 8.09; 95% CI = 5.99-11.03; p = 2.2e-16) and genotype (OR = 76.14; 95% CI = 35.61-177.18; p = 2.2e-16). Individuals who carried GG genotype showed increased risk for suicide attempted (OR = 2.14; CI = 1.10-4.26; p = 0.035) as comorbidity associated with eating disorders. No positive associations were observed for rs6313 polymorphism. CONCLUSION Our results showed an association of rs6311 (A1438G) polymorphism of 5-HTR2A gene with eating disorders, and these polymorphic variants could increase the risk of psychiatric comorbidities. However, more studies are required to replicate the results and to reach to a conclusive association between eating disorders and rs6311.
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Affiliation(s)
| | - David Ruiz-Ramos
- División Académica de Ciencias de la Salud, Universidad Juárez Autónoma de Tabasco, Villahermosa, Tabasco, México
| | | | - Carlos Alfonso Tovilla-Zárate
- División Académica Multidisciplinaria de Comalcalco, Universidad Juárez Autónoma de Tabasco, Comalcalco, Tabasco, México
| | - Ana Rosa García
- Hospital Psiquiátrico Infantil Juan N Navarro, Secretaría de Salud, Ciudad de México, México
| | - Gabriela Cortes Meda
- Hospital Psiquiátrico Infantil Juan N Navarro, Secretaría de Salud, Ciudad de México, México
| | | | - Thelma Beatriz González-Castro
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México
| | - Isela Esther Juárez-Rojop
- División Académica Multidisciplinaria de Jalpa de Méndez, Universidad Juárez Autónoma de Tabasco, Jalpa de Méndez, Tabasco, México
| | - Humberto Nicolini
- Instituto Nacional de Medicina Genómica (INMEGEN), Ciudad de México, México
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Romito P, Cedolin C, Bastiani F, Saurel-Cubizolles MJ. Disordered Eating Behaviors and Sexual Harassment in Italian Male and Female University Students. JOURNAL OF INTERPERSONAL VIOLENCE 2019; 34:2960-2974. [PMID: 27520020 DOI: 10.1177/0886260516664315] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aim of this study is to describe sexual harassment among Italian university students and analyze the relationship between harassment and disordered eating behaviors. An observational survey was conducted among university students at Trieste University (Italy) in spring 2014. Students answered an anonymous self-administered questionnaire about sexual harassment, including three domains-sexual harassment, unwanted comments on physical appearance, cyber-harassment-and disordered eating behaviors. The global sexual harassment index was computed with three levels: Level 0, no harassment; Level 1, harassment in at least one of the three domains; and Level 2, harassment in two or three domains. Disordered eating behaviors were classified by at least one of the following: (a) eating without being able to stop or vomiting at least once or twice a month, (b) using laxatives or diuretics at least once or twice a week, (c) monitoring weight every day, and (d) dieting at least very often. The sample included 759 students (347 men and 412 women; 18-29 years old). Experiencing sexual harassment was related to eating disorder symptoms for both genders with a regular gradient: the higher the harassment score, the more frequent the disordered eating behavior symptoms, even after adjusting for age and previous sexual violence. The association was stronger for males than females. Sexual harassment and disordered eating behaviors have long been considered mainly a female problem. Men are not exempt from these problems and in some cases may be more affected than women. The topics should be assessed in men and women.
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Watson HJ, Diemer EW, Zerwas S, Gustavson K, Knudsen GP, Torgersen L, Reichborn-Kjennerud T, Bulik CM. Prenatal and perinatal risk factors for eating disorders in women: A population cohort study. Int J Eat Disord 2019; 52:643-651. [PMID: 30891792 PMCID: PMC6644683 DOI: 10.1002/eat.23073] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 03/02/2019] [Accepted: 03/02/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVE The fetal programming model hypothesizes that developmental programming in utero and in early life induces adaptations that predetermine the adult phenotype. This study investigated whether prenatal/perinatal complications are associated with lifetime eating disorders in women. METHOD Participants included 46,373 adult women enrolled in the Norwegian Mother and Child Cohort Study (den norske Mor & barn-undersøkelsen [MoBa]). MoBa mothers and their mothers (MoBa grandmothers) were the focus of the current study. MoBa mothers with lifetime eating disorders were compared to a referent group. RESULTS MoBa mothers who weighed more at birth (birth weight, adjusted odds ratio [OR] = 1.14; 95% confidence interval [CI]: 1.10-1.19) or were born large-for-gestational-age (adjusted OR = 1.39; 95% CI: 1.27-1.52) were more likely to develop binge-eating disorder in later life. MoBa mothers who weighed less at birth were more likely to develop anorexia nervosa (birth weight, adjusted OR = 0.88; 95% CI: 0.81-0.95). Bulimia nervosa and purging disorder (PD) were not significantly predicted by the prenatal and perinatal factors examined. DISCUSSION Results of this study, which include the first known investigation of prenatal and perinatal factors in binge-eating disorder and PD, suggest that fetal programming may be relevant to the development of anorexia nervosa and binge-eating disorder. Future genetically informative research is needed to help disentangle whether these associations are a function of genetic influences or a true environmental fetal programming effect.
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Affiliation(s)
- Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, United States,School of Paediatrics and Child Health, The University of Western Australia, Perth, Australia,School of Psychology and Speech Pathology, Curtin University, Perth, Australia
| | - Elizabeth W. Diemer
- Harvard T. H. Chan School of Public Health, Harvard University, Boston, United States
| | - Stephanie Zerwas
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Kristin Gustavson
- Department of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway,Department of Psychology, University of Oslo, Oslo, Norway
| | - Gun Peggy Knudsen
- Department of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Leila Torgersen
- Department of Mental and Physical Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Ted Reichborn-Kjennerud
- Division of Mental Health Services, Akershus University Hospital, Oslo, Norway,Institute of Clinical Medicine, University of Oslo, Norway
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, United States,Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, United States,Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Galmiche M, Déchelotte P, Lambert G, Tavolacci MP. Prevalence of eating disorders over the 2000-2018 period: a systematic literature review. Am J Clin Nutr 2019; 109:1402-1413. [PMID: 31051507 DOI: 10.1093/ajcn/nqy342] [Citation(s) in RCA: 620] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 10/30/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Eating disorders (EDs) lead to multiple psychiatric and somatic complications and thus constitute a major public health concern. OBJECTIVES The aim of this study was to give an exhaustive view of the studies reporting the prevalence of the different EDs or total EDs and to study their evolution. METHODS A literature search following PRISMA Guidelines and limited to studies in English or French published between 2000 and 2018 was performed and relevant studies were included in this systematic review on the prevalence of EDs. The literature search revealed 94 studies with accurate ED diagnosis and 27 with broad ED diagnosis. RESULTS In 94 studies with accurate ED diagnosis, the weighted means (ranges) of lifetime ED were 8.4% (3.3-18.6%) for women and 2.2% (0.8-6.5%) for men. The weighted means (ranges) of 12-month ED prevalence were 2.2% (0.8-13.1%) for women and 0.7% (0.3-0.9%) for men. The weighted means (ranges) of point prevalence were 5.7% (0.9-13.5%) for women and 2.2% (0.2-7.3%) for men. According to continents, the weighted means (ranges) of point prevalence were 4.6% (2.0-13.5%) in America, 2.2% (0.2-13.1%) in Europe, and 3.5% (0.6-7.8%) in Asia.In addition to the former, 27 other studies reported the prevalence of EDs as broad categories resulting in weighted means (ranges) of total point prevalence of any EDs of 19.4% (6.5-36.0%) for women and 13.8% (3.6-27.1%) for men. CONCLUSIONS Despite the complexity of integrating all ED prevalence data, the most recent studies confirm that EDs are highly prevalent worldwide, especially in women. Moreover, the weighted means of point ED prevalence increased over the study period from 3.5% for the 2000-2006 period to 7.8% for the 2013-2018 period. This highlights a real challenge for public health and healthcare providers.
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Affiliation(s)
- Marie Galmiche
- TargEDys SA, Rouen, France.,Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | - Pierre Déchelotte
- Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,Department of Nutrition, Rouen University Hospital, Rouen, France
| | | | - Marie Pierre Tavolacci
- Inserm UMR 1073, Institute for Research and Innovation in Biomedicine, Normandy Rouen University, France.,ClC-CRB 1404, Rouen University Hospital, Rouen, France
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36
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or other psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleVictoriaAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondVictoriaAustralia
| | | | - Sarah E Hetrick
- University of AucklandDepartment of Psychological MedicineAucklandNew Zealand
- University of MelbourneThe Centre of Youth Mental HealthMelbourneVictoriaAustralia
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Abstract
Most theories emphasize the role of sociocultural factors in the etiology of eating disorders (EDs). This article uses a broad search strategy to identify current etiologic studies. Women with an ED outnumber men in each diagnosis, but gender differences vary by diagnosis. Men were underrepresented in study samples, and information about variable risk factors in men is sparse. Findings suggest transdiagnostic risk factors and disorder-specific risk factors. Extracting data from population-based registers represents a major advance. Novel analytic approaches suggest complex pathways to ED. Although used in several studies, reliance on a transdiagnostic ED category (vs diagnosis-specific groupings) is premature.
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Affiliation(s)
- Ruth Striegel Weissman
- Department of Psychology, Wesleyan University, 207 High Street, Middletown, CT 06359, USA.
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Støving RK. MECHANISMS IN ENDOCRINOLOGY: Anorexia nervosa and endocrinology: a clinical update. Eur J Endocrinol 2019; 180:R9-R27. [PMID: 30400050 PMCID: PMC6347284 DOI: 10.1530/eje-18-0596] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/25/2018] [Indexed: 12/17/2022]
Abstract
Anorexia nervosa is a syndrome, that is collections of symptoms, which is not defined by its etiology. The severe cases are intractable. The syndrome is associated with multiple, profound endocrine alterations which may be adaptive, reactive or etiologic. Adaptive changes potentially may be inappropriate in clinical settings such as inpatient intensive re-nutrition or in a setting with somatic comorbidity. Electrolyte levels must be closely monitored during the refeeding process, and the need for weight gain must be balanced against potentially fatal refeeding complications. An important focus of clinical research should be to identify biomarkers associated with different stages of weight loss and re-nutrition combined with psychometric data. Besides well-established peripheral endocrine actions, several hormones also are released directly to different brain areas, where they may exert behavioral and psychogenic actions that could offer therapeutic targets. We need reliable biomarkers for predicting outcome and to ensure safe re-nutrition, however, first of all we need them to explore the metabolism in anorexia nervosa to open new avenues with therapeutic targets. A breakthrough in our understanding and treatment of this whimsical disease remains. Considering this, the aim of the present review is to provide an updated overview of the many endocrine changes in a clinical perspective.
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Affiliation(s)
- René Klinkby Støving
- Nutrition Clinic, Center for Eating Disorders, Odense University Hospital
- Endocrine Elite Research Centre, Institute of Clinical Research, University of South Denmark, Faculty of Health Sciences
- Psychiatric Services in the Region of Southern Denmark, Odense, Denmark
- Correspondence should be addressed to R K Støving;
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Schorr M, Klibanski A. Anorexia Nervosa and Bone. CURRENT OPINION IN ENDOCRINE AND METABOLIC RESEARCH 2018; 3:74-82. [PMID: 31803857 PMCID: PMC6892594 DOI: 10.1016/j.coemr.2018.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Anorexia nervosa (AN), a psychiatric disorder characterized by altered body image, food restriction and low body weight, is associated with low bone mineral density and increased fracture risk. Despite broadening the definition of AN in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, the prevalence of low bone mass remains high, suggesting we continue to capture individuals at high risk for bone loss. Many of the endocrine disturbances adaptive to the state of chronic starvation are thought to be causal in impaired skeletal integrity in females and males with AN. Understanding mechanisms responsible for impaired bone quality is important given the disease's severity and chronicity. Further research is needed to formulate optimal treatment strategies to reduce fracture risk.
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Affiliation(s)
- Melanie Schorr
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Anne Klibanski
- Neuroendocrine Unit, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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40
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Abstract
BACKGROUND Anorexia nervosa (AN) is characterised by a failure to maintain a normal body weight due to a paucity of nutrition, an intense fear of gaining weight or behaviour that prevents the individual from gaining weight, or both. The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. 'Family therapy approaches' indicate a range of approaches, derived from different theories, that involve the family in treatment. We have included therapies developed on the basis of dominant family systems theories, approaches that are based on or broadly similar to the family-based therapy derived from the Maudsley model, approaches that incorporate a focus on cognitive restructuring, as well as approaches that involve the family without articulation of a theoretical approach.This is an update of a Cochrane Review first published in 2010. OBJECTIVES To evaluate the efficacy of family therapy approaches compared with standard treatment and other treatments for AN. SEARCH METHODS We searched the Cochrane Common Mental Disorders Controlled Trials Register (CCMDCTR) and PsycINFO (OVID) (all years to April 2016). We ran additional searches directly on Cochrane Central Register for Controlled Trials (CENTRAL), MEDLINE, Ovid Embase, and PsycINFO (to 2008 and 2016 to 2018). We searched the World Health Organization (WHO) trials portal (ICTRP) and ClinicalTrials.gov, together with four theses databases (all years to 2018). We checked the reference lists of all included studies and relevant systematic reviews. We have included in the analyses only studies from searches conducted to April 2016. SELECTION CRITERIA Randomised controlled trials (RCTs) of family therapy approaches compared to any other intervention or other types of family therapy approaches were eligible for inclusion. We included participants of any age or gender with a primary clinical diagnosis of anorexia nervosa. DATA COLLECTION AND ANALYSIS Four review authors selected the studies, assessed quality and extracted data. We used a random-effects meta-analysis. We used the risk ratio (with a 95% confidence interval) to summarise dichotomous outcomes and both the standardised mean difference and the mean difference to summarise continuous measures. MAIN RESULTS We included 25 trials in this version of the review (13 from the original 2010 review and 12 newly-included studies). Sixteen trials were of adolescents, eight trials of adults (seven of these in young adults aged up to 26 years) and one trial included three age groups: one adolescent, one young adult and one adult. Most investigated family-based therapy or variants. Reporting of trial conduct was generally inadequate, so that in a large number of studies we rated the risk of bias as unclear for many of the domains. Selective reporting bias was particularly problematic, with 68% of studies rated at high risk of bias in this area, followed by incomplete outcome data, with 44% of studies rated at high risk of bias in this area. For the main outcome measure of remission there was some low-quality evidence (from only two studies, 81 participants) suggesting that family therapy approaches might offer some advantage over treatment as usual on rates of remission, post intervention (risk ratio (RR) 3.50, 95% confidence interval (CI) 1.49 to 8.23; I2 = 0%). However, at follow-up, low-quality evidence from only one study suggested this effect was not maintained. There was very low-quality evidence from only one trial, which means it is difficult to determine whether family therapy approaches offer any advantage over educational interventions for remission (RR 9.00, 95% CI 0.53 to 153.79; 1 study, N = 30). Similarly, there was very low-quality evidence from only five trials for remission post-intervention, again meaning that it is difficult to determine whether there is any advantage of family therapy approaches over psychological interventions (RR 1.22, 95% CI 0.89 to 1.67; participants = 252; studies = 5; I2 = 37%) and at long-term follow-up (RR 1.08, 95% CI 0.91 to 1.28; participants = 200; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 0%). There was no indication that the age group had any impact on the overall treatment effect; however, it should be noted that there were very few trials undertaken in adults, with the age range of adult studies included in this analysis from 20 to 27. There was some evidence of a small effect favouring family based therapy compared with other psychological interventions in terms of weight gain post-intervention (standardised mean difference (SMD) 0.32, 95% CI 0.01 to 0.63; participants = 210; studies = 4 with 1 of these contributing 3 pairwise comparisons for different age groups; I2 = 11%) . Overall, there was insufficient evidence to determine whether there were any differences between groups across all comparisons for most of the secondary outcomes (weight, eating disorder psychopathology, dropouts, relapse, or family functioning measures), either at post-intervention or at follow-up. AUTHORS' CONCLUSIONS There is a limited amount of low-quality evidence to suggest that family therapy approaches may be effective compared to treatment as usual in the short term. This finding is based on two trials that included only a small number of participants, and both had issues about potential bias. There is insufficient evidence to determine whether there is an advantage of family therapy approaches in people of any age compared to educational interventions (one study, very low quality) or psychological therapies (five studies, very low quality). Most studies contributing to this finding were undertaken in adolescents and youth. There are clear potential impacts on how family therapy approaches might be delivered to different age groups and further work is required to understand what the resulting effects on treatment efficacy might be. There is insufficient evidence to determine whether one type of family therapy approach is more effective than another. The field would benefit from further large, well-conducted trials.
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Affiliation(s)
- Caroline A Fisher
- Royal Melbourne Hospital, Melbourne HealthAllied Health ‐ PsychologyParkvilleAustralia3050
| | - Sonja Skocic
- HealthscopeThe Melbourne ClinicRichmondAustralia
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41
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Abstract
PURPOSE OF REVIEW This review delineates issues in the conceptualization and operationalization of eating disorder recovery, highlights recent findings about recovery (since 2016), and proposes future directions. RECENT FINDINGS A longstanding problem in the field is that there are almost as many different definitions of recovery in eating disorders as there are studies on the topic. Yet, there has been a general shift to accepting that psychological/cognitive symptoms are important to recovery in addition to physical and behavioral indices. Further, several operationalizations of recovery have been proposed over the past two decades, and some efforts to validate operationalizations exist. However, this work has had limited impact and uptake, such that the field is suffering from "broken record syndrome," where calls are made for universal definitions time and time again. It is critical that proposed operationalizations be compared empirically to help arrive at a consensus definition and that institutional/organizational support help facilitate this. Themes in recent recovery research include identifying predictors, examining biological/neuropsychological factors, and considering severe and enduring anorexia nervosa. From qualitative research, those who have experienced eating disorders highlight recovery as a journey, as well as factors such as hope, self-acceptance, and benefiting from support from others as integral to the process of recovery. The field urgently needs to implement a universal definition of recovery that is backed by evidence, that can parsimoniously be implemented in clinical practice, and that will lead to greater harmonization of scientific findings.
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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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Giombini L, Nesbitt S, Waples L, Finazzi E, Easter A, Tchanturia K. Young people's experience of individual cognitive remediation therapy (CRT) in an inpatient eating disorder service: a qualitative study. Eat Weight Disord 2018; 23:499-505. [PMID: 28244033 DOI: 10.1007/s40519-017-0369-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Accepted: 02/04/2017] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION AND PURPOSE Current literature shows promising results regarding the efficacy of Cognitive Remediation Therapy for Anorexia Nervosa (AN); however, there is a paucity of studies considering the use of CRT in Young People (YP). The aim of this study was to examine YP's experiences of individual CRT in an inpatient eating disorder unit. METHOD Seventy letters following a cycle of eight individual CRT sessions were analysed using thematic analysis, adopting an inductive approach. Inter-rater reliability of findings was ensured. RESULTS The following six higher-order themes, each with lower-order themes, were identified: engaging aspects of CRT; identifying thinking skills; relevance to real-life situations; encountering personal challenges; making sense of the rational of CRT; suggestions for further improvements. YP reported enjoying CRT and described increased learning about their thinking styles and their skills from the activities undertaken during therapy. Some participants were able to apply learning outside of therapy and less frequently to difficulties related to the illness. CONCLUSION Feedback from patients suggests CRT is a useful intervention for YP with AN, which could facilitate their engagement in the treatment, while tackling neuropsychological processes underlying psychological symptoms of AN. Exploring participants' experience of CRT has highlighted specific elements of the intervention perceived as beneficial by YP, and areas where adaption could be made. This will allow clinicians to further develop the intervention from a service users' perspective, tailoring the sessions to their needs.
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Affiliation(s)
- Lucia Giombini
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK. .,Institute of Psychiatry, Psychology and Neuroscience, PO59 Psychological Medicine, King's College, London, SE58AF, UK.
| | - Sophie Nesbitt
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Lauren Waples
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Emilia Finazzi
- Rhodes Wood Hospital, Elysium Healthcare, Sheperd's way, Brookmans Park, Hatfield, London, AL96NN, UK
| | - Abigail Easter
- Health Services Research and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College, London, UK
| | - Kate Tchanturia
- Institute of Psychiatry, Psychology and Neuroscience, PO59 Psychological Medicine, King's College, London, SE58AF, UK. .,Department of Psychology, Illia University, Tbilisi, Georgia. .,South London and Maudsley NHS Foundation Trust, Eating Disorders National Service, London, UK.
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Schildbach S, Schildbach C. Prevalence of psychiatric disorders in detainees serving imprisonment as an alternative punishment for failure to pay penalty fees: A longitudinal study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 58:105-109. [PMID: 29853000 DOI: 10.1016/j.ijlp.2018.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Revised: 03/25/2018] [Accepted: 03/26/2018] [Indexed: 06/08/2023]
Abstract
In Germany, Austria and Switzerland, lawbreakers who are unwilling or unable to pay a fine for committing a criminal offence can face imprisonment. The length of compensation imprisonment corresponds to the amount of the fee the convicted was sentenced to pay. Every tenth German prisoner serves this kind of sentence. Recent meta-analyses indicated that inmates are several times more likely to suffer from psychosis and major depression and are more than ten times more likely to exhibit antisocial personality disorders than the general population. This study set out to assess the levels of mental disorders in the population of compensation prisoners in the German capital Berlin in 1999, 2004, 2010 and 2017. The four study populations, consisting of 100 participants each, showed a high prevalence of mental disorders and were therefore mostly unable to apply for serving voluntary work as alternative to imprisonment. As the prevalence of mental disorders was largely consistent over the investigation timeframe, it seems advisable to make a psychopathological diagnosis at the start of imprisonment in order to filter out those detainees that would benefit from social training in order to enhance their competency to solve problems, strengthen their social skills and enhance their quality of life outside of the penal institution. In addition, as the compensation prisoners exhibited a high degree of substance abuse, it would be recommendable to assess the presence of substance abuse at the beginning of imprisonment. Then, appropriate measures could be taken to reduce the number of reoffenders and enable the temporary detainees to reintegrate successfully into society.
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Affiliation(s)
| | - Carola Schildbach
- Praxisgemeinschaft für Psychosomatik, Bahnhofplatz 88, 9056 Gais, Switzerland
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Clus D, Larsen ME, Lemey C, Berrouiguet S. The Use of Virtual Reality in Patients with Eating Disorders: Systematic Review. J Med Internet Res 2018; 20:e157. [PMID: 29703715 PMCID: PMC5948410 DOI: 10.2196/jmir.7898] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 09/28/2017] [Accepted: 11/16/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patients with eating disorders are characterized by pathological eating habits and a tendency to overestimate their weight and body shape. Virtual reality shows promise for the evaluation and management of patients with eating disorders. This technology, when accepted by this population, allows immersion in virtual environments, assessment, and therapeutic approaches, by exposing users to high-calorie foods or changes in body shape. Objective To better understand the value of virtual reality, we conducted a review of the literature, including clinical studies proposing the use of virtual reality for the evaluation and management of patients with eating disorders. Methods We searched PubMed, PsycINFO, ScienceDirect, the Cochrane Library, Scopus, and Web of Science up to April 2017. We created the list of keywords based on two domains: virtual reality and eating disorders. We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses to identify, select, and critically appraise relevant research while minimizing bias. Results The initial database searches identified 311 articles, 149 of which we removed as duplicates. We analyzed the resulting set of 26 unique studies that met the inclusion criteria. Of these, 8 studies were randomized controlled trials, 13 were nonrandomized studies, and 5 were clinical trials with only 1 participant. Most articles focused on clinical populations (19/26, 73%), with the remainder reporting case-control studies (7/26, 27%). Most of the studies used visual immersive equipment (16/26, 62%) with a head-mounted display (15/16, 94%). Two main areas of interest emerged from these studies: virtual work on patients’ body image (7/26, 27%) and exposure to virtual food stimuli (10/26, 38%). Conclusions We conducted a broad analysis of studies on the use of virtual reality in patients with eating disorders. This review of the literature showed that virtual reality is an acceptable and promising therapeutic tool for patients with eating disorders.
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Affiliation(s)
- Damien Clus
- Department of Mental Health, University Hospital of Brest, Brest, France
| | - Mark Erik Larsen
- Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Christophe Lemey
- Department of Mental Health, University Hospital of Brest, Université de Bretagne Occidentale, Brest, France
| | - Sofian Berrouiguet
- UMR CNRS 6285 Lab-STICC, Institut Mines Télécom Atlantique, Université Bretagne Loire F-29238 Brest, Brest, France.,EA 7479 Soins Primaires, Santé Publique et Registre des cancers de Bretagne Occidentale, Department of Mental Health, Université de Bretagne Occidentale, Brest, France
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Dakanalis A, Alix Timko C, Colmegna F, Riva G, Clerici M. Evaluation of the DSM-5 severity ratings for anorexia nervosa in a clinical sample. Psychiatry Res 2018; 262:124-128. [PMID: 29428775 DOI: 10.1016/j.psychres.2018.02.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 01/11/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
We examined the validity and utility of the DSM-5 severity ratings for anorexia nervosa (AN) in a clinical (treatment-seeking) sample (N = 273; 95.6% women). Participants classified with mild, moderate, severe, and extreme severity of AN based on their measured body mass index, differed significantly from each other in eating disorder features, putative maintenance factors, and illness-specific functional impairment (medium effect sizes). However, they were statistically indistinguishable in psychiatric-disorder comorbidity and distress, demographics, and age-of-AN onset. The implications of our findings, providing limited support for the DSM-5 severity ratings for AN, and directions for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Department of Brain and Behavioral Sciences, University of Pavia, Italy.
| | - C Alix Timko
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, USA; Children's Hospital of Philadelphia, Philadelphia, USA
| | - Fabrizia Colmegna
- Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
| | - Giuseppe Riva
- Department of Psychology, Catholic University of Milan, Italy; Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy; Mental Health Department, San Gerardo Monza Health and Social Care Trust, Monza, Italy
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Factorial Validity of the Toronto Alexithymia Scale (TAS-20) in Clinical Samples: A Critical Examination of the Literature and a Psychometric Study in Anorexia Nervosa. J Clin Psychol Med Settings 2018; 26:33-46. [DOI: 10.1007/s10880-018-9562-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
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Giombini L, Nesbitt S, Cox H, Foxall A, Sharia T, Easter A, Tchanturia K. Cognitive remediation therapy (CRT) in a specialist inpatient eating disorder service for children and adolescents: CAN-CRT study protocol for a pilot randomised controlled trial. EUROPEAN EATING DISORDERS REVIEW 2018; 26:438-446. [PMID: 29577512 DOI: 10.1002/erv.2592] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 02/19/2018] [Accepted: 02/26/2018] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Research on treatments for young people (YP) with anorexia nervosa (AN) is scarce. Evidence supports the use of cognitive remediation therapy (CRT) to improve central coherence and set-shifting, inefficiencies that can negatively impact on prognosis. OBJECTIVE The study aims to evaluate the feasibility of individual CRT in an inpatient setting for YP aged 10-18 years with AN and to qualitatively examine YP's and their parents experiences. METHOD In a single-centre, pilot, randomised controlled trial, 80 patients aged 10-18 years with AN will be randomly allocated to the immediate or delayed CRT group, in addition to standard treatment. A repeated measures design will be conducted across 3 time points. DISCUSSION The data will provide evidence regarding the feasibility of individual CRT in YP with AN, informing directions of further development of CRT. The study is in preparation for a definitive randomised controlled trial. The aim of this manuscript is to describe the study protocol.
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Affiliation(s)
- Lucia Giombini
- Psychology Department, Rhodes Wood Hospital, Elysium Healthcare, UK.,Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Sophie Nesbitt
- Psychology Department, Rhodes Wood Hospital, Elysium Healthcare, UK
| | - Hannah Cox
- Psychology Department, Rhodes Wood Hospital, Elysium Healthcare, UK
| | - Anna Foxall
- Psychology Department, Rhodes Wood Hospital, Elysium Healthcare, UK
| | - Teo Sharia
- Department of Mathematics, Royal Holloway University of London, UK
| | - Abigail Easter
- Centre for Implementation Science, Health Services Research and Population Research Department, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK
| | - Kate Tchanturia
- Psychological Medicine, King's College London, Institute of Psychiatry, Psychology and Neuroscience, UK.,Department of Psychology, Illia State University, Georgia.,Eating Disorders National Service, South London and Maudsley NHS Foundation Trust, UK
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Dakanalis A, Colmegna F, Zanetti MA, Di Giacomo E, Riva G, Clerici M. Evaluation of the DSM-5 Severity Specifier for Bulimia Nervosa in Treatment-Seeking Youth. Child Psychiatry Hum Dev 2018; 49:137-145. [PMID: 28510006 DOI: 10.1007/s10578-017-0735-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
A new severity specifier for bulimia nervosa (BN), based on the frequency of inappropriate weight compensatory behaviours (e.g., laxative misuse, self-induced vomiting, fasting, diuretic misuse, and excessive exercise), has been added to the most recent (fifth) edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a means of addressing variability and heterogeneity in the severity of the disorder. While existing research provides support for the DSM-5 severity specifier for BN in adult patients, evidence for its validity and clinical utility in youth is currently lacking. To address this gap, data from 272 treatment-seeking adolescents with DSM-5 BN (94.2% female, M age = 15.3 years, SD 1.7) were analysed to examine whether these patients, sub-grouped based on the DSM-5 severity definitions, would show meaningful differences in a broad range of clinical variables and demographic and physical characteristics. Analyses revealed that participants categorized with mild, moderate, severe, and extreme severity of BN significantly differed from each other in 15 variables regarding eating disorder pathological features and putative maintenance factors (i.e., core low self-esteem, perfectionism, social appearance anxiety, body surveillance, and mood intolerance), health-related quality of life and comorbid psychiatric (i.e., affective and anxiety) disorders (large effect sizes). Between-group differences in demographics, body mass index, or age-of-BN onset were not observed. Collectively, our findings provide support for the utility of the frequency of inappropriate weight compensatory behaviours as a severity indicator for BN and suggest that age-at-onset of BN is probably more disorder- than severity-dependent. Implications for future research are outlined.
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Affiliation(s)
- Antonios Dakanalis
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy. .,Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
| | | | | | - Ester Di Giacomo
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Giuseppe Riva
- Applied Technology for Neuro-Psychology Laboratory, Istituto Auxologico Italiano, Milan, Italy.,Department of Psychology, Catholic University, Milan, Italy
| | - Massimo Clerici
- Department of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900, Monza, Italy.,Department of Mental Health, San Gerardo Hospital, Monza, Italy
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Breithaupt L, Hübel C, Bulik CM. Updates on Genome-Wide Association Findings in Eating Disorders and Future Application to Precision Medicine. Curr Neuropharmacol 2018; 16:1102-1110. [PMID: 29473515 PMCID: PMC6187759 DOI: 10.2174/1570159x16666180222163450] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 08/11/2017] [Accepted: 10/04/2017] [Indexed: 01/08/2023] Open
Abstract
Heterogeneity, frequent diagnostic fluctuation across presentations, and global concerns with the absence of effective treatments all encourage science that moves the field toward individualized or precision medicine in eating disorders. We review recent advances in psychiatric genetics focusing on genome-wide association studies (GWAS) in eating disorders. Given that the only eating disorder to be the subject of GWAS to date is anorexia nervosa, we review anorexia GWAS and enumerate the prospects and challenges of a genomics-driven approach towards personalized intervention in eating disorders.
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Affiliation(s)
| | | | - Cynthia M. Bulik
- Address correspondence to this author at the Department of Psychiatry, University of North Carolina at Chapel Hill, CB #7160, 101 Manning Drive, Chapel Hill, NC 27599-7160, USA; E-mail:
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